Subarachnoid haemorrhage secondary to traumatic intracranial aneurysm of the posterior cerebral circulation: case series and literature review

Abstract

BackgroundTo identify the clinical features, rebleed risk, timing and method of diagnosis, complications and outcome for subarachnoid haemorrhage (SAH) from traumatic intracranial aneurysm (TICA) of the posterior circulation. Subjects included 26 patients aged 3–54 (mean 24.8).MethodsCase series and literature search to identify all reported cases.ResultsIn our series, two of three cases were fatal as a result of rebleed, and one case had a good outcome with no deficit, following prompt diagnosis and embolisation. Our key findings from the literature review were: 30.7 % of patients were age 16 and under; 88 % had an acute drop in consciousness, 46 % in a delayed manner; the mean time to diagnosis was 7.5 days; initial cerebrovascular imaging was normal in 23 %; the rebleed rate was 23 %; 61 % required emergency diversion of cerebrospinal fluid; 11 % developed vasospasm requiring treatment; 19.2 % had deficits that rendered them unable to live independently. The mortality rate was 27 %.ConclusionsSAH from ruptured posterior circulation TICA is associated with significant morbidity and mortality. A high index of suspicion as well as prompt diagnosis, repeat imaging in selected cases, and treatment of any associated TICA can be crucial to a favourable outcome.

Iatrogenic cortical pseudoaneurysm following ventriculoperitoneal shunt insertion presenting with intraventricular hemorrhage

“…In pseudoaneurysm formation, a contained hematoma associated with the vessel maintains the integrity of the vessel but also, when compared to true aneurysms, accounts for their relative instability and high rate of expansion and rupture. [7,16]…”

Posttraumatic subarachnoid hemorrhage related to concomitant carotid artery dissection and ruptured basilar trunk aneurysm: A case report and literature review

“…Posttraumatic rupture of an IA is uncommon. [ 5 , 7 ] Known risk factors for the development and rupture of IAs include hypertension and smoking. [ 24 , 26 ] Interestingly, many patients with a saccular BTA harbor multiple aneurysms or other vascular abnormalities such as persistent primitive arteries or basilar artery fenestration.…”

“…[ 21 , 28 ] Finally, similar precipitating events such as increased blood pressure or intracranial pressure are reported for both entities as well. [ 5 , 7 , 9 ]…”

“…As mentioned, a preceding trauma is frequently reported in CADs, whereas it has rarely been related to the rupture of an IA. [ 4 , 5 , 7 ] Following the trauma, the patient was conscious and able to skate back to the bench where she lost consciousness. The primary clinical situation reflects that of CAD rather than SAH, whereas the secondary situation fits the presentation of SAH better.…”

Diffuse Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage in a 15-Year-Old Girl: A Case Report

“…Cerebral vasospasm is a prolonged but reversible narrowing of the cerebral arteries occurring several days after subarachnoid hemorrhage (SAH). It is associated with the rupture of cerebral aneurysms within the basal cisterns in 50-90% of cases (1)(2)(3). It occurs in 3-5 days after aneurysmal rupture, appears to be the narrowest diameter of the blood vessel in 5-14 days, and resolves slowly within 2-4 weeks (3)(4)(5).…”