Traumatic Intracranial Aneurysms Research Articles

Traumatic Falcine Artery Aneurysm Resulting in Intracranial Hemorrhage

A 50-year-old man presented with mild unconsciousness after a fall-induced head injury. Initial imaging revealed a left-sided acute subdural hematoma. After transportation to our hospital, his condition deteriorated, leading to the discovery of a new hemorrhage and an anterior falcine artery aneurysm upon further examination. The patient underwent successful decompressive craniectomy and endovascular occlusion. This case, the first reported of a traumatic anterior falcine artery aneurysm, suggests the initial injury caused both the hematoma and aneurysm. The aneurysm's specific location near the crista galli likely contributed to the formation of the traumatic aneurysm, and the compression of the left frontal lobe by the acute subdural hematoma caused the subsequent hemorrhage. This case highlights the importance of considering traumatic aneurysms in atypical postinjury hemorrhages and adds to the understanding of traumatic intracranial aneurysms' mechanisms.

Infantile traumatic pericallosal aneurysm: illustrative case.

Traumatic aneurysms are a rare sequela of nonaccidental head trauma in infants. The rate of nonaccidental trauma (NAT) in the pediatric population is increasing; therefore, traumatic aneurysms are an important consideration in the evaluation of pediatric patients with abusive head trauma. A 24-day-old infant with no significant past medical or birth history presented with twitching and poor oral intake for 1 day. The patient was found to have bilateral subdural hematomas, multifocal contusions, and traumatic subarachnoid hemorrhage. NAT work-up was remarkable for a period of repeated and prolonged abuse. Magnetic resonance angiography revealed a right pericallosal traumatic aneurysm that was treated by means of coil and Onyx embolization. Traumatic intracranial aneurysms are a rare but serious sequela of pediatric abusive trauma. Traumatic intracranial aneurysms should be considered in the setting of intracranial pathology associated with high-energy trauma. Despite new methods for the management of traumatic aneurysms, this pathology remains challenging to identify and treat, and the prognosis remains poor because of the diffuse injury often involved in these patients.

Acute Development of Traumatic Intracranial Aneurysms After Civilian Gunshot Wounds to the Head.

In previous studies, the incidence of traumatic intracranial aneurysms (TICAs) after civilian gunshot wound to the head (cGSWH) was ∼3%. Given the use of delayed vessel imaging, we hypothesize that a significant fraction of TICAs is missed on initial non-contrasted scans. This study was designed to characterize acute TICAs using admission computed tomographic angiography (aCTA) in cGSWH. Over the period from 2017 to 2022, 341 patients were admitted to R. Adams Cowley Shock Trauma Center with cGSWH; 136 subjects had aCTA ∼3 (standard deviation [SD] 3.5) h post-injury. Demographics, clinical findings, imaging techniques, endovascular/surgical interventions, and outcomes were analyzed. Mean age was 34.7 (SD 13.1), male:female ratio was 120:16. Average admission Glasgow Coma Scale (GCS) score was 6 (SD 3.9). Entry site was frontal in 41, temporal in 55, parietal in 18, occipital in 6, suboccipital in 9, temporo-parietal in 1, and frontobasal-temporal in 6. Projectiles crossed multiple dural compartments in 76 (55%) patients. 35 TICAs were diagnosed in 28 subject: 24 were located along the middle cerebral artery (MCA), 6 in the anterior cerebral artery (ACA), 3 in the internal carotid artery (ICA), 1 in the posterior cerebral artery (PCA), and 1 in the middle meningeal artery (MMA). Eleven TICAs resolved spontaneously in nine patients. Eight aneurysms were treated by endovascular means, two via combined endovascular/open approaches. Forty-nine patients died, 10 of whom had 15 TICAs. Eighty patients developed intracerebral hematoma s (ICHs). Regression models showed that the presence of an ICH was the main predictor of TICA in cGSWH. Larger ICHs (average 22.3 cc vs. 9.4 cc in patients with and without aneurysms, respectively) in patients with cGSWH suggest hidden TICAs. Nearly 30% of patients had spontaneous resolution within 1 week. When CTA was performed acutely, TICAs were 10 times more frequent in cGSWH than in previous literature, and those patients were more likely to proceed to surgery. Almost one third of patients in this series died from the devastating effects of cGSWH.

