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

Abstract

A 23-year-old male was admitted after a motor vehicle accident with acute epidural hematoma, diffuse subarachnoid hemorrhage (SAH) in the basal cistern, and fractures at the anterior cranial base. Angiography revealed an aneurysm of the right supraclinoid internal carotid artery (ICA). His consciousness suddenly worsened on the 23rd day. Expansion of the SAH in the basal cistern and two hump aneurysms were detected. He underwent endovascular embolization of these aneurysms and the right ICA with Guglielmi detachable coil. Traumatic aneurysms are difficult to diagnose in the early period after injury and are associated with a high mortality. Endovascular treatments for traumatic aneurysms have lower mortality rate, and can be performed under local anesthesia.

A Rare Case of Posterior Communicating Artery Pseudoaneurysm Caused by Traumatic Head Injury

“…Most traumatic aneurysms are pseudoaneurysms and have broad necks, so direct clipping or endovascular obliteration is rarely successful [3]. Our case had the typical characteristics of traumatic pseudoaneurysm including wide neck and huge size.…”

“…The mechanisms causing traumatic aneurysms of supraclinoid internal carotid artery (ICA) are believed to be as follows: Direct injury to the ICA by basal skull fracture, overstretching or torsion of the ICA wall by movement of the brain following impact, tearing by nearby prominent bony structures, and avulsion of a perforator [3]. TICAs are also classified histologically as true or false.…”

“…Angiography should be repeated 2 weeks later if no aneurysm is detected, because early angiography results in a large percentage of false negatives. However, repeated monitoring of the size and shape of the aneurysm with 3D-CT or magnetic resonance angiography is absolutely necessary [3]. The total mortality rate is 34.6%.…”

Blister-Like Supraclinoid Internal Carotid Artery Pseudoaneurysm in a 15-Year-Old Male: Case Report and Review of the Literature

“…Traumatic aneurysms of the supraclinoid ICA are exceedingly rare, with only 39 reported cases in the literature [9,10]. Of these, only two clearly reported involvement the dorsal surface of the supraclinoid ICA; both in adults [11].…”

Fatal subarachnoid hemorrhage following traumatic rupture of the internal carotid artery

“…The vast majority of TSAH is associated with rupture of the vertebral artery [1], although rare cases of traumatic aneurysm of the internal carotid artery (ICA) have been reported [9]. We report a fatal case of SAH due to traumatic rupture of the intracranial segment of the right internal carotid artery in a young man following blunt force trauma to the head.…”