Traumatic aneurysm of the cortical middle cerebral artery

Description

A right-handed man aged 79 years presented with increasing confusion following a mechanical fall with head strike 2 weeks prior. CT demonstrated a left frontoparietal convexity subacute subdural haematoma (SDH) measuring 3 mm in depth and with 5 mm of midline shift to the right (figure 1). There was no skull fracture. Initial examination revealed no localising neurological deficit and he was admitted for observation. On day 3, the patient developed intermittent episodes of right-sided weakness and expressive dysphasia. Contrast MRI showed expansion of the SDH to 10 mm in thickness, and also demonstrated a 9 mm vividly enhancing focus within the haematoma overlying the frontal lobe (figure 2). The lesion enhanced on the arterial and venous phases of contrast CT (figure 3). Digital subtraction angiography demonstrated the lesion to be a 6 mm sidewall aneurysm of the cortical middle cerebral artery (MCA) (figure...

http://ift.tt/2m6WPKD