Traumatic intracranial aneurysm in a distal posterior cerebral artery: A case report and literature review

Background: Traumatic intracranial aneurysms (TICAs) are rare and known to rupture easily and have a high mortality rate. Case Description: An 87-year-old male patient with no neurological deficits presented to our hospital after head trauma. Computed tomography (CT) revealed a tentorial acute subdural hematoma (ASDH). The patient was managed conservatively and discharged home six days after hospitalization. Two days later, the patient returned with a severe headache. CT showed that the ASDH had enlarged and extended from the tentorium to the convexity. CT angiography and digital subtraction angiography revealed a pseudoaneurysm in a branch of the left posterior inferior temporal artery. The patient was diagnosed with an enlarged ASDH due to a ruptured TICA that arose from the P3 segment. We performed endovascular intervention with parent artery occlusion (PAO) using n-butyl-2-cyanoacrylate (NBCA). The parent artery was accessed through the left posterior communicating artery because left vertebral angiography revealed an aplastic left P1 segment. After navigating the microcatheter near the aneurysm, we injected 33% NBCA into the parent artery. The pseudoaneurysm disappeared after injection. The patient was discharged on hospital day 25 despite persistent delirium. Conclusion: This is the first report of a TICA arising from the P3 segment that was treated with PAO using NBCA. TICAs are rare; however, a TICA must be considered when an enlarged hematoma caused by head injury is detected.

Endoluminal flow diversion as a primary treatment strategy for pediatric traumatic intracranial aneurysms: a case-based review of literature.

Traumatic intracranial aneurysms (TICAs) constitute a notable portion of pediatric intracranial aneurysms. Their unstable structure dictates a high incidence of rupture or mass effect from enlarging unruptured aneurysms, necessitating prompt diagnosis and treatment. TICAs often lack a true neck or are wide-necked, making them unsuitable for coil embolization and surgical clipping, and their fragile nature poses a risk of rupture during surgical and intrasaccular interventions. Endoluminal flow diverters (FD), deployed without requiring direct access to the aneurysmal sac, have emerged as an appealing sole treatment modality for TICAs. However, the clinical experience with this technique remains limited in the pediatric population. We describe the successful treatment of a paraclinoid TICA in a 4-year-old female using an endoluminal FD alone. Additionally, we conducted a literature review to assess the safety and effectiveness of this treatment modality in pediatric TICAs. Endoluminal flow diversion led to complete aneurysm obliteration in our case, with no observed complication, at the 9-month follow-up. Our review of the previously reported pediatric TICAs managed by standalone flow diversion highlights this technique as safe, efficient, and promising as a sole treatment modality, particularly in the anterior circulation, with a high rate of persistent total obliteration and a low rate of complications. However, the requirement for long-term antiplatelet therapy with the possibility of frequent dose monitoring and adjustments warrants special attention when using endoluminal FDs. Until guidelines specifically addressing optimal antiplatelet therapy in children with intracranial FDs are formulated, adherence to existing protocols is imperative to avoid in-stent thrombosis. Our literature review and personal experience indicate that endoluminal flow diversion can be a viable treatment approach for pediatric TICAs. However, prospective studies with extensive follow-ups are required to assess the durability of endoluminal FDs in treating pediatric TICAs, considering the long life expectancy of this demographic.

Delayed rupture of traumatic anterior cerebral artery A4 segment aneurysm: A case report.

Delayed rupture of traumatic intracranial aneurysms is relatively rare, and traumatic anterior A4 segment aneurysms may be associated with trauma to the cerebral falx. The mortality rate in patients with delayed traumatic rupture of intracranial aneurysms is>50%. Therefore, early diagnosis and treatment are critical. Herein, we present a case of a patient who did not have an intracranial aneurysm on computed tomographic angiography (CTA) after admission. Subsequently, the patient consciousness deteriorated, and CTA revealed aneurysm and bleeding. A 55-year-old man fell from a 3-meter-high truck and was unconscious. During the following few hours, the gradually regained consciousness. No intracranial aneurysms were found on CTA of the patient head immediately after admission. The final diagnosis was delayed rupture of traumatic intracranial aneurysms. The patient underwent endovascular and symptomatic treatments. The patient gradually recovered and was referred to the rehabilitation department for further treatment. Considering the catastrophic consequences of the disease, we should review CTA or digital subtraction angiography many times after admission, and take appropriate surgical procedures in time.

