Intracerebral aneurysm rupture due to head trauma

• Published in: Forensic Science International. Reports Vol. 2; p. 100123
• Main Authors: Steinmann, Julia, Hartung, Benno, Bostelmann, Richard, Kaschner, Marius, Husien, Mohammed Ben, Karadag, Cihat, Li, Lan, Steiger, Hans-Jakob, Petridis, Athanasios K.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.12.2020; Elsevier
• Subjects: Aneurysm rupture; Subarachnoid hemorrhage; Traumatic brain injury; Subarachnoid hemorrhage; Aneurysm rupture; Traumatic brain injury
• ISSN: 2665-9107; 2665-9107
• DOI: 10.1016/j.fsir.2020.100123

Intracranial aneurysms are known to rupture spontaneously in the absence of exogenous stimuli. Physical exercise or stress situations, with their accompanying rise in blood pressure, are often associated with aneurysm rupture. Very few cases reported in the literature show a suspected correlation of aneurysm rupture, aneurysm formation, or both with traumatic head injury. In most cases reported in the literature, a diagnosis of ruptured aneurysm is made only at postmortem examination, which explains why these cases are published in forensic medicine journals. We present a case of a 36-year-old male patient with ruptured aneurysm of the left posterior inferior cerebellar artery (PICA) in the context with head trauma, allegedly under the influence of alcohol. The initial native computed tomography (CT) scan of the patient showed blood pattern, which was atypical for traumatic subarachnoid hemorrhage (SAH) and typical for aneurysmal SAH. The CT-Angiography was inconclusive. Conventional angiography was performed and the PICA aneurysm was diagnosed. Trapping of the aneurysm with PICA-PICA side to side anastomosis was performed. The patient was discharged 21 days after admission without neurological deficits. In conclusion, even in cases of obvious head trauma, patients should undergo further diagnostic testing, when CT imaging reveals a blood pattern, which is typical for aneurysmal SAH.