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Case Reports
. 2023 Aug 21;15(8):e43880.
doi: 10.7759/cureus.43880. eCollection 2023 Aug.

Combining Endovascular Coiling and Open Evacuation for a Delayed-Onset Ruptured Post-traumatic Pseudoaneurysm of the Distal Paracentral Pericallosal Artery Branch

Manisha Koneru  1 , Clint Badger  2 , Alan R Turtz  2 , Hamza Shaikh  3
Affiliations
Case Reports

Combining Endovascular Coiling and Open Evacuation for a Delayed-Onset Ruptured Post-traumatic Pseudoaneurysm of the Distal Paracentral Pericallosal Artery Branch

Manisha Koneru et al. Cureus. .

Abstract

Cerebrovascular pseudoaneurysm development and rupture is a rare, delayed sequelae of trauma. We present a case of a female patient in her sixties who presented after a fall without evidence of vascular injury on imaging. However, after one week, repeat imaging due to an abrupt change in mental status revealed a ruptured pseudoaneurysm, which was treated with a combination of coil embolization and open surgical evacuation of associated intracranial hematoma. This case illustrates the importance of continued surveillance beyond the acute traumatic period to identify late-onset complications in trauma patients requiring emergent treatment.

Keywords: blunt cervical trauma; endovascular coil embolization; frontal craniotomy; intracranial hematoma; traumatic pseudoaneurysm.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT head without contrast on admission.
An axial view of CT of the head without contrast demonstrates a large right frontal scalp hematoma (arrowhead) and 3 mm interhemispheric subdural hematoma (arrow) without midline shift. CT, computed tomography
Figure 2
Figure 2. CT head without contrast after mental status change.
An axial view of the CT of the head without contrast demonstrates a 4 cm left frontal parenchymal hematoma (arrow) with rightward subfalcine herniation. CT, computed tomography
Figure 3
Figure 3. CTA of the head and neck showing ruptured pseudoaneurysm.
A sagittal view of CTA of the head and neck on the arterial phase demonstrates a 2 mm ruptured pseudoaneurysm (arrowhead) within a left frontal parenchymal hematoma (arrow). CTA, computed tomography angiography
Figure 4
Figure 4. DSA and 3D tumble showing intracranial pseudoaneurysm.
(A) DSA demonstrating a 3.2 mm × 2.0 mm × 1.8 mm pseudoaneurysm with active contrast extravasation (arrow) in the distal paracentral pericallosal branch of the left anterior cerebral artery. (B) 3D tumble reconstruction demonstrating pseudoaneurysm (arrow) in the distal paracentral pericallosal branch of the left anterior cerebral artery. 3D, three-dimensional; DSA, digital subtraction angiography
Figure 5
Figure 5. DSA after embolization.
DSA demonstrating platinum coil embolization of pseudoaneurysm and distal parent artery (arrow). DSA, digital subtraction angiography
Figure 6
Figure 6. Endovascular coils visualized during open surgical hematoma evacuation.
Left frontal craniotomy for evacuating associated clotted hematoma exposed endovascularly placed coils (arrow) in the left pericallosal artery.
See this image and copyright information in PMC

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