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[Posttraumatic pseudoaneurysm of the middle meningeal artery: a case report]
Abstract:
An epidural hematoma associated with posttraumatic pseudoaneurysm of the middle meningeal artery is a very rare clinical entity. Only 31 such cases have been reported in the literature. A 54-year-old man was admitted with lethargy and right hemiparesis. A skull X-ray film revealed a linear fracture in the left parietal and temporal bone, extending to the base of the skull. A brain CT scan disclosed an acute epidural hematoma over the left cerebral hemisphere, contusional hematoma in the right frontal lobe and thalamus, and subarachnoid hemorrhage in the left Sylvian fissure. During an emergency craniotomy a large epidural hematoma was evacuated and external decompression was performed. Angiography, which was performed about one month after the head injury, revealed an aneurysm of the middle meningeal artery. The aneurysm was removed to avoid delayed rupture at the time of cranioplasty. Histological diagnosis was pseudoaneurysm. We discussed the pathogenesis of a pseudoaneurysm of the meningeal artery and the necessity to pay attention to the presence of a pseudoaneurysm when an active bleeding point is not observed during surgery of the epidural hematoma.
Insights
This case report highlights a rare instance of epidural hematoma linked to a posttraumatic pseudoaneurysm of the middle meningeal artery. Prompt diagnosis and surgical intervention are crucial for managing this uncommon but potentially severe condition.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Radiology
Background:
- Epidural hematoma (EDH) is a serious traumatic brain injury.
- Pseudoaneurysms of the middle meningeal artery (MMA) are exceedingly rare complications of head trauma.
Observation:
- A 54-year-old male presented with altered consciousness and hemiparesis following head trauma.
- Imaging revealed an acute epidural hematoma, intracranial contusions, and subarachnoid hemorrhage.
- Angiography identified a pseudoaneurysm of the middle meningeal artery.
Findings:
- Surgical evacuation of the epidural hematoma was performed.
- The middle meningeal artery pseudoaneurysm was successfully resected.
- Histopathological examination confirmed a pseudoaneurysm.
Implications:
- This case underscores the importance of considering MMA pseudoaneurysm in EDH, especially when active bleeding is not evident during surgery.
- Early recognition and treatment can prevent delayed rupture and improve patient outcomes.
- Further research into the pathogenesis and optimal management of traumatic MMA pseudoaneurysms is warranted.