Traumatic intracranial aneurysms following combat damage

To develop the principles for the treatment of traumatic intracranial aneurysms after combat damage to skull and brain. There were 18 patients with traumatic intracranial aneurysms from February 2022 to the present. Of these, 15 ones had gunshot penetrating wounds of the skull and brain. In 3 cases, aneurysms developed after explosive injury. All patients underwent computed tomography (CT) of the brain, CT angiography of brain vessels and selective cerebral angiography. We analyzed nature of brain damage, trajectory of the wounding projectile and aneurysm location to determine predictors of traumatic intracranial aneurysms. Surgical treatment was performed in all cases. Hemorrhagic manifestations were observed in 11 patients. In 4 cases, traumatic intracranial aneurysms were diagnosed before rupture. Blunt head injury was followed by subarachnoid hemorrhage in 2 cases and ischemic stroke in 1 case. Endovascular or microsurgical intervention was performed depending on location of aneurysm, clinical manifestations and severity of brain damage. In case of distal aneurysms, endovascular and microsurgical destructive interventions prevailed. At the same time, proximal aneurysms (within or below the circle of Willis) required reconstructive endovascular treatment. Traumatic aneurysms should be suspected in all patients with penetrating craniocerebral injuries. Follow-up is contraindicated for traumatic intracranial aneurysms due to high risk of hemorrhage.

Acute Development of a Traumatic Pseudoaneurysm of the Posterior Inferior Cerebellar Artery Due to a Fracture of the Clivus

BACKGROUND AND IMPORTANCE: Traumatic intracranial aneurysms are uncommon and are mostly located in the anterior circulation. Aneurysms involving the posterior circulation are extremely rare and account for less than 10% of traumatic aneurysms. In this study, we describe an extremely rare case of a traumatic pseudoaneurysm of the posterior inferior cerebellar artery due to a fracture of the clivus that ruptured in the acute stage after blunt brain injury and that was successfully cured endovascularly. CLINICAL PRESENTATION: A 68-year-old man presented with loss of consciousness because of a severe subarachnoid hemorrhage and multiple contusions after blunt brain injury. Angiography the day after trauma revealed a traumatic pseudoaneurysm near the clivus fracture that had not been identified on the first day of trauma. The aneurysm's location was consistent with the location of the increased thick subarachnoid hemorrhage. The aneurysm was successfully occluded endovascularly through posterior inferior cerebellar artery parent artery occlusion. The patient survived the acute stage because of management that included endovascular treatment followed by decompressive craniectomy. CONCLUSION: A traumatic pseudoaneurysm that is likely to rupture due to the fragility of the aneurysm wall can be identified within 1 day after trauma. Neurosurgeons should pay careful attention to the aneurysm formation and perform early treatment to prevent its rupture, which could lead to a fatal hemorrhage.

Traumatic intracranial aneurysms associated with traffic accidents and endovascular management options

Traumatic intracranial pseudoaneurysms are rare complications of head injuries following traffic accidents, occurring in less than 1% of all cerebral aneurysms. Most cases are associated with fracture of the skull. Rupture of these traumatic aneurysms occur in up to 50% of all cases and are typically delayed from days to weeks following the initiating trauma. Traumatic pseudoaneurysms are often called a pulsating hematoma, which occurs when the arterial wall is ruptured by trauma and bleeding is confined only by the adventitia or surrounding tissues. Unlike the structure of a true aneurysm, that has all anatomical layers, the wall of a traumatic intracranial pseudoaneurysm is composed mainly of blood clot and a small amount of fibrous tissue. Difficult diagnosis, delayed presentation and poor outcomes contribute to overall prognosis of these traumatic intracranial aneurysms.
 We investigated the patients with traumatic intracranial aneurysms developed after traffic accidents and treated with endovascular embolization in our Institution, with a review of literature and discussion of management options.
 As traumatic intracranial aneurysms may present both diagnostic challenges and surgical difficulties, especially after polytrauma cases, rarely being appropriate for conservative treatment, early and precise diagnosis with cerebral angiography and prompt treatment are essential for good prognosis. Due to its nature to be fragile and prone to rupture, careful and precise endovascular embolization is thus a method of choice for treatment of these pseudoaneurysms.

