1129. Intraparenchymal Hematoma: Rare presentation of Traumatic Ruptured Middle Meningeal Artery Pseudoaneurysm

Authors: Anvesh Balabhadra (Hyderabad, India)

Introduction: Traumatic Pseudoaneurysms of the Middle Meningeal Artery (MMA) are very rare. Traumatic pseudoaneurysms make up for less than 1% of all intracranial aneurysms. The most common presentation is an epidural haematoma, but it can also cause a subdural or subarachnoid hemorrhage. However, an Intraparenchymal hematoma due to a traumatic pseudoaneurysm is extremely rare. Methods: A case report of a MMA pseudoaneurysm presenting as an Intraparenchymal Hematoma Case Description: 46 y/o Male, presented with altered sensorium after a road traffic accident. On examination, GCS was E1V2M5 and vitals were stable. CT brain showed showed a left posterior temporal hematoma with an overlying temporal bone fracture and bifrontal and right temporal contusion. Due to an atypical location of the temporal hematoma, he further underwent an MRI brain with an MRV and an MRA. MRA revealed a pseudoaneurysm of the Left MMA with a hematoma originating from the same. CT Angio confirmed the presence of a pseudoaneurysm of the left MMA with an overling temporal bone fracture. The patient also had thrombocytopenia, secondary to Idiopathic Thrombocytopenic Purpura. He later underwent endovascular occlusion of the left MMA and made a good recovery post- procedure. Conclusion: Intraparenchymal hematoma secondary to a ruptured MMA pseudoaneursym have poor outcomes without early diagnosis and intervention. Atypical location of the hematoma, overlying temporal bone fracture, proximity of the fracture to the MMA and in cases where mechanism of injury doesn’t correlate with location of the hematoma should arouse the suspicion of this rare entity. Both surgical and endovascular approaches yield good outcomes. Early detection and treatment is the key for the best.