Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization
Pseudoaneurysm of the middle meningeal artery, presenting as a delayed sequela of trauma, being a rare entity, may sometimes present as an acute intraparenchymal hemorrhage, with a risk of rerupture and mortality. The optimal management in acute settings remains undetermined. We, hereby, report a ca...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2024-08-01
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| Series: | Indian Journal of Neurosurgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1761602 |
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| author | Mandar G. Waghralkar Piyush Ojha Gaurav Goel Anirban Deep Banerjee Anshu Mahajan |
| author_facet | Mandar G. Waghralkar Piyush Ojha Gaurav Goel Anirban Deep Banerjee Anshu Mahajan |
| author_sort | Mandar G. Waghralkar |
| collection | DOAJ |
| description | Pseudoaneurysm of the middle meningeal artery, presenting as a delayed sequela of trauma, being a rare entity, may sometimes present as an acute intraparenchymal hemorrhage, with a risk of rerupture and mortality. The optimal management in acute settings remains undetermined. We, hereby, report a case of elderly gentleman with a history of a road traffic accident. Noncontrast computed tomography (NCCT) brain was reported to have left parietal hemorrhagic contusion without any mass effect. The patient was managed conservatively without any major neurological deficits. After 7 months, the patient presented with severe headache, altered sensorium, and right hemiparesis. NCCT brain showed acute left thalamocapsular hemorrhage with minimal subarachnoid hemorrhage with associated mass effect and impending herniation. Considering the fall in patient's baseline Glasgow comma scale response, pupillary asymmetry, and CT findings, immediate decompression and hematoma evacuation were advised. In view of atypical morphology, the patient was planned for urgent digital subtraction angiography prior to the surgery to rule out the ruptured aneurysm or pial arterio-venous fistula. Selective angiography of the left external carotid artery demonstrated a dissecting pseudoaneurysm feeding from the middle meningeal artery (MMA), which was embolized using n-butyl cyanoacrylate (NBCA). Postprocedure DynaCT revealed the left temporal bone fracture, indicating this pseudoaneurysm to be most likely posttraumatic delayed sequelae. Postembolization, the patient underwent surgical decompression and excision of hematoma. Patient's neurological status gradually improved and was discharged with the minimal deficit. Our case highlights the importance of awareness of the posttraumatic MMA pseudoaneurysm as an uncommon but treatable entity, which can be easily diagnosed using cerebral angiography and amenable to safe and effective endovascular embolization using NBCA. |
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| language | English |
| publishDate | 2024-08-01 |
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| series | Indian Journal of Neurosurgery |
| spelling | doaj-art-f4dd9f152b5d4a68a8ef7ca2572c1ce42025-08-20T02:04:33ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Neurosurgery2277-954X2277-91672024-08-01130217217510.1055/s-0043-1761602Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate EmbolizationMandar G. Waghralkar0https://orcid.org/0000-0002-1154-4789Piyush Ojha1https://orcid.org/0000-0001-7659-0383Gaurav Goel2https://orcid.org/0000-0002-2953-719XAnirban Deep Banerjee3https://orcid.org/0000-0002-3208-2384Anshu Mahajan4https://orcid.org/0000-0003-3261-9812Department of Neurointervention Surgery, Medanta Institute of Neurosciences, Medanta—The Medicity, Gurgaon, Haryana, IndiaDepartment of Neurointervention Surgery, Medanta Institute of Neurosciences, Medanta—The Medicity, Gurgaon, Haryana, IndiaDepartment of Neurointervention Surgery, Medanta Institute of Neurosciences, Medanta—The Medicity, Gurgaon, Haryana, IndiaDepartment of Neurosurgery, Medanta Institute of Neurosciences, Medanta—The Medicity, Gurgaon, Haryana, IndiaDepartment of Neurointervention Surgery, Medanta Institute of Neurosciences, Medanta—The Medicity, Gurgaon, Haryana, IndiaPseudoaneurysm of the middle meningeal artery, presenting as a delayed sequela of trauma, being a rare entity, may sometimes present as an acute intraparenchymal hemorrhage, with a risk of rerupture and mortality. The optimal management in acute settings remains undetermined. We, hereby, report a case of elderly gentleman with a history of a road traffic accident. Noncontrast computed tomography (NCCT) brain was reported to have left parietal hemorrhagic contusion without any mass effect. The patient was managed conservatively without any major neurological deficits. After 7 months, the patient presented with severe headache, altered sensorium, and right hemiparesis. NCCT brain showed acute left thalamocapsular hemorrhage with minimal subarachnoid hemorrhage with associated mass effect and impending herniation. Considering the fall in patient's baseline Glasgow comma scale response, pupillary asymmetry, and CT findings, immediate decompression and hematoma evacuation were advised. In view of atypical morphology, the patient was planned for urgent digital subtraction angiography prior to the surgery to rule out the ruptured aneurysm or pial arterio-venous fistula. Selective angiography of the left external carotid artery demonstrated a dissecting pseudoaneurysm feeding from the middle meningeal artery (MMA), which was embolized using n-butyl cyanoacrylate (NBCA). Postprocedure DynaCT revealed the left temporal bone fracture, indicating this pseudoaneurysm to be most likely posttraumatic delayed sequelae. Postembolization, the patient underwent surgical decompression and excision of hematoma. Patient's neurological status gradually improved and was discharged with the minimal deficit. Our case highlights the importance of awareness of the posttraumatic MMA pseudoaneurysm as an uncommon but treatable entity, which can be easily diagnosed using cerebral angiography and amenable to safe and effective endovascular embolization using NBCA.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1761602Intraparenchymal hemorrhageNBCA embolizationPosttraumatic middle meningeal artery pseudoaneurysm |
| spellingShingle | Mandar G. Waghralkar Piyush Ojha Gaurav Goel Anirban Deep Banerjee Anshu Mahajan Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization Indian Journal of Neurosurgery Intraparenchymal hemorrhage NBCA embolization Posttraumatic middle meningeal artery pseudoaneurysm |
| title | Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization |
| title_full | Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization |
| title_fullStr | Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization |
| title_full_unstemmed | Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization |
| title_short | Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization |
| title_sort | unusual intracerebral hemorrhage secondary to delayed posttraumatic middle meningeal artery pseudoaneurysm successfully treated by endovascular n butyl cyanoacrylate embolization |
| topic | Intraparenchymal hemorrhage NBCA embolization Posttraumatic middle meningeal artery pseudoaneurysm |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1761602 |
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