Intracerebral hematoma caused by ruptured traumatic pseudoaneurysm of the middle meningeal artery : a case report

Abstract

Hematomas caused by ruptured traumatic pseudoaneurysms of the middle meningeal artery (MMA) usually present with extradural hematomas, whereas intradural intraparenchymal hematomas are extremely rare. We report a case of traumatic pseudoaneurysm of the MMA giving rise to an intracerebral hematoma after head trauma. A 70-year-old man suffered a massive intracerebral temporoparietal hemorrhage after a head injury. CT angiogram of the brain revealed a large hematoma in the right middle cranial fossa extending to the right sylvian fissure. Cerebral angiogram also revealed a pseudoaneurysm of the MMA, which was successfully treated surgically. Although traumatic MMA pseudoaneurysm producing intracerebral hematoma (ICH) is rare, it should be considered as a possible cause of intracerebral hematoma.

Keywords: Intracerebral hematoma; Middle meningeal artery (MMA); Traumatic pseudoaneurysm.

Fig. 1

Skull x-ray shows no skull fracture.

Fig. 2

A : Preoperative brain computed tomography (CT) scan showing a large scalp hematoma and fatal intracerebral hematoma in the right temporoparietal region, centered on the sylvian fissure, contacting the dura mater and extending to the ventricles. B : Postoperative CT scan showing evidence of right frontotemporal cranioplasty and hematoma removal.

Fig. 3

Right external carotid angiogram, lateral view, A : Early phase, B : Late phase. There is delayed filling of the pseudoaneurysm during the arterial phase and a very slow emptying during the venous phase. The distal segment of the artery is not visible.