Traumatic enucleation with avulsion of the ophthalmic artery resulting in aneurysm-like subarachnoid hemorrhage.

Full Abstract

Traumatic, nonaneurysmal subarachnoid hemorrhage (SAH) is common after closed head injury and most often results from ruptured cortical microvessels. Here, the authors present the case of a 60-year-old woman who fell and struck her head, causing traumatic enucleation and avulsion of both the optic nerve and ophthalmic artery. The arterial avulsion caused a Fisher Grade 3 SAH. During her stay in the intensive care unit, hydrocephalus and vasospasm developed, clinical conditions commonly observed after aneurysmal SAH. Epileptiform activity also developed, although this may have been related to concurrent Pantoea agglomerans ventriculitis. It is reasonable to suggest that intracerebral arterial avulsion with profuse arterial bleeding may be more likely than traditional traumatic SAH to result in clinical events similar to that of aneurysmal SAH. Special consideration should be given to the acute care of patients with intracranial arterial avulsions (conservative management vs surgical exploration or endovascular treatment), as well as long-term follow-up for vascular or other neurosurgical complications.

Author information

Author/s: Limbrick, David D (DD); Behdad, Amir (A); Derdeyn, Colin P (CP); Custer, Phillip L (PL); Zipfel, Gregory J (GJ); Santiago, Paul (P);

Affiliation: Department of Neurosurgery, Washington University in St. Louis, School of Medicine, St. Louis, Missouri 63110, USA. limbrickd(-atsign-)nsurg.wustl.edu

Journal and publication information

Publication Type: Case Reports; Journal Article

Journal: Journal of neurosurgery (J Neurosurg), published in United States. (Language: eng)

Reference: 2009-Oct; vol 111 (issue 4) : pp 653-7

Dates: Created 2009/10/02; Completed 2009/10/23;

PMID: 19374504, status: MEDLINE (last retrieval date: 10/23/2009, IMS Date: )

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