A Case of Ruptured Carotid Traumatic Blood Blister-like Aneurysm

• Published in: NMC Case Report Journal 2023/12/31, Vol.10, pp.259-263
• Main Authors: MATSUMOTO, Yoshiyuki, NAKAE, Ryuta, MATANO, Fumihiro, KUBOTA, Asami, MORITA, Akio, MURAI, Yasuo, YOKOBORI, Shoji
• Format: Article
• Language: English
• Subjects: carotid artery injuries; Case Report; extracranial-intracranial arterial bypass; intracranial aneurysm; rupture; traumatic brain injury
• ISSN: 2188-4226; 2188-4226
• DOI: 10.2176/jns-nmc.2023-0088

Ruptured cerebral aneurysms that occur in the anterior wall of the internal carotid artery (ICA) are known as blood blister-like aneurysms (BBAs); they have been reported to account for 0.3% to 1% of all ruptured ICA aneurysms. In this report, we describe the treatment of an unusual traumatic BBA (tBBA) with high-flow bypass using a radial artery graft, which resulted in a favorable outcome. A 59-year-old female suffered from an acute epidural hematoma, traumatic subarachnoid hemorrhage, and traumatic carotid-cavernous sinus fistula (tCCF) after being involved in a motor vehicle accident. Her angiography results showed tCCF and a tBBA on the anterior wall of the right ICA. On the fourth day after injury, we found rebleeding from the tBBA and performed an emergency high-flow bypass using a radial artery graft with lesion trapping as a curative procedure for the tCCF and tBBA. Postoperatively, right abducens nerve palsy appeared, but no other neurological symptoms were noted; the patient was thereafter transferred to a rehabilitation hospital 49 days after injury. Traumatic ICA aneurysms commonly occur close to the anterior clinoid process, form within 1 to 2 weeks of injury, and often rupture around 2 weeks after trauma. This case was considered rare as the ICA was likely injured and bleeding at the time of injury, resulting in a form of tBBA; this allowed early detection and appropriate treatment that resulted in a good outcome.