‘Alien sign’ as bad prognostic factor in basilar tip aneurysm

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Aneurysm illustration. (Source: CNN Indonesia)

Stroke bleeding due to ruptured aneurysm is one of the diseases with high disability and death rates, including in Indonesia. A ruptured brain aneurysm needs to be dealt with quickly with a comprehensive approach. Initial radiological examination is very important in determining the handling and prognosis of patients with ruptured aneurysms. This is a case report of ruptured aneurysm which is quite interesting, where certain radiological features that we introduce as ‘ Alien Sign ‘ can be a reference in determining actions and prognosis.

A 44-year-old pregnant woman experiences a sudden onset of coma. When the patient arrived, the GCS recorded was E2V2M4 with a positive meningeal sign. CT shows massive subarachnoid hemorrhage around the basal cistern and communicating hydrocephalus. Emergency extraventricular drainage was performed. CT angiography showed that the basilar tip aneurysm measures 1.4 0.8 0.4 cm. The patient’s condition suddenly worsened with the GCS value being E1V1M2. Moreover, fresh blood is also found to flow in the EVD, which indicated aneurysm rupture.

The patient died before the aneurysm can be treated. CTA with surface rendering showed a clear alien anthropomorphic appearance, with aneurysms as head, basilar arteries as body and superior cerebellar arteries and vertebral arteries as arms and legs. The authors call it head-body ratio disproportion, which usually occurs in humans with a ratio of 1: 8, ‘Alien sign’ (Figure 1). This image showed a large aneurysm and hence the situation got worse.

To contribute to this field, a unique case complete with its image was reported by Arifianto et al., (2020) from Universitas Airlangga – RSUD Dr. Soetomo Surabaya, a case report that has been published in the British Journal of Neurosurgery (Taylor & Francis) aims to make a new contribution in the management of strokes due to ruptured aneurysm.

In the end, this report revealed that this article made a positive contribution to the world of medicine, especially in the fields of nerves and neurosurgery, by providing new findings of an ‘ Alien Sign ‘ in the case of aneurysm rupture. (*)

Author: Asra Al Fauzi

The full article can be accessed through the following link:


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Media komunikasi dan informasi seputar kampus Universitas Airlangga (Unair).

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