Traumatic Aneurysm on the Posterior Cerebral Artery Following Blunt Trauma in a 14-Year-Old Girl: Case Report

Shanghai Changzheng Hospital, Shanghai, People’s Republic of China.
Neuropediatrics (Impact Factor: 1.24). 10/2011; 42(5):204-6. DOI: 10.1055/s-0031-1291221
Source: PubMed


A 13-year-old girl sufferring from a car accident presented with a symptom of oculomotor nerve palsy. A CT scan revealed diffuse SAH in the suprasellar cistern, cisterna ambiens and interpeduncular cistern. MRI showed contusion of the left cerebral peduncle and a flowing void signal in front of the left cerebral peduncle. Cerebral angiography revealed a bilobulated aneurysm on the P1-P2 junction of the left posterior cerebral artery. Endovascular treatment was performed, with coil packing within the aneurysm and occlusion of the parent vessel. There were no neurological deficits and no recurrence of the aneurysm on follow-up studies. Endovascular embolization of traumatic posterior cerebral artery aneurysm is a safe and effective therapeutic approach.

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    ABSTRACT: Background: Traumatic intracranial aneurysms (TICAs) have previously been described in literature. However, the evidence of TICAs secondary to blunt brain injury have not been elucidated well, with most of the conclusions coming from isolated case reports. We have attempted to examine the epidemiology, classification, clinical presentation, therapeutic modalities, and outcomes of TICAs with our series of patients at the neurosurgery department of Xuanwu Hospital, China. Methods: We reviewed our aneurysm database from January 1, 2005 to December 31, 2011. In particular, patients with TICAs secondary to blunt brain injury were reviewed. Variables assessed included age, sex, causes of blunt brain injury, skull fracture, location, classification, clinical presentation, time elapsed to arrive at diagnoses, treatment, and eventual outcome. Based on our assessment, we arrived at a modified classification scheme to categorize these aneurysms. Results: We reviewed 2335 patients with cerebral aneurysm from January 1, 2005 to December 31, 2011. Of these, 15 patients (0.64 %) with traumatic aneurysms secondary to blunt brain injury were identified.Motor vehicle accidents (MVA) were observed to be the most common cause of injury (10 patients, 66.7 %), followed by TICAs sustained after falling down (5 patients, 33.3 %). The most common symptom at presentation was epistaxis (6 patients, 40 %), followed by ophthalmic problems (6 patients, 40 %), with both presentations seen in 1 patient. The most common diagnostic modality used was DSA in 12 patients (80 %) followed by CTA in 2 patients (13.3 %). Infraclinoid TICAs were seen in 9 patients (60 %), whereas supraclinoid TICAs were seen in 5 patients (33.3 %), with perifalx TICAs seen in 1 patient. Endovascular intervention therapies were performed in 11 patients (73.3 %), bypass surgery and trapping in 2 (13.3 %), transnasal endoscopic approach in combination with balloon assisted in 2 patients. At discharge, 2 patients had poor clinical outcomes (13.3 %), 5 had fair (33.3 %),and 8 resulted with good outcomes (53.3 %). Conclusions: TICAs arising secondary to blunt brain injury account for 0.64 % of all cerebral aneurysms. Infraclinoid, supraclinoid ICA and perifalx TICAs are the most common aneurysms arising from blunt brain injury. Our study further shows that traumatic patients presenting with recurrent epistaxis, oculomotor nerve palsy, and delayed intracranial hemorrhage should receive cerebroangiography as soon as possible. An early diagnosis and proper treatment could prove to be helpful in terms of improving final clinical outcome.
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