Delayed diagnosis of post-traumatic aneurysm of distal anterior cerebral artery

Policicchio, Domenico; Muggianu, Giampiero; Dipellegrini, Giosuè; Boccaletti, Riccardo

doi:10.4103/sni.sni_252_18

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…A TIPC should be suspected in case of delayed deterioration in a head-injured patient and should be investigated with angiography [1,4,5,22,25,44,47]. Conservative management is worsened by poor prognosis [25,28,34].…”

Section: Resultsmentioning

confidence: 99%

“…In conclusion, we affirm that a follow‐up angiogram should be obtained even if the initial one was negative. The second DSA should be performed at least 3 weeks after the trauma, and it could be argued that a third angiogram should be performed 6–12 weeks after injury [ 4 , 34 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…A spontaneous rupture of BrA addresses for the 80% of non-traumatic cases of subarachnoid hemorrhage (SAH) [ 18 ] with a reported case fatality rate that ranges between 25 and 50% (where several risk factors have been identified in high blood pressure, kidney disorders, alcohol consumption, and arterial walls’ infections [ 13 , 34 ]). BrA rupture resulting from traumatic brain injury (TBI) represents a well-note but less common occurrence [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Post-traumatic intracranial pseudo-aneurysms of posterior circulation: a comprehensive review of an under-diagnosed and rare entity

et al. 2021

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Traumatic aneurysms are rare and the total number of cases involving the posterior circulation (TIPC) is even smaller. Traumatic brain injury (TBI) may be responsible not only of rupture in brain aneurysm (BrA) pre-existing to trauma, but it has been identified also as a possible pathogenetic cause of TIPC formation in patients not affected by intracranial vascular lesions. A complete literature review was performed of all reported cases regarding rupture of BrA with SAH resulting from TIPC not previously identified at the first radiological screening. A representative case of a left posterior inferior cerebellar artery (PICA) pseudo-aneurysm caused by left vertebral artery’s dissection is reported. We show a unique complete collection of all 34 cases. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate, as high as 40–60%. Of the 22 patients with good neurological status (64.7%), we did not notice a significant correlation with regard to the location of the aneurysm, type of treatment, or clinical onset. Early recognition of a pseudo-aneurysm and adequate treatment seem to be the most important prognostic factor for these patients. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate. A TIPC should be suspected in case of delayed deterioration in head‐injured patient and should be investigated with angiography. Conservative management is worsened by poor prognosis and the goal of treatment is to exclude the aneurysm from circulation with surgical or endovascular methods as soon as possible.

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