Ruptured traumatic pseudoaneurysm of the middle meningeal artery presenting delayed intracerebral hematoma

Abstract

  Pseudoaneurysms of the middle meningeal artery (PMMAs) are rare and usually present an epidural hematoma. We report an extremely rare case of PMMA that developed a delayed intracerebral hematoma (ICH). The 94‒year‒old Japanese male patient, who had been in a traffic accident, recovered well after the conservative therapy, but on the 12th day after his admission, he suddenly deteriorated with loss of consciousness and anisocoria. Head CT demonstrated an ICH in the right temporal lobe with intraventricular hemorrhage. CT angiography revealed an aneurysm of the MMA underneath the temporal bone fracture. He underwent an emergency craniotomy for the removal of the ICH. The intraoperative and pathological findings were consistent with PMMA. We have identified only five prior cases of delayed ICH caused by a PMMA. Most of the prior PMMAs are associated with an ipsilateral temporal rim fracture. Clinicians should be aware PMMA is one of the causes of delayed ICH after head trauma.