What’s the diagnosis?
- Penetrating cerebrovascular injuries are rare events. Penetrating trauma can lacerate an intracranial artery forming a traumatic pseudoaneurysm. In a traumatic pseudoaneurysm, the aneurysm walls are actually formed by surrounding tissues and not vessel wall.
- Penetrating trauma mechanisms that lead to traumatic pseudoaneurysms are typically low velocity, such as stab wounds, as opposed to high velocity penetrating trauma (e.g., gun shot wounds).
What's your treatment plan?
In this case, because of the hemorrhage noted on the post nail removal CT head scan the patient immediately returned to the angiography suite. The distal right anterior cerebral artery, pericallosal segment, traumatic pseudoaneurysm was identified. A microcatheter was advanced into the right ACA and brought just proximal to the aneurysm. Onyx liquid embolization material was used to occlude the pericallosal vessel both distal and just proximal to the aneurysm, to eliminate the risk of further hemorrhage.
The microcatheter was advanced into the distal pericallosal branch and a gentle injection through the microcatheter was used to confirm its location just proximal to the traumatic pseudoaneurysm.