"Early" Apoplexy Due to Traumatic Intracranial Aneurysm. Case Report.

Abstract

A 76-year-old man presented with a traumatic aneurysm of the left internal carotid artery which caused repeated subarachnoid hemorrhages within 20 hours of a fall from a height. Early computed tomography (CT) detected no brain abnormalities, but repeat CT found subarachnoid hemorrhage. Internal carotid angiography detected a pseudoaneurysm, which was not treated because of his poor clinical condition. He died of multiple organ failure. Early detection of a traumatic intracranial aneurysm is important for the prevention of aneurysmal rupture, or``delayed'' apoplexy. Review of 171 cases with traumatic aneurysms from the literature found that false negative angiography occurred only in three cases on post-trauma day 7 and thereafter. Early diagnostic angiography within a week of the initial trauma is indicated if traumatic aneurysm is suspected to detect early signs of irregularity, spasm, and narrowing of the arterial wall. Repeat angiography is indicated if aneurysmal formation is still highly suspected in spite of negative initial angiography.

Delayed Post-traumatic Pseudoaneurysmal Formation of the Intracranial Ophthalmic Artery After Closed Head Injury -Case Report-

“…3,5) Review of 171 cases of the TICAs to investigate the location found only two TICAs (1.2%) of the ophthalmic artery. 9) Only five cases of traumatic ophthalmic artery Neurol Med Chir (Tokyo) 52, January, 2012…”

Traumatic Aneurysm of the Supraclinoid Internal Carotid Artery -Case Report-

“…The mechanisms causing traumatic aneurysms of the supraclinoid ICA are believed to be as follows: Direct injury to the ICA by basal skull fracture, 16,23) overstretching or torsion of the ICA wall by movement of the brain following impact, 21,27) tearing by nearby prominent bony structures, 5,21,25) and avulsion of a perforator. 20,24) Our case was probably caused by basal skull fracture.…”

“…3,7,8,12,19) Angiography performed the day of injury detected traumatic aneurysms in only 54% of the cases. 16) False negatives accounted for 46% of cases. Therefore, angiography should be performed repeatedly, but less risky modalities such as three-dimensional CT (3D-CT) and magnetic resonance angiography can be selected.…”

“…Angiography should be repeated 2 weeks later if no aneurysm is detected, because early angiography results in a large percentage of false negatives. 16) Only one false negative was found among 171 cases in which angiography was performed 2 weeks after injury, 16) so if angiography performed 2 weeks after injury shows no aneurysm, then repeat is generally not necessary, provided there are no signs of suspected aneurysm such as delayed SAH, unexplained neurological deterioration, cranial nerve palsy, or recurrent severe epistaxis. 29) If the initial angiography shows an aneurysm, immediate treatment is recommended.…”

“…7,11,23,28) Such aneurysms are usually located on the distal cerebral arteries, and rarely on the internal carotid artery (ICA), mostly in the petrous, cavernous, and supraclinoid segments. 7,11,16,21,23,24) Traumatic intracranial aneurysms are associated with high mortality and morbidity, 16,20,28) so must be detected as early as possible, normally by angiography. The optimal timing of angiography after head injury remains unclear.…”