Fatal Traumatic Subarachnoid Hemorrhage due to Acute Rebleeding of a Pseudoaneurysm Arising from the Distal Basilar Artery

Abstract

Isolated traumatic pseudoaneurysms of the basilar artery are extremely rare but often fatal resulting in a mortality rate as high as 50%. A 51-year-old man presented with craniofacial injury after blunt trauma. A brain computed tomography (CT) scan showed thick basal subarachnoid hemorrhage associated with multiple craniofacial fractures, while CT angiography revealed contrast extravasation at the distal basilar artery with pseudoaneurysm formation. After this primary survey, the condition of the patient suddenly deteriorated. Conventional angiography confirmed the contrast extravasation resulted from pseudoaneurysm formation, which was successfully treated with endovascular coil embolization. Decompressive craniectomy and coma therapy with propofol were also performed. However, the patient died on the 7th hospital day because of the poor initial clinical condition. The current case is the first report of acute pseudoaneurysm rupture arising from the basilar artery within the first day after trauma. Our findings suggest the possibility that pseudoaneurysm rupture should be considered if brain CT shows thick traumatic subarachnoid hemorrhage on the basal cistern with a basal skull fracture.

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

“…al., 2014 [ 11 ] F 7 Motorcycle accident 3 Coma SAH \ \ \ 5 months BA Endovascular Good Kim et. al., 2014 [ 16 ] M 51 Fall 12 Confusion SAH GCS 3 New SAH Extravasation on the basilar artery 1 day BA (top) Endovascular Dead Purgina et. al., 2014 [ 36 ] M 22 Assault 14 Confusion SAH, IVH, hydrocephalus GCS 3 New SAH Negative 9 days Left PICA No Dead Huh et.…”

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

“…Subarachnoid haemorrhage (SAH) secondary to traumatic intracranial aneurysm (TICA) of the posterior cerebral circulation is a rare but treatable cause of neurological morbidity and mortality in young patients [ 1 ]. The significant mortality associated with this condition is likely due to the high risk of rupture and rebleed when compared to berry aneurysms [ 2 ].…”