Intracerebral Hematoma Caused by Ruptured Traumatic Pseudoaneurysm of the Middle Meningeal Artery : A Case Report

Abstract

Hematomas caused by ruptured traumatic pseudoaneurysms of the middle meningeal artery (MMA) usually present with extradural hematomas, whereas intradural intraparenchymal hematomas are extremely rare. We report a case of traumatic pseudoaneurysm of the MMA giving rise to an intracerebral hematoma after head trauma. A 70-year-old man suffered a massive intracerebral temporoparietal hemorrhage after a head injury. CT angiogram of the brain revealed a large hematoma in the right middle cranial fossa extending to the right sylvian fissure. Cerebral angiogram also revealed a pseudoaneurysm of the MMA, which was successfully treated surgically. Although traumatic MMA pseudoaneurysm producing intracerebral hematoma (ICH) is rare, it should be considered as a possible cause of intracerebral hematoma.

A Patient with a Pseudoaneurysm of the Middle Meningeal Artery Who Developed Intracerebral Hemorrhage during Conservative Treatment for Traumatic Subarachnoid Hemorrhage

“…It is sometimes associated with subdural hematomas or subarachnoid hemorrhage, 2) but the onset of intracerebral hemorrhage is extremely rare. 3) To our knowledge, nine patients have been reported [4][5][6][7][8][9][10][11] ( Table 1). Several studies indicated that temporal bone fracture crossing over the MMA was present in approximately 70%-90%.…”

“…Bozzetto-Ambrosi et al 7) did not describe the severity of head trauma in a PMMA patient who developed intracerebral in the absence of fracture. As for mechanism of fracture-free PMMAs, Lim et al 5) speculated that closed head injury with traction injury of the vascular wall might be involved in the pathogenesis. Holland et al 13) assumed that the presence of a defect of the medial layer of the intracranial hemorrhage in the absence of fracture.…”

Traumatic Middle Meningeal Artery Pseudoaneurysms Presenting with Intractable Epistaxis: A Rare Case Report and Review of Literature

“…Pseudoaneurysms are less than 1% of all intracranial aneurysms and mostly associated with a history of trauma [4]. Pseudoaneurysms of the middle meningeal artery (MMA) are rare.…”

Traumatic giant pseudoa-neurysm of the middle meningeal artery causing intracerebral hematoma

“…There are only six case reports of traumatic PMMA presenting with intracerebral bleed in the English literature. [1][2][3][4][5]7] In all of these patients, the clinical presentation was with an intracerebral bleed, and the pseudoaneurysm was only later detected by angiography. There has been no report of a giant pseudoaneurysm with an associated intracerebral bleed in literature.…”

“…[1][2][3][4][5] Wang et al reported a patient who gradually developed an extradural giant PMMA over a period of 46 days and on the basis of their findings put forth four CT findings that may be useful for early diagnosis of such lesions; these are (1) basal skull fracture in the temporal region, (2) hypodense nodule within an acute hematoma, (3) hypodense nodule within an organized and encapsulated hematoma, and (4) strong and homogenous enhancement of the hypodense nodule within an organized and encapsulated hematoma. [6] Our patient had CT findings similar to those reported by Wang et al, [6] but differed from their description in that the bleed was intracerebral and the progression much more rapid (only 4 days).…”