Digital subtraction angiography (DSA) is the definitive investigation for the identification of aneurysms and for surgical planning. It should demonstrate the aneurysmal site, type, size, orientation and neck, intraluminal calcification and thrombus, the relationship between aneurysm and parent vessels, collateral flow through the circle of Willis, the presence of adjacent perforators and the state of the cerebral vasculature, including other aneurysms. It also allows visualization of the osseous anatomy surrounding the aneurysm on non-subtracted films, necessary for planning of the surgical approach and decisions regarding operability.
In the case of multiple aneurysms, identification of the ruptured lesion may be difficult. Most useful for identification are the distribution of SAH and the location of any ICH. In situations where the CT reveals diffuse SAH or the SAH has been diagnosed on LP, the aneurysm most likely to have ruptured is larger, has a greater irregularity, mass effect or associated local vasospasm.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.