{"id":"701acba7-23b8-40a7-8d57-bd90df1c9e3a","slug":"ruptured-pseudoaneurysm-of-the-middle-meningeal-artery-presenting-with-a-temporal-lobe-hematoma-and-a-contralateral-subdural-hematoma","title":"Ruptured pseudoaneurysm of the middle meningeal artery presenting with a temporal lobe hematoma and a contralateral subdural hematoma","authors":["Eric Marvin","Lindsay Hilken Laws","Jeroen Raymond Coppens"],"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. Case Description: 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.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/701acba7-23b8-40a7-8d57-bd90df1c9e3a/featured/hero-1782420946852.png","publishDate":"2016-01-07T00:00:00.000Z","doi":"10.4103/2152-7806.173564","categories":["Neurovascular","Case Report"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2016/01/6426/SNI-7-23.pdf"}