J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):322-326. 10.7461/jcen.2016.18.3.322.

Traumatic Pseudoaneurysm Related to Calcified Nodules of Cerebral Convexity Dura Mater in an American College Football Player

• Jeon YS
• Lee JG
• Chun YI
• Cho J
• Choe WJ

• KMID: 2355662
• DOI: http://doi.org/10.7461/jcen.2016.18.3.322

Abstract

Repeated concussion is common among football players; however, these minor blunt head trauma rarely result in serious complications. We report a case of a young college football player who presented acute subdural hematoma, cerebral edema, and seizure due to pseudoaneurysm rupture. The pseudoaneurysm, located at the cortical branch of the middle cerebral artery, was speculated to be formed by dural calcification and adhesion with the underlying brain, possibly due to repeated concussions. Following successful excision of the pseudoaneurysm and control of brain swelling, the patient recovered without sequelae and was discharged after a short while.

Keyword

Calcification; Dura mater; Football; Sports injury; Traumatic cerebral aneurysm

MeSH Terms

Aneurysm, False*
Athletic Injuries
Brain
Brain Edema
Craniocerebral Trauma
Dura Mater*
Football*
Hematoma, Subdural, Acute
Humans
Middle Cerebral Artery
Rupture
Seizures

Figure

• 

  Fig. 1 Initial brain CT reveals several calcified nodules embedded in the subdural hematoma that covers the left cerebral convexity. CT = computed tomography.

• 

  Fig. 2 (A) MR images show the subdural hematoma covering the left cerebral convexity and small portion of the right frontal convexity. (B) Note the nodular signal void on the temporal operculum in the coronal section of the T2-weighted MR image (arrowhead). MR image = Magnetic resonance image.

• 

  Fig. 3 MR angiography reveals a small middle cerebral artery aneurysm (arrowhead) at the junction of the left M3 and M4. The TOF images show calcified nodules (arrow) and MCA (double arrows) located closely together, where 4mm sized pseudoaneurysm is found. MCA = middle cerebral artery.

• 

  Fig. 4 Images from the microscopic operation. Top left, the dura mater is severely adhered to the underlying cerebral surface and veins. Top middle, after careful dissection, calcific nodules (arrow) and the aneurysm (arrowhead) are confirmed. Top right, the calcific nodules are excised. Bottom, the middle cerebral artery is trapped by clips and then the aneurysm is excised.

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