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Delayed Spontaneous Resolution of a Traumatic Middle Meningeal Artery Pseudoaneurysm
Jaime L Atiles1, Amanda P Marrero-González1, Eduardo J Labat1
1Department of Diagnostic Radiology, University of Puerto Rico - School of Medicine, San Juan, Puerto Rico.
Abstract:
BACKGROUND Middle meningeal artery (MMA) aneurysms are a very rare entity, comprising less than 1% of all intracranial aneurysms. In particular, traumatic MMA pseudoaneurysms (MMAP) are reported in the literature to have a poor outcome in about 20% of cases. Moreover, in extremely rare cases, MMAPs can spontaneously thrombose. CASE REPORT We present the case of a 42-year-old Hispanic man with multiple craniofacial hemangiomas and history of chronic migraines that increased in frequency after blunt head trauma 1 month prior to initial evaluation. CTA and brain MRI showed a right-sided MMAP adjacent to the foramen spinosum with a pan-hemispheric subdural hematoma and no associated skull fractures. The MMAP was not visualized 2 days later on digital subtraction angiography (DSA) and was therefore presumed to be thrombosed. CTA at 3 months showed interval progression of the MMAP with subsequent spontaneous resolution on CTA at 10 months. CONCLUSIONS Knowledge regarding MMAPs is limited since it is based on a small number of cases and literature reviews. Additional studies are needed to elucidate the true incidence and natural course of this entity and produce adequate treatment guidelines.
Insights
Traumatic middle meningeal artery pseudoaneurysms (MMAP) can spontaneously thrombose and resolve, challenging typical poor outcomes. This case highlights the unpredictable natural course of MMAPs.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Middle meningeal artery (MMA) aneurysms are rare, accounting for <1% of intracranial aneurysms.
- Traumatic MMA pseudoaneurysms (MMAP) have a reported poor outcome in ~20% of cases.
- Spontaneous thrombosis of MMAPs is exceptionally rare.
Observation:
- A 42-year-old man with craniofacial hemangiomas and migraines presented after head trauma.
- CTA/MRI revealed a right-sided MMAP with subdural hematoma, no skull fractures.
- Initial DSA showed no MMAP; presumed thrombosed.
- Follow-up CTA demonstrated MMAP progression then spontaneous resolution over 10 months.
Findings:
- This case illustrates a rare instance of spontaneous thrombosis and resolution of a traumatic MMAP.
- The natural history of MMAPs may be more variable than previously understood.
- Imaging demonstrated dynamic changes, including initial apparent thrombosis followed by recanalization and eventual resolution.
Implications:
- Limited data necessitates further research into the true incidence and natural course of MMAPs.
- Understanding MMAP variability is crucial for developing appropriate treatment guidelines.
- This case underscores the importance of serial imaging for evaluating MMAP evolution.
