J Korean Neurosurg Soc.  2014 Nov;56(5):428-430. 10.3340/jkns.2014.56.5.428.

Fatal Traumatic Subarachnoid Hemorrhage due to Acute Rebleeding of a Pseudoaneurysm Arising from the Distal Basilar Artery

• Kim BC
• Lee JI
• Cho WH
• Nam KH

• KMID: 2018103
• DOI: http://doi.org/10.3340/jkns.2014.56.5.428

Abstract

Isolated traumatic pseudoaneurysms of the basilar artery are extremely rare but often fatal resulting in a mortality rate as high as 50%. A 51-year-old man presented with craniofacial injury after blunt trauma. A brain computed tomography (CT) scan showed thick basal subarachnoid hemorrhage associated with multiple craniofacial fractures, while CT angiography revealed contrast extravasation at the distal basilar artery with pseudoaneurysm formation. After this primary survey, the condition of the patient suddenly deteriorated. Conventional angiography confirmed the contrast extravasation resulted from pseudoaneurysm formation, which was successfully treated with endovascular coil embolization. Decompressive craniectomy and coma therapy with propofol were also performed. However, the patient died on the 7th hospital day because of the poor initial clinical condition. The current case is the first report of acute pseudoaneurysm rupture arising from the basilar artery within the first day after trauma. Our findings suggest the possibility that pseudoaneurysm rupture should be considered if brain CT shows thick traumatic subarachnoid hemorrhage on the basal cistern with a basal skull fracture.

Keyword

Traumatic brain injury; Subarachnoid hemorrhage; Basilar artery; Pseudoaneurysm

MeSH Terms

Aneurysm, False*
Angiography
Basilar Artery*
Brain
Brain Injuries
Coma
Decompressive Craniectomy
Embolization, Therapeutic
Humans
Middle Aged
Mortality
Propofol
Rupture
Skull Fractures
Subarachnoid Hemorrhage
Subarachnoid Hemorrhage, Traumatic*
Propofol

Figure

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  Fig. 1 Initial non-enhanced brain CT demonstrating diffuse and thick subarachnoid hemorrhage in basal cistern and prepontine cistern (A) with other traumatic intracranial hemorrhages (B).

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  Fig. 2 CT angiography showing contrast extravasation (white arrow) on the distal basilar artery.

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  Fig. 3 Follow-up brain CT showing the aggravation of subarachnoid hemorrhage after neurologic deterioration.

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  Fig. 4 A : Conventional angiography demonstrating pseudoaneurysm arising from distal basilar artery. B : Angiography confirming complete occlusion of the pseudoaneurysm sac and rupture point of distal basilar artery. C : Left internal cerebral artery angiography demonstrating posterior cerebral artery with collateral flow through the posterior communicating artery.

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