Pseudoaneurysm Resulting in Rebleeding After Evacuation of Spontaneous Intracerebral Hemorrhage.
Aneurysm, False
/ complications
Cerebral Angiography
Cerebral Hemorrhage
/ surgery
Decompressive Craniectomy
Drainage
Endovascular Procedures
Hematoma
/ surgery
Humans
Male
Middle Aged
Middle Cerebral Artery
/ diagnostic imaging
Postoperative Complications
/ diagnostic imaging
Postoperative Hemorrhage
/ diagnostic imaging
Recurrence
Embolization
Intracerebral hemorrhage
Pseudoaneurysm
Rebleeding
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
15
06
2020
revised:
12
07
2020
accepted:
13
07
2020
pubmed:
24
7
2020
medline:
20
4
2021
entrez:
24
7
2020
Statut:
ppublish
Résumé
Spontaneous intracerebral hemorrhage (ICH) is a devastating cerebrovascular disease with high morbidity and mortality. Branching pattern of the lenticulostriate arteries from the middle cerebral artery makes them susceptible to formation of microaneurysms, which have been implicated in hypertensive ICH. Recurrence of hematoma due to delayed development of pseudoaneurysm after initial surgical evacuation is uncommon. Our patient is a 61-year-old gentleman who underwent primary evacuation of a spontaneous right-sided ICH. The initial vascular imaging was unremarkable for any underlying vascular malformation. After initial neurologic recovery, the patient developed another rebleeding in the hematoma cavity nearly 10 days after presentation. A formal angiogram showed the presence of a pseudoaneurysm that was treated via endovascular means. The rates of rebleeding have ranged from 10%-40% in various studies and have been directly correlated with mortality. Since follow-up with angiograms are not a usual practice in spontaneous ICH management, such as pseudoaneurysmal rebleeds could go undiagnosed. This case report reinforces the need for a thorough angiographic evaluation in the event of a deviation from expected clinical course, rebleeding not in concordance with intraoperative findings and significantly delayed hematoma recurrence.
Sections du résumé
BACKGROUND
Spontaneous intracerebral hemorrhage (ICH) is a devastating cerebrovascular disease with high morbidity and mortality. Branching pattern of the lenticulostriate arteries from the middle cerebral artery makes them susceptible to formation of microaneurysms, which have been implicated in hypertensive ICH. Recurrence of hematoma due to delayed development of pseudoaneurysm after initial surgical evacuation is uncommon.
CASE DESCRIPTION
Our patient is a 61-year-old gentleman who underwent primary evacuation of a spontaneous right-sided ICH. The initial vascular imaging was unremarkable for any underlying vascular malformation. After initial neurologic recovery, the patient developed another rebleeding in the hematoma cavity nearly 10 days after presentation. A formal angiogram showed the presence of a pseudoaneurysm that was treated via endovascular means.
CONCLUSIONS
The rates of rebleeding have ranged from 10%-40% in various studies and have been directly correlated with mortality. Since follow-up with angiograms are not a usual practice in spontaneous ICH management, such as pseudoaneurysmal rebleeds could go undiagnosed. This case report reinforces the need for a thorough angiographic evaluation in the event of a deviation from expected clinical course, rebleeding not in concordance with intraoperative findings and significantly delayed hematoma recurrence.
Identifiants
pubmed: 32702497
pii: S1878-8750(20)31609-0
doi: 10.1016/j.wneu.2020.07.088
pii:
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
1-6Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.