title: Ruptured pseudoaneurysm of the middle meningeal artery presenting with a temporal lobe hematoma and a contralateral subdural hematoma.
abstract: BACKGROUND
  Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare, associated with skull fractures, and have a high mortality rate. When they rupture, MMA pseudoaneurysms frequently cause epidural hematomas and occasionally ipsilateral subdural or subarachnoid hemorrhage. Isolated intraparenchymal hemorrhage has also been reported.
  
  
  METHODS
  A 54-year-old female who suffered a loss of consciousness resulting in a fall presented with a Glasgow Coma Scale of 7t. Imaging demonstrated a right subdural hematoma (SDH) with midline shift, left skull fracture overlying the left MMA, and left temporal lobe intraparenchymal hematoma extending to the surface. The patient underwent a right craniectomy with evacuation of the SDH, and the preoperative computed tomographic angiography revealed abnormal dilation of the left MMA consistent with a pseudoaneurysm. The pseudoaneurysm was treated with endovascular treatment, and the intraparenchymal hematoma was treated conservatively. Her recovery was uneventful, and she received a cranioplasty 3 months after the decompression.
  
  
  CONCLUSIONS
  The presence of a fracture over the MMA and intraparenchymal hematoma should prompt suspicion for a traumatic pseudoaneurysm. Pseudoaneurysms of the MMA can cause catastrophic bleeding, and prompt treatment is necessary. Endovascular embolization is an effective method that decreases the hemorrhage risk of MMA pseudoaneurysms.
authors: Department of Neurosurgery, St. Louis University, St. Louis, Missouri, USA.
authors: Eric
authors: E
authors: Marvin
authors: Department of Neurosurgery, St. Louis University, St. Louis, Missouri, USA.
authors: Lindsay Hilken
authors: LH
authors: Laws
authors: Department of Neurosurgery, St. Louis University, St. Louis, Missouri, USA.
authors: Jeroen Raymond
authors: JR
authors: Coppens
keywords: Intraparenchymal hemorrhage; subdural hematoma; traumatic pseudoaneurysm