Giant serpentine aneurysm: Imaging features including potential diagnostic utility of arterial spin labeling

We present a case of an otherwise healthy mid 30s male with right sided vision loss. CT and MR imaging demonstrated a giant serpentine aneurysm of the right anterior cerebral artery A1-A2 segments. The patient was successfully treated with craniotomy for intracranial A3-A3 bypass followed by endovascular coil embolization of the inflow vessel. We highlight the imaging findings, reviewing both the pertinent findings and potential diagnostic utility of arterial spin labeling, an emerging noninvasive, MRI technique to assess brain perfusion.