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Updated: May 2, 2026

Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
The "Spot Sign" secondary to a ruptured lenticulostriate artery aneurysm
Lee A Tan1, Manish K Kasliwal1, Andrew K Johnson1
1Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA.
Abstract:
The "Spot Sign" is a well-recognized radiographic predictor for hematoma expansion in patients with intracerebral hemorrhages. Although the exact underlying pathophysiology is unknown, it is generally assumed to be the site of blood vessel rupture and contrast extravasation. We report a case of an 81-year-old man who presented with right basal ganglia hemorrhage and the "Spot Sign" on computed tomography angiography. Conventional angiography subsequently revealed a lenticulostriate artery aneurysm within the hematoma, which was treated with surgical clipping. This case demonstrates that rare entities such as lenticulostriate aneurysms must be kept in the differential diagnoses in order to optimize patient management and improve clinical outcome.
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