<I>Traumatic Occlusion of the Anterior Cerebral Artery</I>

Abstract

A 71-year-old female presented with posttraumatic occlusion of the anterior cerebral artery (ACA) after a road accident in which she was hit in the mid-frontal region. Initial computed tomography (CT) demonstrated frontal skull fractures and pneumocephalus. High density areas were also identified in the right basal cisterns, suggesting traumatic subarachnoid hemorrhage. She was alert on admission, but with attendant shock due to crush wounds. Her condition rapidly deteriorated and an emergency amputation of her left leg was performed. After aggressive treatment with transfusion and infusion, her systolic pressure increased to 120 mmHg. Her consciousness remained disturbed. Serial CT disclosed hemorrhagic infarction in the entire medial side of the right frontal lobe. Magnetic resonance angiography demonstrated decreased flow voids in the bilateral A1 segments and right ACA, and a basilar artery aneurysm, which was unruptured clinically. Three weeks after the injury, she regained consciousness. Six months later, she had motor aphasia and left upper extremity weakness. The clinicopathological mechanism causing the traumatic occlusion of the ACA in the present case was probably dissecting aneurysm.

Translucent Three-Dimensional CT is Useful in Considering the Treatment Strategy for the Penetrating Skull Base Injury With a Metal Rod: Case Report

“…PHI accounts for about 0.4% of all head injuries. 4 , 6) There are many causes of PHI, including chopsticks, nail-guns, arrows, pencils, knives, screwdriver, and twigs. 2 , 5 , 7 , 9) In our case, the foreign body was a metal rod used for engineering measurements.…”

“…Most traumatic ICA occlusions that have been reported are due to thrombus formation and dissociation. 4 , 8 , 10 , 11) In cases of well-developed collateral circulation, conservative treatment or endovascular surgery is certainly one of the choices. However, if the ICA has been compressed directly by a foreign object, such as in our case, surgical treatment is mandatory.…”

Traumatic Anterior Cerebral Artery Aneurysm following Blunt Craniofacial Trauma

“…The primary goals of managing such lesions are early diagnosis and intervention to prevent delayed-onset rebleeding [4] or further thromboembolic complications [5]. Frequent causes of peripheral traumatic aneurysms are closed-head trauma (62%), head-penetrating wounds (27%) and iatrogenic trauma (11%) [6].…”

Bilateral anterior cerebral infarcts from a depressed anterior base of skull fracture: Case report and review of the literature

“…5,11 Direct intracranial vascular trauma is a rare manifestation of injury although involvement of the Circle of Willis should be considered in association with fractures through the clivus or when internal carotid artery dissection is suspected. 14,20,22,25,29 Fractures through the sella turcica may also involve its resident pituitary gland as well as potential optic nerve damage at the level of the optic chiasm. Usually greater forces are involved for this type of damage to occur and therefore more extensive intracranial vascular involvement should be considered.…”

“…28 Experience with the management of BOS fractures with cerebral artery involvement is poor, although the management has tended to be non-operative. 1,14,25 Bilateral occlusion of the anterior cerebral arteries with cerebral infarction is a very rare injury. In the case we describe the mechanism of infarction is likely to be due to external compression on the anterior cerebral arteries from the depressed skull fragment.…”