Traumatic Subarachnoid Hemorrhage and Subdural Hematoma Due to Acute Rebleeding of a Pseudoaneurysm with Dural Arteriovenous Fistula Between Inferolateral Trunk of the Internal Carotid Artery and Middle Cerebral Vein.

Background: According to previous reports, pseudoaneurysms that are concomitant with a dural arteriovenous fistula (dAVF) are associated with penetrating trauma, blunt trauma, and skull fractures. Moreover, dAVFs between the inferolateral trunk of the internal carotid artery and middle cerebral vein are a rare disease manifestation. Pseudoaneurysms concomitant with dural arteriovenous fistulas (dAVF) are rare and traumatic pseudoaneurysms with dAVF typically developed slowly with less rebleeding than isolated traumatic aneurysms.

Case Description: Here, we report an extremely rare case of a traumatic pseudoaneurysm with a dAVF between the inferolateral trunk and middle cerebral vein. The traumatic pseudoaneurysm presented with acute pseudoaneurysm formation and rebleeding within 1 day of the trauma and was managed with direct surgery.

Conclusions: The traumatic pseudoaneurysm was completely obliterated by surgical clipping, followed by decompressive craniectomy and postoperative coma therapy with propofol. Resulting from these surgical and postoperative treatments, 56 days after the operation the patient recovered fully and did not present any neurologic deficits.