Abstract
Introduction: Traumatic cerebral aneurysm can complicate severe head injury and has a high mortality rate. This report presents a case in which aneurysm coil embolization and two instances of therapeutic hypothermia were effective for treating traumatic pericallosal aneurysm rupture after severe head injury.
Case: A 33-year-old woman was admitted with a Glasgow Coma Scale score of 6 (E1V1M4) following severe head injury. Bilateral decompressive craniectomy was performed and subdural and epidural hematomas were removed under therapeutic hypothermia at 34°C. Her level of consciousness gradually improved. However, following seizures on day 17 after injury, three-dimensional computed tomography angiography revealed a falx subdural hematoma, severe brain swelling, and a right pericallosal artery aneurysm. Considering the brain swelling, coil embolization was performed. The patient was again placed under therapeutic hypothermia therapy and intracranial pressure and cerebral perfusion pressure were controllable. On day 64 after injury, the patient was able to walk and eat independently.
Conclusion: Coil embolization during a second craniectomy under a second instance of therapeutic hypothermia achieved a good outcome. It is necessary to consider a combined modality therapy such as craniotomy and intensive care strategies in cases of severe head injury complicated by aneurysm rupture.
