Traumatic intracranial aneurysm in blunt trauma

Zangbar, Bardiya; Wynne, Julie; Joseph, Bellal; Pandit, Viraj; Meyer, David; Kulvatunyou, Narong; Khalil, Mazhar; OʼKeeffe, Terence; Tang, Andrew; Lemole, Michael; Friese, Randall S.; Rhee, Peter

doi:10.3109/02699052.2015.1004559

Cited by 12 publications

(9 citation statements)

References 22 publications

(42 reference statements)

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“…Only 0.65% of traumatic aneurysms were found in blunt traumatic brain injury. 2,20,21 Motor vehicle accidents represented the most common cause of traumatic dissection. In patients without symptoms, antiplatelet therapy was recommended.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes in cerebral artery dissection and literature review

et al. 2018

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Methods Patients with cerebral artery dissections were reviewed in a hospital setting from 2008 to 2015. Clinical presentations, lesion locations, treatment modalities, functional outcomes, and mortality were reviewed. Parent artery occlusion was the first choice for surgery or endovascular treatment of a hemorrhagic dissecting cerebral artery. Endovascular or surgical reconstructive treatment was indicated in patients whose parent artery could not be occluded. Favorable functional outcomes were determined using modified Rankin Scale (mRS) scores of 0–2. Results In total, 61 patients with cerebral artery dissections were admitted to the hospital. Seven (11.5%) had traumatic dissections. All traumatic dissections were located in the internal carotid arteries. Overall favorable outcome rate was about 57% (4/7). Spontaneous cerebral artery dissections were found in 54 patients. No difference in favorable outcomes was observed between parent vessel occlusion and selective occlusion with parent vessel preservation (or vessel reconstruction) (70% and 63%, respectively, p = 1.000). Patients who presented with spontaneous dissection without intracranial hemorrhage had more favorable outcomes than those with intracranial hemorrhage (79% and 52%, respectively, p = 0.045). The mortality rate of patients with spontaneous dissection was 7.4%. Conclusions Most of the traumatic dissections were located on the internal carotid arteries and spontaneous dissections were commonly located on vertebral arteries. Nonhemorrhagic spontaneous cerebral dissections had better functional outcomes after treatment. Endovascular and surgical management were effective treatments by parent vessel occlusion or reconstructions.

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Section: Discussionmentioning

confidence: 99%

Treatment outcomes in cerebral artery dissection and literature review

et al. 2018

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“…Traumatic intracranial aneurysm is a type of BCVI diagnosed angiographically, based on irregular shape of the arterial wall and delayed filling of the sac at a non‐branching portion . The incidence of TICA was reported to be approximately 1% among intracranial aneurysms, and 0.65% in blunt traumatic brain injury patients …”

Section: Discussionmentioning

confidence: 99%

Delayed massive epistaxis from traumatic intracranial aneurysm after blunt facial injury

Nakamura

Fujinaka

Tasaki

et al. 2016

Acute Medicine & Surgery

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CasesTraumatic intracranial aneurysm following blunt head injury is uncommon but can be induced by extension of skull base fracture and causes unexpected hemorrhagic complications. We present two cases of traumatic intracranial aneurysm in the paraclinoid area that was revealed by delayed massive epistaxis. Lack of initial neurological deficits omitted screening for cerebrovascular injury.OutcomeInternal trapping was carried out using endovascular techniques in both cases, with extracranial–intracranial bypass in one case. No recurrent bleeding occurred in either case.ConclusionTo prevent unexpected delayed life‐threatening hemorrhagic accidents, careful assessment of skull‐base fracture is prerequisite, even in cases of mild facial injury.

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“…頭部外傷後，脳血管損傷により動脈瘤を形成することがある。鈍的頭部外傷のうち，約2～3%が脳血管損傷を合併するといわれており 1)，外傷に起因する頭蓋内動脈瘤においては，全頭蓋内動脈瘤のうちの1%であり 4), 5)，鈍的頭部外傷では0.65%のみである 6)。また，外傷性頭蓋内動脈瘤の形成には時間を要することがあり，受傷時に発見される割合は約50%と報告されている 2)。つまり半数程度は受傷時に検出できないことを認識しておく必要がある 2)。…”

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頭蓋底骨折後遅発性に鼻出血を契機に発見された内頸動脈仮性瘤の1例(A case of delayed discovery of a internal carotid artery pseudoaneurysm by nosebleeds after skull base fracture)

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et al. 2021

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨　頭部外傷に伴う頭蓋底骨折はときに仮性動脈瘤を合併する。今回我々は，頭蓋底骨折後受傷時に損傷を認めなかった右内頸動脈に遅発性に仮性動脈瘤を形成した1例を経験したので報告する。症例は74歳の男性。約3mの高さから墜落し顔面を強打した。救急隊接触時，外表上頭部・顔面に外傷を認め，発語不能であったため，重症頭部外傷が疑われ当院へ搬送された。来院時CT検査において右視神経損傷を伴う頭蓋底骨折，脳挫傷，外傷性くも膜下出血，右肩甲骨骨折，多発肋骨骨折を認めたが，仮性動脈瘤は認めなかった。上記各外傷に対し保存的加療を行い，第19病日軽快転医となった。第38病日初回の鼻出血を認めた。第47病日中等量の鼻出血を認め，鼻腔内ガーゼ充填で止血を得た。第79病日より隔日で鼻出血を認めるようになったが，耳鼻科診察では鼻粘膜に特記すべき異常を認めなかった。第84病日多量の鼻出血と血圧低下，冷汗を認め，造影CTで右内頸動脈に仮性動脈瘤を認めたため，当院へ再度転医となった。第85病日右浅側頭動脈–中大脳動脈吻合術および右内頸動脈瘤コイル塞栓術を行い，第90病日MRAで瘤への血流がないことを確認した。第96病日に転医し，第106病日独歩退院となった。本症例では頭部外傷後の鼻出血により，仮性動脈瘤を発見し得た。頭蓋底骨折後の血管評価は受傷時に損傷を認めなくても継時的な画像評価などを慎重に行う必要がある。

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Traumatic intracranial aneurysm in blunt trauma

Abstract: The incidence of traumatic intracranial aneurysm was exceedingly low (0.65%) over 10-years. This study adds to the growing literature questioning the empiric use of CTA for detecting vascular injuries in patients with blunt TBI.

Cited by 12 publications

References 22 publications

Treatment outcomes in cerebral artery dissection and literature review

Treatment outcomes in cerebral artery dissection and literature review

Delayed massive epistaxis from traumatic intracranial aneurysm after blunt facial injury

頭蓋底骨折後遅発性に鼻出血を契機に発見された内頸動脈仮性瘤の1例(A case of delayed discovery of a internal carotid artery pseudoaneurysm by nosebleeds after skull base fracture)

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