Pericallosal Artery Pseudoaneurysm: Blunt Head Trauma Complicated with Pseudoaneurysm, Delayed Callosal Cistern and Intraventricular Bleeding, Endovascular Coiling

You are here:

Home
The Aneurysm Casebook
Pericallosal Artery Pseudoaneurysm: Blunt Head Trauma Complicated with Pseudoaneurysm, Delayed Callosal Cistern and Intraventricular Bleeding, Endovascular Coiling

Pericallosal Artery Pseudoaneurysm: Blunt Head Trauma Complicated with Pseudoaneurysm, Delayed Callosal Cistern and Intraventricular Bleeding, Endovascular Coiling

Pericallosal Artery Pseudoaneurysm:
Blunt Head Trauma Complicated with Pseudoaneurysm, Delayed Callosal Cistern and Intraventricular Bleeding, Endovascular Coiling
Carlos Candanedo, Samuel Moscovici, Guy Rosenthal, and José E. Cohen

Abstract

Traumatic intracranial pseudoaneurysms are usually secondary to penetrating brain injury, with rare cases reported after blunt head trauma. Exclusion of the aneurysm should be the main treatment to avoid rebleeding, which could be associated with high morbidity and mortality, especially in cases where the aneurysm has been misdiagnosed after a moderate traumatic brain injury (TBI).

We report an unusual case of an interhemispheric subarachnoid hemorrhage (SAH) after a bicycle accident involving a helmeted 61-year-old male. The resulting blunt head trauma caused the rupture of a pseudoaneurysm of the pericallosal artery. The patient developed delayed rebleeding 8 days after admission, with enlargement of the callosal cistern, intraventricular bleeding, and secondary contralateral crural monoparesis.

Cerebral angiography confirmed the presence of a small traumatic pericallosal pseudoaneurysm at the level of the superior aspect of the body of the corpus callosum, after the exit of the paracentral artery. This pseudoaneurysm gave rise to an inferior and a superior branch, with the clinical monoparesis likely related to the superior branch. Coil occlusion was performed to occlude the pseudoaneurysm and the superior branch, since its potential clinical implication was already established. The inferior branch patent was left intact to avoid a new visual deficit.

We suggest that in a patient with a history of blunt head injury and delayed development of subarachnoid or intraventricular hemorrhage, neurovascular studies including cerebral angiography should be performed for early recognition of a possible pseudoaneurysm, which may be related to high morbidity and mortality if unrecognized and untreated. The management of traumatic intracranial aneurysms secondary to blunt head trauma and the advantages of the endovascular management are the main topic of this chapter.