Two Internal Carotid Aneurysms After a Car Accident in a Young Man

Posttraumatic internal carotid aneurysms are rare. Two posttraumatic aneurysms occurring at the same time are even more rare. Two pseudoaneurysms located in different segments of the ipsilateral internal carotid artery have not been found in the literature. We provide the results of angiographic images of traumatic aneurysms over time.

We report a young man aged 17 years with multiple aneurysms of the internal carotid artery following head injury. Head computed tomography examination was performed in our hospital showing a small amount of subarachnoid hemorrhage, nodular high-density shadow on the left side of the sellar region, casting a high-density shadow on the suprasellar cistern and left sulcus approximately 1 x 1 cm in size, and subarachnoid hemorrhage. Digital subtraction angiography was performed on the sixth day of admission: the C5 and C6 segments of the left internal carotid artery had 2 x 4 mm mound processes and 7 x 7 mm saccular processes, respectively. Interventional surgery was performed immediately. Due to aneurysm enlargement, intravascular surgery was performed for coiling of the corresponding aneurysms. The left internal carotid artery occlusion test showed that the right internal carotid artery was well compensated by the left side via the anterior communicating artery. The ophthalmic artery aneurysm of the left internal carotid artery and the clinoid segment pseudoaneurysms were embolized. Follow-up for 1 year showed no obvious sequelae and a good recovery.

This case suggests that patients with posttraumatic subarachnoid hemorrhage should be considered for the possibility of traumatic aneurysms. If this occurs, an aggressive operation would achieve a good outcome.