Extradural hematoma due to traumatic pseudoaneurysm of middle meningeal artery

Extradural hematoma due to rupture of post-traumatic pseudoaneurysm of the middle meningeal artery is a very rare clinical entity. Only fourteen such cases have been reported in the literature. A 52-year-old, right-handed Mexican male was admitted with motor aphasia and right-sided signs but no history of unconsciousness. He had been struck by an automobile almost 24 hours earlier. His neurological signs appeared shortly thereafter. A left temporoparietal linear fracture of the skull was recognized as well as a fracture of the right knee. Angiography revealed a lenticular parietal avascular area with depression of the middle cerebral artery and a shift of the anterior cerebral artery. An aneurysm was observed on the left middle meningeal artery below the skull fracture. At craniotomy a large extradural hematoma was evacuated and the aneurysm removed. The patient had a complete recovery.