Traumatic extracranial pseudoaneurysm on the peripheral ophthalmic artery presenting as delayed intraparenchymal hematoma: case report

Abstract 

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.

Case Description

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.

Conclusion

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.

Abbreviations: CT, computed tomography, POD, postoperative day

Keywords: Delayed intraparenchymal hemorrhage, Peripheral ophthalmic artery, Pseudoaneurysm, Skull fracture, Traumatic brain injury