Traumatic extracranial pseudoaneurysm on the peripheral ophthalmic artery presenting as delayed intraparenchymal hematoma: case report.
BACKGROUND
Extracranial pseudoaneurysm is barely noticed after head injury, and therefore, recognizing such sequels is amenable when there is severe initial injury, unexplained intracranial bleeding, or neurologic sequelae. We report such an unexpected case of intraorbital pseudoaneurysm presenting as delayed intraparenchymal hemorrhage.


METHODS
A 71-year-old man with traumatic brain injury sustained delayed intraparenchymal hemorrhage after unremarkable surgical evacuation. Suspicious intraorbital mass was shown adjacent to the fracture line of medial orbital wall. Catheter angiogram revealed peripheral, extracranial ophthalmic artery pseudoaneurysm, and endovascular occlusion was attempted. The patient made gradual recovery with radiographic evidence of disappeared pseudosac and resolved intracranial hematoma.


CONCLUSIONS
Traumatic aneurysm of peripheral ophthalmic artery should be strongly suspected when there is skull fracture at the orbital wall or persistent or delayed intraparenchymal hemorrhage despite proper surgical hematoma evacuation, and in such case, swift endovascular occlusion can be done safely.
Chun
Hyoung-Joon
HJ
Department of Neurosurgery, Hanyang University Medical Center, Seoul 133-792, South Korea.
Yi
Hyeong-Joong
HJ
D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D020202:Cerebral Hemorrhage, Traumatic / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D009880:Ophthalmic Artery; D012887:Skull Fractures / Q000150:complications* / Q000175:diagnosis / Q000601:surgery