Korean J Neurotrauma.  2014 Oct;10(2):126-129. 10.13004/kjnt.2014.10.2.126.

Visualization of a Traumatic Pseudoaneurysm at Internal Carotid Artery Bifurcation due to Blunt Head Injury: A Case Report

• Han JH
• Koh EJ
• Choi HY
• Park JS
• Lee JM

• KMID: 2256246
• DOI: http://doi.org/10.13004/kjnt.2014.10.2.126

Abstract

Traumatic intracranial pseudoaneurysms occurring after blunt head injuries are rare. We report an unusual case of subarachnoid hemorrhage (SAH) caused by rupturing of the traumatic pseudoaneurysm of the internal carotid artery (ICA) bifurcation that resulted from a non-penetrating injury. In a patient with severe headache and SAH in the right sylvian cistern, which developed within 7 days after a blunt-force head injury, a trans-femoral cerebral angiogram (TFCA) showed aneurysmal sac which was insufficient to confirm the pseudoaneurysm. We obtained a multi-slab image of three dimensional time of flight (TOF) of magnetic resonance angiography (MRA). The source image of the gadolinium-enhanced MRA revealed an intimal flap within the intracranial ICA bifurcation, providing a clue for the diagnosis of a dissecting pseudoaneurysm at the ICA bifurcation due to blunt head trauma. We performed direct aneurysmal neck clipping, without neurological deficit. A follow-up TFCA did not show either aneurysm sac or luminal narrowing. We suggest that in the patient with a history of blunt head injury with SAH following shortly, multi-slab image of 3D TOF MRA can give visualization of the presence of a pseudoaneurysm.

Keyword

Head injuries closed; Carotid artery injuries; Magnetic resonance angiography; Aneurysm false

MeSH Terms

Aneurysm
Aneurysm, False*
Carotid Artery Injuries
Carotid Artery, Internal*
Craniocerebral Trauma
Diagnosis
Follow-Up Studies
Head Injuries, Closed*
Headache
Humans
Magnetic Resonance Angiography
Neck
Phenobarbital
Subarachnoid Hemorrhage
Phenobarbital

Figure

• 

  FIGURE 1 A: Brain computed tomography image showing su-barachnoid hemorrhage in the right sylvian cistern. B: Trans-femoral cerebral angiogram showing luminal narrowing of distal internal carotid artery (ICA), proximal M1, and aneurysmal dilatation of right ICA bifurcation.

• 

  FIGURE 2 A: Initial source image of gadolinium-enhanced 3D time of flight image showing aneurysm of Rt. internal carotid artery bifurcation (white arrow). B: Resetting the initial image showing an intimal flap (white arrow) within the aneurysmal sac, suggesting of a pseudoaneurysm (parameters: TR 28 ms, TE 4.8 ms, flip angle 18°, matrix size 296×384, field of view 109×120 mm, slice thickness 0.29 mm, and scan time 4 min 39 sec).

• 

  FIGURE 3 A: Intraoperative findings, under microscopic guidance, of the direct neck clipping: the aneurysmal sac was larger than the preoperative evaluation suggested, and the wall was friable. B: Pos-toperative trans-femoral cerebral angiogram, showing no aneurysm and luminal narrowing.

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