A Patient with a Pseudoaneurysm of the Middle Meningeal Artery Who Developed Intracerebral Hemorrhage during Conservative Treatment for Traumatic Subarachnoid Hemorrhage

Objective: We report a 73-year-old male in whom a traumatic pseudoaneurysm of the middle meningeal artery (PMMA) increased during conservative treatment for traumatic subarachnoid hemorrhage, an acute subdural hematoma, and brain contusion, leading to intracerebral hemorrhage related to its rupture. Case Presentation: During decommissioning operations, he fell down from the bed of a truck, and was brought to our hospital by ambulance. Head CT revealed traumatic subarachnoid hemorrhage, left acute subdural hematoma, and brain contusion. Conservative treatment was performed. Left temporal lobe hemorrhage related to the rupture of a traumatic pseudoaneurysm of the left middle meningeal artery (MMA) was observed 20 days after onset. Emergency endovascular treatment and hematoma removal under craniotomy were conducted. Conclusion: In cases of subarachnoid hemorrhage after head trauma, serial changes should be assessed using CTA and DSA, considering the possibility of a traumatic PMMA.