[Hemiparesis as a sequela of traumatic pseudoaneurysm of the carotid bifurcation].
METHODS
A 20-year-old patient was referred to our clinic after sudden onset of a left-sided hemiparesis. His past history revealed a severe trauma 4 years ago, including multiple bone fractures, rupture of the spleen, as well as renal failure, and an acute respiratory distress syndrome, from which he showed good recovery. At that time no central-nervous symptoms could be found. However, eighteen months ago, he complained about a transient weakness of his left arm and leg.


METHODS
Examination of the cerebral arteries by duplex-sonography showed an aneurysm on the bifurcation of the right carotid artery with a peripheral flow-reduction. This could be confirmed by CT- and MR-based angiography, which also revealed a reopened embolic occlusion of the M1-segment of the right middle cerebral artery. On CT and diffusion weighted imaging there was evidence of an ischemic infarction pattern.


METHODS
Under anticoagulation therapy with heparin the patient showed complete recovery from his symptoms. Duplex-sonography as well as MR-angiography documented a complete reopening of the primarily occluded middle cerebral artery. Finally, surgical reconstruction of the aneurysmatic part of the vessel was done.


CONCLUSIONS
This case illustrates the potential risk of a traumatic aneurysm as a potential source of ischemic brain infarctions. We emphasize the importance of imaging the cerebral arteries in traumatic patients, even in the absence of initial neurological symptom.
Cornelius
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Neurologische Klinik, Universität Heidelberg am Universitätsklinikum Mannheim.
Ries
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Sommer
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Schwartz
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D000328:Adult; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis; D008297:Male; D010291:Paresis / Q000209:etiology*