Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Traumatic Pericallosal Artery Dissection
- Background:
- Posttraumatic intracranial aneurysms are uncommon, representing less than 1% of all cerebral aneurysms. They are usually associated with severe head trauma, but have also been reported following minor trauma.
- Accounts of pseudoaneurysms associated with pericallosal artery dissection are rare. They are theoretically due to the shearing force against the lower margin of the falx cerebri. Their formation can be late, up to 4 weeks after the initial trauma.
- Clinical Presentation:
- Clinical presentation can be variable, depending on the severity of the trauma and coexistent traumatic lesions.
- Key Diagnostic Features:
- History of minor or major head trauma with immediate or delayed interhemispheric cerebral hemorrhage and typical associated angiographic findings
- Differential Diagnoses:
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Traumatic brain contusion
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Primary brain infarct with hemorrhagic transformation
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Primary parenchymal hemorrhage with surrounding edema
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Primary ruptured aneurysm of the pericallosal artery and associated edema
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Glioma of the corpus callosum with associated bleeding
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These hypotheses could be raised in the initial diagnostic formulation. However, it is an atypical location for 1, 2, and 3; there is a disproportion between the hematoma size and the neighboring edema for 3; restricted diffusion and angiographic findings exclude 1, 2, 3, 4, and 5.
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- Treatment:
- The best treatment is still debatable.
- Unlike extracranial dissections—and despite the coexisting artery occlusion and parenchymal infarct—antithrombotic therapy is discouraged owing to the risk of precocious or delayed pseudoaneurysmatic hemorrhage.
- While some authors favor surgical or endovascular intervention to exclude the aneurysm, these approaches are difficult and risk-benefit has to be evaluated on a case-by-case basis.
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