Internal Carotid Artery Dissection with Traumatic Pseudoaneurysm Formation after Penetrating Head Injury

Traumatic pseudoaneurysm of the intracranial arteries is a devastating event leading to high mortality. Its prevalence is rare, and associated with blunt or penetrating head injuries. Here, we describe a case of a 46-year-old woman who was transferred to our hospital following a stab-induced head trauma. Owing to multiple assaults by a sharp knife, the patient presented with an injured intracranial internal carotid artery that formed dissecting pseudoaneurysms. Stupor mentality was noted, and brain computed tomography revealed traumatic subarachnoid hemorrhage, and intracerebral hemorrhage in a “knife shape”. Diagnostic angiography showed an active extravasation in the middle cerebral artery and distal internal carotid artery with two pseudoaneurysms. Immediate trapping was planned, and embolization was performed with detachable coils. The patient was transferred to the operation room and emergent decompressive craniectomy with wide durotomy was performed. Unfortunately, the patient expired few days after the operation despite maximal neurocritical care.