Traumatic Pseudoaneurysm of Middle Meningeal Artery with Delayed Presentation as Intracerebral Hematoma: A Report with Review of Literature. 2021

Karthik Kulanthaivelu, and Shahyan Mohsin Siddiqui, and Chandrajit Prasad, and Abhinith Shashidhar
Department of Neuroimaging, Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

BACKGROUND Post-traumatic pseudoaneurysm of the middle meningeal artery is a rare entity. We report an atypical case of a delayed presentation as parenchymal hemorrhage due to a ruptured middle meningeal artery pseudoaneurysm. METHODS A 22-year-old man with an alleged history of cranial trauma following a road traffic accident presented 10 days later with a new right temporal intraparenchymal hemorrhage. The CT revealed a differentially hypodense circumscribed structure in the anterior temporal location eccentrically in the hematoma. The cerebral angiogram depicted a pseudoaneurysm arising from the middle meningeal artery. The patient underwent craniotomy and excision of the aneurysm. On follow up, the patient was asymptomatic and had no focal neurological deficits. CONCLUSIONS Despite its rare occurrence, meningeal artery pseudoaneurysm should be considered as a possible etiology of a post-traumatic delayed presentation as an intracerebral hematoma. Prompt diagnosis and management are warranted in view of the mortality and morbidity.

UI MeSH Term Description Entries
D008297 Male Males
D008576 Meningeal Arteries Arteries which supply the dura mater. Arteries, Meningeal,Artery, Meningeal,Meningeal Artery
D002533 Cerebral Angiography Radiography of the vascular system of the brain after injection of a contrast medium. Angiography, Cerebral,Angiographies, Cerebral,Cerebral Angiographies
D002543 Cerebral Hemorrhage Bleeding into one or both CEREBRAL HEMISPHERES including the BASAL GANGLIA and the CEREBRAL CORTEX. It is often associated with HYPERTENSION and CRANIOCEREBRAL TRAUMA. Brain Hemorrhage, Cerebral,Cerebral Parenchymal Hemorrhage,Hemorrhage, Cerebral,Intracerebral Hemorrhage,Hemorrhage, Cerebrum,Brain Hemorrhages, Cerebral,Cerebral Brain Hemorrhage,Cerebral Brain Hemorrhages,Cerebral Hemorrhages,Cerebral Parenchymal Hemorrhages,Cerebrum Hemorrhage,Cerebrum Hemorrhages,Hemorrhage, Cerebral Brain,Hemorrhage, Cerebral Parenchymal,Hemorrhage, Intracerebral,Hemorrhages, Cerebral,Hemorrhages, Cerebral Brain,Hemorrhages, Cerebral Parenchymal,Hemorrhages, Cerebrum,Hemorrhages, Intracerebral,Intracerebral Hemorrhages,Parenchymal Hemorrhage, Cerebral,Parenchymal Hemorrhages, Cerebral
D006407 Hematoma, Epidural, Cranial Accumulation of blood in the EPIDURAL SPACE between the SKULL and the DURA MATER, often as a result of bleeding from the MENINGEAL ARTERIES associated with a temporal or parietal bone fracture. Epidural hematoma tends to expand rapidly, compressing the dura and underlying brain. Clinical features may include HEADACHE; VOMITING; HEMIPARESIS; and impaired mental function. Cranial Epidural Hematoma,Hemorrhage, Cranial Epidural,Epidural Hemorrhage, Cranial,Extradural Hematoma, Cranial,Extradural Hemorrhage, Cranial,Hematoma, Epidural, Intracranial,Intracranial Epidural Hematoma,Cranial Epidural Hematomas,Cranial Epidural Hemorrhage,Cranial Epidural Hemorrhages,Cranial Extradural Hematoma,Cranial Extradural Hematomas,Cranial Extradural Hemorrhage,Cranial Extradural Hemorrhages,Epidural Hematoma, Cranial,Epidural Hematoma, Intracranial,Epidural Hematomas, Cranial,Epidural Hematomas, Intracranial,Epidural Hemorrhages, Cranial,Extradural Hematomas, Cranial,Extradural Hemorrhages, Cranial,Hematoma, Cranial Epidural,Hematoma, Cranial Extradural,Hematoma, Intracranial Epidural,Hematomas, Cranial Epidural,Hematomas, Cranial Extradural,Hematomas, Intracranial Epidural,Hemorrhage, Cranial Extradural,Hemorrhages, Cranial Epidural,Hemorrhages, Cranial Extradural,Intracranial Epidural 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
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
D055815 Young Adult A person between 19 and 24 years of age. Adult, Young,Adults, Young,Young Adults

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