Neurointervention.  2016 Mar;11(1):42-45. 10.5469/neuroint.2016.11.1.42.

Delayed Intracerebral Hemorrhage from a Pseudoaneurysm Following a Depressed Skull Fracture

• Nazari P
• Kasliwal M
• Wewel JT
• Dua SG
• Chen M

• KMID: 2155718
• DOI: http://doi.org/10.5469/neuroint.2016.11.1.42

Abstract

A 26-year-old male presented with delayed intracerebral hemorrhage from a ruptured distal middle cerebral artery pseudoaneurysm that followed a compound depressed skull fracture from years ago. The brain protrusion through the skull defect likely resulted in stretching and subsequent tearing of the arterial wall resulting in the pseudoaneurysm formation. No prior report of such a clinical occurrence exists in the literature. We highlight an unusual but treatable cause for intracerebral hemorrhage following surgery for traumatic brain injury.

Keyword

Middle cerebral artery; Pseudoaneurysm; Depressed skull fracture; Treatment; Delayed; Hemorrhage

MeSH Terms

Adult
Aneurysm, False*
Brain
Brain Injuries
Cerebral Hemorrhage*
Hemorrhage
Humans
Male
Middle Cerebral Artery
Skull
Skull Fracture, Depressed*
Tears

Figure

• 

  Fig. 1 Axial non contrast CT scan of the head (A and B) and MRI (C) showing a 3.5 × 2.6 cm acute intraparenchymal hematoma in the right parietal lobe along with a large defect in the cranium in the parietotemporal region from prior craniotomy. An old, right parietal craniotomy is redemonstrated. Also visible is the protrusion of the brain parenchyma through the defect (arrows in the B and C), particularly along its superior aspect seen both on CT and axial MRI. An axial MRA image (D), suggestive of a pseudoaneurysm (arrow).

• 

  Fig. 2 AP (A) and lateral (B) views of conventional angiograms following injection of the right-sided internal carotid artery, showing the pseudoaneurysm (arrows) arising from the right middle cerebral artery M4 segment, measuring 3×3 mm in size with a neck of 1 mm (2A and B, middle image) that was successfully coiled (2C). Insets in 2A and B show a magnified view of the aneurysm. An unsubtracted lateral view (D) of the angiogram showing coil mass occluding the aneurysm.

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