Delayed Spontaneous Resolution of a Traumatic Middle Meningeal Artery Pseudoaneurysm. 2021

Jaime L Atiles, and Amanda P Marrero-González, and Eduardo J Labat
Department of Diagnostic Radiology, University of Puerto Rico - School of Medicine, San Juan, Puerto Rico.

BACKGROUND Middle meningeal artery (MMA) aneurysms are a very rare entity, comprising less than 1% of all intracranial aneurysms. In particular, traumatic MMA pseudoaneurysms (MMAP) are reported in the literature to have a poor outcome in about 20% of cases. Moreover, in extremely rare cases, MMAPs can spontaneously thrombose. CASE REPORT We present the case of a 42-year-old Hispanic man with multiple craniofacial hemangiomas and history of chronic migraines that increased in frequency after blunt head trauma 1 month prior to initial evaluation. CTA and brain MRI showed a right-sided MMAP adjacent to the foramen spinosum with a pan-hemispheric subdural hematoma and no associated skull fractures. The MMAP was not visualized 2 days later on digital subtraction angiography (DSA) and was therefore presumed to be thrombosed. CTA at 3 months showed interval progression of the MMAP with subsequent spontaneous resolution on CTA at 10 months. CONCLUSIONS Knowledge regarding MMAPs is limited since it is based on a small number of cases and literature reviews. Additional studies are needed to elucidate the true incidence and natural course of this entity and produce adequate treatment guidelines.

UI MeSH Term Description Entries
D008297 Male Males
D008576 Meningeal Arteries Arteries which supply the dura mater. Arteries, Meningeal,Artery, Meningeal,Meningeal Artery
D006408 Hematoma, Subdural Accumulation of blood in the SUBDURAL SPACE between the DURA MATER and the arachnoidal layer of the MENINGES. This condition primarily occurs over the surface of a CEREBRAL HEMISPHERE, but may develop in the spinal canal (HEMATOMA, SUBDURAL, SPINAL). Subdural hematoma can be classified as the acute or the chronic form, with immediate or delayed symptom onset, respectively. Symptoms may include loss of consciousness, severe HEADACHE, and deteriorating mental status. Hemorrhage, Subdural,Subdural Hematoma,Subdural Hematoma, Traumatic,Hematoma, Traumatic Subdural,Hematomas, Subdural,Hematomas, Traumatic Subdural,Hemorrhages, Subdural,Subdural Hematomas,Subdural Hematomas, Traumatic,Subdural Hemorrhage,Subdural Hemorrhages,Traumatic Subdural Hematoma,Traumatic Subdural Hematomas
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012887 Skull Fractures Fractures of the skull which may result from penetrating or nonpenetrating head injuries or rarely BONE DISEASES (see also FRACTURES, SPONTANEOUS). Skull fractures may be classified by location (e.g., SKULL FRACTURE, BASILAR), radiographic appearance (e.g., linear), or based upon cranial integrity (e.g., SKULL FRACTURE, DEPRESSED). Linear Skull Fracture,Skull Fracture, Linear,Skull Fracture, Non-Depressed,Non-Depressed Skull Fracture,Fracture, Non-Depressed Skull,Fracture, Skull,Fractures, Linear Skull,Fractures, Non-Depressed Skull,Fractures, Skull,Linear Skull Fractures,Non Depressed Skull Fracture,Non-Depressed Skull Fractures,Skull Fracture,Skull Fracture, Non Depressed,Skull Fractures, Linear,Skull Fractures, Non-Depressed
D015901 Angiography, Digital Subtraction A method of delineating blood vessels by subtracting a tissue background image from an image of tissue plus intravascular contrast material that attenuates the X-ray photons. The background image is determined from a digitized image taken a few moments before injection of the contrast material. The resulting angiogram is a high-contrast image of the vessel. This subtraction technique allows extraction of a high-intensity signal from the superimposed background information. The image is thus the result of the differential absorption of X-rays by different tissues. Digital Subtraction Angiography,Subtraction Angiography, Digital
D017541 Aneurysm, False Not an aneurysm but a well-defined collection of blood and CONNECTIVE TISSUE outside the wall of a blood vessel or the heart. It is the containment of a ruptured blood vessel or heart, such as sealing a rupture of the left ventricle. False aneurysm is formed by organized THROMBUS and HEMATOMA in surrounding tissue. Pseudoaneurysm,False Aneurysm,Aneurysms, False,False Aneurysms,Pseudoaneurysms

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