P97 Post-traumatic bilateral pseudoaneurysms of the middle meningeal artery: case report

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A 67-year-old male with no relevant medical history who was brought to the emergency room after he was found by a companion with a right temporal and orbital trauma. In the neurological examination, he was somnolent, disoriented in time and space, with isochoric normoreactive, retrograde amnesia of the event, without motor deficit. Simple cranial computed tomography (CT) scan: fracture of the squamous portion of the temporal bone, right frontotemporal SAH and temporal intraparenchymal hemorrhage. Digital subtraction angiography, pseudoaneurysm of the right middle meningeal artery (direct trauma). Endovascular embolization treatment was performed with two coils (7mm x 30cm Concerto Helix Coil and 5mm x 15cm Concerto Helix Coil) for a 100% occlusion. A second pseudoaneurysm was found in the left MMA probably shear stress trauma. Endovascular embolization was performed of the second pseudoaneurysm with 21% Histoacryl for 100% occlusion. Conclusion MMA traumatic pseudoaneurysms are an infrequent pathology (<1% intracranial aneurysm) associated with head trauma. Bilateral pseudoaneurysms are even more uncommon. Because the natural history is under discussion and its mortality is high (20–25%) in case of rupture, it is important to perform an early diagnosis and timely treatment to prevent a catastrophic outcome.

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