Delayed Tentorial Subdural Hematoma Caused by Traumatic Posterior Cerebral Artery Aneurysm: A Case Report and Literature Review

Patient: Male, 42-year-old Final Diagnosis: Traumatic posterior cerebral artery aneurysm Symptoms: Deterioration of mental status and disorientation Medication: — Clinical Procedure: Parent artery occlusion by endovascular approach Specialty: Neurosurgery Objective: Unusual clinical course Background:Subdural hematoma (SDH) caused by traumatic intracranial aneurysm (TICA) is rare. TICAs are known to rupture easily, resulting in a high morbidity and mortality rate. Therefore, accurate diagnosis and treatment are crucial for preserving life. We describe a case of delayed SDH in the setting of posterior cerebral artery (PCA) aneurysm.Case Report:A 42-year-old man presented with sustained head injury from a traffic accident, and was being followed-up conservatively for traumatic SDH and subarachnoid hemorrhage. Three weeks after the head trauma, the patient developed a sudden deterioration of mental status and disorientation. Computed tomography revealed de novo SDH at the cerebellar tentorium. Computed tomography angiography and magnetic resonance imaging demonstrated TICA in the PCA. The patient was diagnosed with SDH due to a ruptured PCA aneurysm at the quadrigeminal segment. To avoid SDH growth due to re-rupture of the aneurysm, parent artery occlusion was subsequently performed with no complications. The patient was discharged home 2 months after endovascular treatment, with moderate disability. Follow-up angiography 2 years after the operation showed no recanalization, and the patient had returned to work.Conclusions:TICA in the PCA can cause tentorial SDH with or without the presence of subarachnoid hemorrhage. Routine cerebrovascular assessment is crucial for head trauma with hematoma adjacent to the cerebellar tentorium. Parent artery occlusion via an endovascular procedure is an alternative treatment for TICA in the PCA that is less invasive than other approaches.

Treatment of Traumatic Intracranial Pseudoaneurysms: A Single-Center Experience.

Background and Purpose: As a rare lesion secondary to brain trauma, traumatic intracranial aneurysms (TICAs) lead to high mortality and morbidity, and multiple treatment modalities have been applied for TICAs. All patients diagnosed with TICAs in our institution from 2010 to 2020 were included in the report, and their clinical features, treatment, and outcomes are described in detail. The purpose of this study is to illustrate the characteristic of different therapeutic methods of TICAs, and focus on the endovascular treatment.Methods: A total of 20 patients were included in this study. The 3 patients who declined treatment all died. Five of the other 17 patients were treated surgically, including clipping, wrapping, and trapping with or without EC-IC high-flow bypass, with only 1 case of parent artery preservation. Twelve patients underwent endovascular treatment, including bare coil embolization (1 case), stent-assisted coiling (2 cases), balloon-assisted coils/Onyx glue embolization (1 case) and covered stents (8 cases), with only 1 case of parent artery sacrifice.Results: 20 patients were included in the present study with 17 males, and the mean of age on 27 years (IQR: 22, 44 years). Eight patients presented with epistaxis, followed by 5 patients with coma, 3 patients with visual defects and 2 patients with CSF leakage. There were 18 TICAs located at the internal carotid artery (ICA); The other 2 TICAs located at pericallosal artery and A1 segment anterior cerebral artery (ACA). One case of diplopia occurred due to sacrifice of the ICA. Occlusion of the ophthalmic artery occurred in 3 patients after placement of a covered stent, with 1 patient suffering an irreversible vision decrease. None of the other patients who underwent the treatment have experienced an aggravation of their symptoms since the treatment; During the imaging follow-up, 1 case of recurrence and 1 case of endoleak occurred in this case series.Conclusions: TICAs are associated with significant morbidity and mortality, and endovascular treatment has emerged as a valuable option, which may be promising to improve the clinical outcomes due to their advantages of preserving the parent artery if occlusion of the side branch artery can be avoided.

Traumatic Distal Anterior Cerebral Artery Aneurysms – Pathomechanism and Revascularisation Strategies

Traumatic intracranial aneurysms (TICA) of the distal anterior cerebral artery (dACA) are exceptionally rare and display therapeutic challenges due to their angioanatomical characteristics. The objective of this work was to discuss the mechanisms of TICA formation of the dACA and to elucidate the best treatment and revascularization strategies in these patients based on two illustrative cases. Case 1: 20-year-old patient with a traumatic, partially thrombosed 14 × 10 mm aneurysm of the right pericallosal artery (rPericA), distal to the origin of the right callosomarginal artery (rCMA). Complete trapping of the right dissection A3 aneurysm and flow replacement extra-to-intracranial (EC-IC) bypass (STA – radial artery – A4) was performed. Case 2: 16-year-old patient with a traumatic polylobulated, partially thrombosed 16 × 10 mm aneurysm of the rPericA. Microsurgical excision of the A3- segment harboring the aneurysm and flow replacement intra-to-intracranial (IC-IC) bypass via reimplantation of the right remaining PericA on the contralateral PericA (end-to-side anastomosis) was performed (in situ bypass). TICA of the dACA are exceptionally rare. Mechanical vessel wall injury and aneurysm formation of the dACA in blunt head trauma is very likely due to the proximity of the dACA with the rigid free edge of the falx. Given their nature as dissecting (complex) aneurysm, trapping and revascularization is a very important strategy. The interhemispheric cistern offers multiple revascularization options with its numerous donor vessels. The IC-IC bypass is often the simplest revascularization construct.

