Korean J Neurotrauma.  2015 Oct;11(2):154-157. 10.13004/kjnt.2015.11.2.154.

Post Traumatic Pseudoaneurysm Arising from V4 Segment of Vertebral Artery: A Case Report

• Huh CW
• Nam KH
• Choi CH
• Lee JI

• KMID: 2378277
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.154

Abstract

This case report describes a traumatic pseudoaneurysm arising from the right V4 segment of the vertebral artery, near the origin of the posterior inferior cerebellar artery. Post-traumatic vertebral artery pseudoaneurysm is rare, but associated with a high mortality rate. We report on an extremely rare case of post-traumatic pseudoaneurysm of the vertebral artery with delayed manifestation. A 9-year-old child was admitted to the emergency room after a pedestrian car accident. A computed tomography (CT) scan showed subarachnoid hemorrhage with intraventricular hemorrhage (IVH), multiple facial bones, and temporal bone fracture. External ventricular drainage and decompressive suboccipital craniectomy were performed for acute hydrocephalus and posterior fossa swelling. The patient's clinical condition became suddenly aggravated on the 15th hospital day, and brain CT confirmed appearance of a new 4th ventricle IVH. Digital subtraction angiography revealed a ruptured pseudoaneurysm arising from the right V4 segment of the vertebral artery. Parent artery occlusion using detachable coils was achieved. Despite intensive care, the patient's clinical condition showed continuous deterioration and the patient died of respiratory complications on the 52nd hospital day.

Keyword

Craniocerebral trauma; Subarachnoid hemorrhage; Aneurysm, false; Vertebral artery

MeSH Terms

Aneurysm, False*
Angiography, Digital Subtraction
Arteries
Brain
Child
Craniocerebral Trauma
Drainage
Emergency Service, Hospital
Facial Bones
Hemorrhage
Humans
Hydrocephalus
Critical Care
Mortality
Parents
Subarachnoid Hemorrhage
Temporal Bone
Vertebral Artery*

Figure

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  FIGURE 1 Initial non-contrast computed tomography (CT) showing subarachonoid hemorrhage around pons, both Sylvian fissures, and basal cistern (A). No abnormality was observed on cervical spine CT (B).

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  FIGURE 2 Follow-up computed tomography (CT) and digital subtraction angiography (DSA). A: Follow-up brain CT confirming increased 4th ventricle hemorrhage and hydrocephalus. B, C: DSA demonstrating a pseudoaneurysm arising from the right V4 segment of the vertebral artery, near the origin of the posterior inferior cerebellar artery.

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  FIGURE 3 Computed tomography angiography showing a saccular lesion at the right distal vertebral artery and similar size of both vertebral arteries.

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  FIGURE 4 A: Post-procedural unsubtracted image reveals complete obliteration of the right distal vertebral artery including pseudoaneurysm. B: Left vertebral artery angiography confirms sufficient collateral flow of the right cerebellar hemisphere.

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  FIGURE 5 Chest X-ray showing haziness of both lung fields.

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