Ruptured Anterior Communicating Artery Aneurysm in an Elderly Patient With Cerebrovascular Anomalies: A Case for Palliative Management.

The anterior communicating artery is a key component of the Circle of Willis and a frequent site of intracranial aneurysm formation, particularly in elderly individuals in whom rupture carries substantial morbidity and mortality. We describe an 80-year-old hypertensive woman who presented after a sudden collapse and was found unconscious with a Glasgow Coma Scale score of 3, requiring immediate airway protection and intubation. Brain multidetector computed tomography revealed extensive acute hemorrhage involving the suprasellar region, bilateral frontal lobes, ventricles, and subdural spaces, and computed tomography angiography identified a ruptured anterior communicating artery aneurysm and a second smaller middle cerebral artery aneurysm, along with multiple cerebrovascular anomalies, including left internal carotid artery occlusion with collateral flow across the anterior communicating artery, hypoplastic carotid vessels, and posterior circulation irregularities. The combination of extensive hemorrhage, severe neurological compromise, and complex vascular anatomy rendered surgical or endovascular treatment nonviable, and the patient was transitioned to comfort-focused palliative management. This case highlights the importance of considering non-traumatic intracranial hemorrhage from aneurysmal rupture in elderly patients presenting with sudden collapse and underscores the need for urgent neuroimaging to guide timely decision-making. When imaging reveals catastrophic hemorrhage and a prognosis incompatible with meaningful recovery, early transition to palliative care is appropriate to prioritize patient comfort and dignity.