Efficacy of pipeline endovascular device and Willis stent graft in the treatment of traumatic pseudo intracranial aneurysms

ObjectiveTo investigate the advantages and effects of pipeline embolization device (PED) or Willis stent, in treating traumatic pseudoaneurysms. Traumatic pseudo intracranial aneurysms (TPIA) can be caused by either direct trauma or iatrogenic injuries, usually caused by direct arterial wall injury or shear due to acceleration. We describe a series of patients with TPIA who received a PED or Willis stent. Materials and methodsRetrospective analysis was performed on nine patients with TPIA admitted to the southern hospital of Southern Medical University from December 2017 to June 2019, of whom four were treated with PED and five were implanted with six Willis covered stents. The occlusive rate and complication in the two kinds of stents were compared by postoperative follow-up and modified rankin score (MRS). ResultsAfter the implantation of PED, four patients showed an immediate stagnation of blood flow or a decreased filling in aneurysms, three out of four patients exhibited complete occlusion, and the remaining patient had nearly complete occlusion. Four out of five cases of Willis stent implantation were associated with immediate complete occlusion of aneurysms, and the modified rankin score of these patients ranged from 0 to 1. One patient died of unassociated complications. ConclusionFor different types of TPIA in the internal carotid artery (ICA), PED and Willis stents provide significant advantages in treatment, with fewer postoperative complications and prognosis well.

Traumatic distal anterior cerebral artery aneurysm in a 3-year-old child: An uncommon but notable case

Aneurysm in paediatric population is a relatively less reported vascular pathology. In contrary to degenerative and dysplastic causes as in their adult counterpart, the mechanism lies either in a congenital defect in vessel wall or following some traumatic event. Traumatic intracranial aneurysms (TICA) are again not a common occurrence. TICAs constitute <1% of all intracranial aneurysms. They can occur following blunt or penetrating head trauma and are more common in the paediatric population. Traumatic aneurysms are typically associated with an acute episode of delayed intracranial haemorrhage with an average time from initial trauma to aneurysm haemorrhage of approximately 21 days. The youngest case reported for a traumatic distal anterior cerebral artery (ACA) aneurysm is of a 6-week old child due to shaken baby syndrome. We report an interesting and rare case of a traumatic distal ACA aneurysm in a 3-year-old child.

Treatment of traumatic intracranial aneurysm: Experiences at a single center

ObjectiveTo report the treatment and outcome of traumatic intracranial aneurysm (TICA) cases at the Southwest Hospital, Army Medical University in China. Patients and methodsAll patients diagnosed with TICA at our institution from January 1, 1977, to October 31, 2018, and meeting the inclusion/exclusion criteria were included in the study. Cases were reported separately for those diagnosed before 1998 and those after 1998. ResultsA total of 25 patients were included in the study. Ten were diagnosed with TICA prior to 1998. Seven of these 10 patients were treated surgically with parent artery sacrificed, including aneurysmectomy, trapping, and bypass. The mean Glasgow Outcome Scale (GOS) score for the 7 patients with surgical treatment was 3.1. Three of the 10 patients died of severe complications, including intracranial infection, delayed bleeding, and deadly injury. After 1998, 15 patients were diagnosed with TICA. Thirteen presented with head trauma and two with iatrogenic TICA following ventricle drainage or sphenoid ridge meningioma resection. Thirteen were treated with endovascular treatment, including coil alone, glue, coil-associated glue, stent alone, stent-assisted coil embolization, one with clipping, and one with conservative treatment. The 13 patients with endovascular treatment achieved a mean GOS score of 4.5. Among the 13 patients, one died from intracranial infection, one suffered recurrence, and one had intraoperative rupture. ConclusionAlthough the treatment of TICA has traditionally been surgical, endovascular treatment with different techniques, such as endovascular patch, provides a valuable alternative. Currently, the flow diverter is a popular embolization device and may represent another valid treatment option for TICA.

A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment.

