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Case Reports
. 2014 Dec 12:2014:bcr2014011410.
doi: 10.1136/bcr-2014-011410.

Intracranial pseudoaneurysm after intracranial pressure monitor placement

Kushal J Shah  1 , Aaron M Jones  2 , Paul M Arnold  2 , Koji Ebersole  2
Affiliations
Case Reports

Intracranial pseudoaneurysm after intracranial pressure monitor placement

Kushal J Shah et al. BMJ Case Rep. .

Abstract

Traumatic intracranial pseudoaneurysms are a rare but severe complication following arterial injury. Pseudoaneurysm formation can occur secondary to blunt or penetrating trauma or iatrogenic injury. We report a case of traumatic pseudoaneurysm secondary to placement of an intracranial pressure (ICP) monitor. A 27-year-old man was involved in a motorcycle accident resulting in multiple intracranial hemorrhages. The patient underwent craniectomy and placement of an ICP monitor. 17 days later he developed dilation of his left pupil, with imaging demonstrating a new hemorrhage in the vicinity of the previous ICP monitor. A cerebral angiogram confirmed a left-sided distal M4 pseudoaneurysm which was treated by n-butyl cyanoacrylate embolization. Intracranial pseudoaneurysm formation following neurosurgical procedures is uncommon. Delayed intracranial hemorrhage in a region of prior intracranial manipulation, even following a procedure as 'routine' as placement of an ICP monitor, should raise the suspicion for this rare but potentially lethal complication.

Keywords: Aneurysm; Complication; Hemorrhage; Intracranial Pressure; Vessel Wall.

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Figures

Figure 1
Figure 1
Axial non-contrast CT scan of the head showing a 5 mm right-sided subdural hematoma with 6.5 mm of midline shift.
Figure 2
Figure 2
Axial non-contrast CT scan of the head showing a left-sided epidural hematoma with evidence of midline shift.
Figure 3
Figure 3
Axial non-contrast CT scan of the head showing left frontal intraparenchymal hemorrhage with intraventricular extension.
Figure 4
Figure 4
Sagittal reconstruction of a CT angiogram of the brain showing an intracranial pseudoaneurysm (arrow) along the tract of the previously placed intracranial pressure monitor.
Figure 5
Figure 5
Anteroposterior left carotid artery angiogram showing the pseudoaneurysm (arrow), as well as on a superselective angiogram (arrow).
Figure 6
Figure 6
All three images show lateral left carotid artery angiogram. (A) The pseudoaneurysm (box), (B) magnified view of the pseudoaneurysm (arrow), and (C) post embolization sequence showing absence of filling of the pseudoaneurysm (box).
Figure 7
Figure 7
Anteroposterior left carotid artery angiogram showing the aneurysm has been excluded from the circulation after embolization with n-butyl cyanoacrylate.
See this image and copyright information in PMC

References

    1. Le H, Munshi I, Macdonald RL et al. . Traumatic aneurysm resulting from insertion of an intracranial pressure monitor. Case illustration. J Neurosurg 2001;95:720. - PubMed
    1. Blaha M, Lazar D. Traumatic brain injury and haemorrhagic complications after intracranial pressure monitoring. J Neurol Neurosurg Psychiatry 2005;76:147. - PMC - PubMed
    1. Lim J, Suh SH, Lee KY et al. . Endovascular treatment of iatrogenic intracranial pseudoaneurysm following stent angioplasty. J Neuroimaging 2012;22:194–6. - PubMed
    1. Rayes M, Bahgat DA, Kupsky WJ et al. . Middle cerebral artery pseudoaneurysm formation following stereotactic biopsy. Can J Neurol Sci 2008;35:664–8. - PubMed
    1. Blei AT, Olafsson S, Webster S et al. . Complications of intracranial pressure monitoring in fulminant hepatic failure. Lancet 1993;341:157–8. - PubMed

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