The Diffuse and Severe Traumatic Subarachnoid Hemorrhage Being Hard to Distinguish to Aneurysmal Subarachnoid Hemorrhage
| Autor: | Nobuhiko Arai, Makoto Inaba, Hiroshi Kagami, Yutaka Mine |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Middle Cerebral Artery medicine.medical_specialty Subarachnoid hemorrhage Middle meningeal artery Diagnosis Differential 03 medical and health sciences Subarachnoid Hemorrhage Traumatic 0302 clinical medicine medicine.artery medicine Hematoma Subdural Acute Humans cardiovascular diseases 030223 otorhinolaryngology Aged Computed tomography angiography Intracerebral hemorrhage medicine.diagnostic_test business.industry 030206 dentistry General Medicine medicine.disease Aneurysm Cerebral Angiography Otorhinolaryngology Middle cerebral artery Angiography Surgery Radiology Internal carotid artery Tomography X-Ray Computed business Carotid Artery Internal Cerebral angiography |
| Zdroj: | Journal of Craniofacial Surgery. 30:196-199 |
| ISSN: | 1049-2275 |
| DOI: | 10.1097/scs.0000000000004908 |
| Popis: | Background In primary intracerebral hemorrhage, several studies showed that contrast extravasation (CEV) is reported to be an indicator of delayed hematoma expansion, emergent hematoma removal and poor prognosis. On the contrary in head trauma, few researches validated the effectiveness of CEV because of other influences such as subarachnoid hemorrhage (SAH), contusion or brain swelling. The authors experienced a patient showing diffuse SAH caused by traumatic mechanism with acute subdural hematoma (ASDH). In the angiography, a notable rare image of CEV was found and emergency operation mainly to cease the bleeding points was performed. Patient presentation A 70-year-old man was found being comatose and brought to emergency room. Computed tomography (CT) revealed diffuse SAH with left ASDH. Computed tomography angiography (CTA) also did not clarify any abnormal vessel structure except for slightly dilatation at the part of internal carotid artery, suggesting tiny ruptured aneurysm. The authors performed a cerebral angiography and resulted in no aneurysm or arteriovenous shunt detection but revealed the extravasation from middle cerebral artery and middle meningeal artery. Follow-up CT revealed increased left ASDH though 5 hours have already elapsed. The authors performed surgical intervention to halt the bleeding. Conclusion The authors experienced a notably rare image of the extravasation from middle cerebral artery and middle meningeal artery in the cerebral angiography. When an obscure arterial abnormality is suspected on CTA for the unknown origin SAH with ASDH, the authors may have an affirmative attitude toward performing conventional cerebral angiography, which is most promising modality to detect the source of bleeding including CEV. |
| Databáze: | OpenAIRE |
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