The “Spot Sign” secondary to a ruptured lenticulostriate artery aneurysm

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.