Gunshot injuries are the most common cause of penetrating brain injury (PBI) and carry a high morbidity and mortality. The incidence of PBI has increased over the last decade with an estimated 35,000 civilian deaths annually. Patients that survive to reach the hospital require rapid triage and imaging evaluation. CT findings in conjunction with the Glasgow Coma Scale are typically used to determine which patients are surgical candidates. Radiologists should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators, notably brainstem, bilateral hemispheric, multilobar, or transventricular injuries. Post-traumatic complications, including intracranial infections, cerebrospinal fluid leaks, traumatic intracranial aneurysms, intraventricular hemorrhage, dural venous sinus thrombus, and bullet fragment migration, also have specific imaging features and serious treatment implications. In this article, we review the initial imaging evaluation of penetrating brain injury using computed tomography with and without angiography. We also describe the imaging features of various post-traumatic complications and their treatment implications. Finally, we discuss the clinical and imaging parameters that serve as important prognostic indicators and the surgical management.

Surgical Treatment of Traumatic Intracranial Aneurysms: Experiences at a Single Center over 30 Years

Traumatic intracranial aneurysm (tIA) is rare and is associated with high rates of morbidity and mortality. We describe our experiences with tIA at our institution. We retrospectively reviewed records from patients who underwent treatment for tIA between January 1986 and December2015. Data from 5532 patients with cerebral aneurysms between January 1986 and December 2015 were reviewed. Of these, 13 cases (0.23%) were tIA. Most occurred after blunt brain trauma (12/13; 92%). The most common location was the distal anterior cerebral artery (7/13; 53%) followed by the internal carotid artery (5/13; 38%). One patient had a tIA in the distal middle cerebral artery. Delayed intracerebral hemorrhage was the major presentation at the time of aneurysmal rupture (70%). Most patients underwent surgical treatment (10/12; 83.3%), which included clipping (5/10), trapping (3/10), aneurysmal excision and bypass (1/10), and aneurysmal excision and coagulation (1/10). In 2 cases, tIA located in the internal carotid artery was treated with coil embolization and detachable balloon occlusion, respectively. Most patients had good recovery (5/12; 41.7%); 3 patients and 1 patient had moderate and severe disability, respectively; 1 patient was in a vegetative state; and 2 patients died. tIA is an uncommon complication of head trauma. tIA should be considered when unexpected new symptoms develop in patients with head trauma. Early diagnosis and prompt treatment could help to improve final clinical outcomes.

Spontaneous Resolution of a Traumatic Intracranial Aneurysm

Traumatic intracranial aneurysms are rare, and normally result from blunt or penetrating head traumas. Carotid angiography is considered the gold standard and reliable exam to detect this aneurysm. There are specific angiography features that mark the contrasts between a traumatic aneurysm and a common saccular aneurysm. Most authors agree that once the diagnosis is made, surgery is the ideal treatment. This article presents a case of a successful expectant treatment based on the clinical findings of the patient and combined with a constant evaluation of her case. The clinical findings depend on the location and direction of growth of the aneurysm. Traumatic aneurysms of the internal carotid artery (ICA) are unusual, and occur predominantly in the intracavernous portion of that vessel.

Subarachnoid haemorrhage secondary to traumatic intracranial aneurysm of the posterior cerebral circulation: case series and literature review.

BackgroundTo identify the clinical features, rebleed risk, timing and method of diagnosis, complications and outcome for subarachnoid haemorrhage (SAH) from traumatic intracranial aneurysm (TICA) of the posterior circulation. Subjects included 26 patients aged 3–54 (mean 24.8).MethodsCase series and literature search to identify all reported cases.ResultsIn our series, two of three cases were fatal as a result of rebleed, and one case had a good outcome with no deficit, following prompt diagnosis and embolisation. Our key findings from the literature review were: 30.7 % of patients were age 16 and under; 88 % had an acute drop in consciousness, 46 % in a delayed manner; the mean time to diagnosis was 7.5 days; initial cerebrovascular imaging was normal in 23 %; the rebleed rate was 23 %; 61 % required emergency diversion of cerebrospinal fluid; 11 % developed vasospasm requiring treatment; 19.2 % had deficits that rendered them unable to live independently. The mortality rate was 27 %.ConclusionsSAH from ruptured posterior circulation TICA is associated with significant morbidity and mortality. A high index of suspicion as well as prompt diagnosis, repeat imaging in selected cases, and treatment of any associated TICA can be crucial to a favourable outcome.

Blunt orbital injury causing traumatic intracranial aneurysm in a child.

Blunt orbital injury causing traumatic intracranial aneurysm in a child.