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Delayed Spontaneous Resolution of a Traumatic Middle Meningeal Artery Pseudoaneurysm

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

(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


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

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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