Traumatic vertebral artery aneurysm following blunt suboccipital trauma

Abstract

Traumatic vertebral artery (VA) injury has been neglected and mistaken to be innocuous. Herein, we present a rare case with a as subarachnoid hemorrhage (SAH) following blunt suboccipital trauma. Initially, it was mistaken as a saccular aneurysm and was just coincident with traumatic SAH. Surgical clipping was performed by our senior neurosurgeon and looked secure. But massive bleeding occurred before complete closure of the dura wound. Opening the wound again, blood gushed out from the junction of the aneurysm and the parent artery. Because preoperative angiography evaluation had revealed good collateral flow from the contralateral VA, the involved segment of VA was trapped. The patient recovered well with uneventful course. Blunt suboccipital trauma may result in traumatic VA injury which may cause catastrophic complications if neglected. The incidence, risk factors, the pathophysiology of traumatic VA aneurysm, and the treatments are reviewed.

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

“…Delayed deterioration in consciousness and headache at day 8 due to bleed from VA TICA Left vertebral 8 At second presentation after TICA rupture on day 8 No DSA at day 1 (occlusion) and day 8 (TICA) Clipping after bleed from new TICA post coiling Yes No deficits at 1 year Hydrocephalus not needing permanent CSF diversion Cohen et al, 2010 [ 13 ] 23 Direct neck trauma during taekwondo Acute drop in conscious level Left vertebral 1 Yes No DSA at day 1 Endovascular vessel occlusion Yes Mild dizziness and ataxia at 1 month Hydrocephalus not needing permanent CSF diversion Coulter et al, 2011 [ 14 ] 20 Road traffic accident Acute drop in conscious level Right vertebral 1 Yes No DSA at day 1 Endovascular vessel occlusion No No deficits No Purgina et al, 2015 [ 15 ] 22 Assault Loss of consciousness with improvement. Acute deterioration in consciousness at day 9 due to rebleed Left PICA 7 Yes Yes, day 1 DSA negative, CTA at day 7 positive DSA at day 1 normal, CTA at day 7 small PICA aneurysm, DSA at day 9 enlarged PICA aneurysm Too unstable for treatment No Death Rebleed and hydrocephalus Morard & deTribolet, 1991 [ 16 ] 31 Fall Acute drop in conscious level Right PICA 10 Yes No DSA at day 10 Clipping Yes Full recovery Hydrocephalus requiring shunt Chiang et al, 2009 [ 17 ] 50 Assault Acute drop in conscious level Right vertebral 1 Yes No …”

“…A retrospective series of 130 patients with blunt head trauma and SAH demonstrated that only 8 % of SAH related to head injury resulted from congenital aneurysm rupture [ 28 ]. SAH from a traumatic posterior circulation TICA may therefore be initially misdiagnosed as aneurysmal SAH [ 17 ]. With a history of trauma and cisternal SAH identified on CT scans, vascular imaging is usually undertaken (CTA and/or DSA) during hospital admission.…”