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

Palmieri, Mauro; Pesce, Alessandro; Zancana, Giuseppa; Armocida, Daniele; Maiese, Aniello; Cirelli, Carlo; Santoro, Antonio; Frati, Paola; Fineschi, Vittorio; Frati, Alessandro

doi:10.1007/s10143-021-01657-4

Cited by 5 publications

(5 citation statements)

References 41 publications

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“…As it is well known, even a slight rotational trauma could have led to the formation and rupture of aneurysms [3,11,14]. Performing CT angiography and Digital Subtraction Angiography (DSA) a few hours after the attack not only has a diagnostic-therapeutic role, but can be useful tool to carry out medico-legal assessment [15]. Histological investigations are a further tool to clarify the nature of the aneurysm [16].…”

Section: Discussionmentioning

confidence: 99%

Traumatic Aneurysm Involving the Posterior Communicating Artery

Napoletano,

Di Fazio,

Delogu

et al. 2024

Healthcare

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Traumatic intracranial aneurysms (TICAs) are rare, accounting for less than 1% of all intracranial aneurysms. However, they are associated with a mortality rate of over 50%. The case presented herein focuses on a posterior communicating artery TICA caused by violent aggression. A 41-year-old man with massive subarachnoid hemorrhage (SAH), on admission to hospital, had a CT angiography that showed a ruptured left posterior communicating artery aneurysm with continuous blood loss and underwent neurosurgical cooling. The CT scan also showed fractures of the mandible, mastoid and left styloid process, as well as brain contusions caused by blows and kicks. Despite medical treatment and surgery, after four days, he died. The assault dynamics were recorded by a camera in the bar. The damage was caused by kicks to the neck and head. The forensic neuropathological examination showed the primary injury (SAH, subdural hemorrhage, cerebral contusions, head–neck fractures), as well as secondary damage following the attack (cerebral infarcts, edema, supratentorial hernia, midbrain hemorrhage). The coil was intact and well positioned. In this case, circumstantial information, medical records, and the type of injury could shed light on the mechanism of the production of a TICA. In addition, the CT angiography and histological investigations helped to distinguish a recent and traumatic aneurysm from a pre-existing one. Following precise steps, the study of aneurysms can be helpful in clarifying their traumatic origin even when the victim was taking drugs. The aim of this study is also to share the diagnostic process that we used in the forensic field for the assessment of suspected traumatic aneurysms.

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Section: Discussionmentioning

confidence: 99%

Traumatic Aneurysm Involving the Posterior Communicating Artery

Napoletano,

Di Fazio,

Delogu

et al. 2024

Healthcare

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“…The rupture time of intracranial aneurysms often varies greatly, mostly 2 to 3 weeks after trauma, and the mortality rate often exceeds 50%. [7] Therefore, timely diagnosis and treatment before aneurysm rupture are very important. [8] CTA or cerebral angiography should be performed immediately after the injury, and CTA or digital subtraction angiography should be reviewed within the next few days.…”

Section: Discussionmentioning

confidence: 99%

Delayed rupture of traumatic anterior cerebral artery A4 segment aneurysm: A case report

Sui

Chen

et al. 2023

Medicine

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Rationale: Delayed rupture of traumatic intracranial aneurysms is relatively rare, and traumatic anterior A4 segment aneurysms may be associated with trauma to the cerebral falx. The mortality rate in patients with delayed traumatic rupture of intracranial aneurysms is>50%. Therefore, early diagnosis and treatment are critical. Herein, we present a case of a patient who did not have an intracranial aneurysm on computed tomographic angiography (CTA) after admission. Subsequently, the patient consciousness deteriorated, and CTA revealed aneurysm and bleeding. Patient concerns: A 55-year-old man fell from a 3-meter-high truck and was unconscious. During the following few hours, the gradually regained consciousness. No intracranial aneurysms were found on CTA of the patient head immediately after admission. Diagnoses: The final diagnosis was delayed rupture of traumatic intracranial aneurysms. Interventions: The patient underwent endovascular and symptomatic treatments. Outcomes: The patient gradually recovered and was referred to the rehabilitation department for further treatment. Lessons: Considering the catastrophic consequences of the disease, we should review CTA or digital subtraction angiography many times after admission, and take appropriate surgical procedures in time.

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“…A review of the English and Japanese language literature performed on December 3, 2021, revealed 12 reports describing 15 cases of PICA-TICA. [1,2,5,8,9,12,[14][15][16][17] e clinical characteristics and outcomes of these patients are summarized in Table 1. Among the 15 cases (including our patient), the mean patient age was 32.4 (15-69) years.…”

Section: Discussionmentioning

confidence: 99%

“…[12,13] Endovascular treatment was performed in five of the previously reported 20 cases of PICA-TICA. [5,14] is case report outlines the steps taken to treat the PICA-TICA, patient outcomes, and lessons learned for effective treatment of future PICA-TICA patients. We also reviewed previous reports on the characteristics and treatment of PICA-TICA.…”

Section: Introductionmentioning

confidence: 99%

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Ruptured traumatic posterior inferior cerebellar artery pseudoaneurysm: A case report and literature review

Ikeuchi

Shimasaki

Nitta

et al. 2022

Surgical Neurology International

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Background: Traumatic intracranial aneurysm (TICA) accounts for approximately 1% of cerebral aneurysms. There are few reports of TICA limited to the posterior inferior cerebellar artery (PICA-TICA). Case Description: A 69-year-old woman fell into a shallow river, bruising her head and chest, and was admitted to our emergency department with disorientation. Computed tomography (CT) showed subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), left temporal lobe contusion, and fractures of the right temporal bone. A cerebral CT angiogram revealed no vascular abnormalities or aneurysms. The patient was in a semi-comatose state 2 h later, and CT showed worsening SAH. A cerebral angiogram revealed an 11 mm aneurysm of the anterior medullary segment of the right PICA. We attempted intra-aneurysmal embolization intending to preserve the PICA, but the aneurysmal neck was thin, and the microcatheter could not be placed in a stable position. Therefore, n-butyl-2-cyanoacrylate (NBCA) was injected to embolize the aneurysm. When the microcatheter was removed, NBCA was scattered distally in the PICA, and the distal PICA was occluded. The aneurysm could be embolized, but there was an increase in hemorrhagic contusion in the left temporal lobe. Decompression craniectomy was performed, but she died due to hemorrhagic contusion and uncal herniation 6 days after surgery. Conclusion: PICA-TICA is often accompanied by IVH and SAH, and there are some reports of cases with a vascular anomaly of the posterior circulation. Since TICA is at risk of rapid growth and rupture, an early and appropriate diagnosis is important.

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

Cited by 5 publications

References 41 publications

Traumatic Aneurysm Involving the Posterior Communicating Artery

Traumatic Aneurysm Involving the Posterior Communicating Artery

Delayed rupture of traumatic anterior cerebral artery A4 segment aneurysm: A case report

Ruptured traumatic posterior inferior cerebellar artery pseudoaneurysm: A case report and literature review

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