Traumatic aneurysms and arteriovenous fistulas of intracranial vessels associated with penetrating head injuries occurring during war: principles and pitfalls in diagnosis and management

Abstract

In the early days of the war between Iran and Iraq, reports of the sudden deaths of soldiers who previously had survived a penetrating head injury suggested the possibility that a late complication, traumatic aneurysm (TA), could be the cause of this catastrophe. In response, the authors planned a prospective study to perform cerebral angiography in victims with penetrating head traumas, especially in those who had artillery shells or bone fragments passing through areas of dense vasculature. Thirty-one TAs and arteriovenous fistulas were documented. Not all of the lesions, however, were deemed appropriate for surgical intervention. Six aneurysms (19.4%) healed spontaneously and shrank or disappeared on repeated serial angiograms. The authors present their cases and discuss the incidence of TAs, their natural course and behavior, and the special problems encountered in managing these interesting and potentially fatal complications of penetrating head injuries.

Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

“…4,6 This argument was further strengthened by our results, as 3 of 7 TICAs were not identified on initial CTA and DSA performed at the time of admission. According to Bell et al, 5 TICAs can rupture as early as postinjury Day 4 and as late as 32 days after injury.…”

“…TICAs are usually located along the harboring vessel and not over the branching point. 4 Similarly, none of the TICAs in our group was noted at the arterial bifurcations or the circle of Willis (Fig. 2).…”

Predicting Arterial Injuries after Penetrating Brain Trauma Based on Scoring Signs from Emergency CT Studies

“…fragments scattered in paths that branch into various directions 3 . Identification of such risk factors and formulating a scoring system based on CT findings (i.e., a high score to a valuable variable) can help clinicians prompt DSA in high-risk patient groups.…”

“…The incidence of intracranial vascular rupture after penetrating brain injury remains largely unknown due to significant mortality caused by severe trauma before admission to a hospital [1][2][3][4][5][6][7] . In those who survive, the aim of the emergent diagnostic strategy is to determine the extent of the intracranial damage and provide crucial information for therapeutic decision-making.…”

Cavernous carotid artery pseudo-aneurysm treated by stenting in acromegalic patient

“…The resulting false aneurysm does not have a real wall and its limits are formed by organized clot. Its natural history is not entirelly defined, some authors show expansion of those lesions without a timing pattern 2,3 . Most pseudoaneursms following transsphenoidal operation described in the literature were associated to growth hormone (GH) secreting tumors and it is intriguing that acromegalic patients also have tendency to develop intracranial elongated and ectatic arteries [4][5][6] .…”