Fatal Traumatic Subarachnoid Hemorrhage due to Acute Rebleeding of a Pseudoaneurysm Arising from the Distal Basilar Artery.
10.3340/jkns.2014.56.5.428
- Author:
Byung Chul KIM
1
;
Jae Il LEE
;
Won Ho CHO
;
Kyoung Hyup NAM
Author Information
1. Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. namdark@daum.net
- Publication Type:Case Report
- Keywords:
Traumatic brain injury;
Subarachnoid hemorrhage;
Basilar artery;
Pseudoaneurysm
- MeSH:
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*
- From:Journal of Korean Neurosurgical Society
2014;56(5):428-430
- CountryRepublic of Korea
- Language:English
-
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.
