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Medical Science Monitor Basic Research


Delayed Spontaneous Resolution of a Traumatic Middle Meningeal Artery Pseudoaneurysm

Jaime L. Atiles, Amanda P. Marrero-González, Eduardo J. Labat

Puerto Rico Department of Diagnostic Radiology, University of Puerto Rico – School of Medicine, San Juan, Puerto Rico

Am J Case Rep 2021; 22:e926852 :: DOI: 10.12659/AJCR.926852

Available online: 2021-02-11, In Press, Corrected Proof

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The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


BACKGROUND Middle meningeal artery (MMA) aneurysms are a very rare entity, comprising less than 1% of all intracranial aneurysms. In particular, traumatic MMA pseudoaneurysms (MMAP) are reported in the literature to have a poor outcome in about 20% of cases. Moreover, in extremely rare cases, MMAPs can spontaneously thrombose.
CASE REPORT We present the case of a 42-year-old Hispanic man with multiple craniofacial hemangiomas and history of chronic migraines that increased in frequency after blunt head trauma 1 month prior to initial evaluation. CTA and brain MRI showed a right-sided MMAP adjacent to the foramen spinosum with a pan-hemispheric subdural hematoma and no associated skull fractures. The MMAP was not visualized 2 days later on digital subtraction angiography (DSA) and was therefore presumed to be thrombosed. CTA at 3 months showed interval progression of the MMAP with subsequent spontaneous resolution on CTA at 10 months.
CONCLUSIONS Knowledge regarding MMAPs is limited since it is based on a small number of cases and literature reviews. Additional studies are needed to elucidate the true incidence and natural course of this entity and produce adequate treatment guidelines.

Keywords: Aneurysm, False; Angiography, Digital Subtraction; Craniocerebral Trauma; Intracranial Aneurysm; Meningeal Arteries