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Demonstration of Traumatic Subarachnoid Hemorrhage from the Anterior Choroidal Artery |
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| Authors: | Ki-Bum Sim Sukh Que Park H Alex Choi Daniel H Kim |
| Institution: | 1Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea.;2Department of Neurosurgery, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, Seoul, Korea.;3Department of Neurosurgery and Neurology, University of Texas Medical School at Houston, Houston, TX, USA.;4Department of Neurosurgery, University of Texas Medical School at Houston, Houston, TX, USA. |
| Abstract: | We present a case of angiographically confirmed transection of the cisternal segment of the anterior choroidal artery (AChA) associated with a severe head trauma in a 15-year old boy. The initial brain computed tomography scan revealed a diffuse subarachnoid hemorrhage (SAH) and pneumocephalus with multiple skull fractures. Subsequent cerebral angiography clearly demonstrated a complete transection of the AChA at its origin with a massive extravasation of contrast medium as a jet trajectory creating a plume. We speculate that severe blunt traumatic force stretched and tore the left AChA between the internal carotid artery and the optic tract. In a simulation of the patient''s brain using a fresh-frozen male cadaver, the AChA is shown to be vulnerable to stretching injury as the ipsilateral optic tract is retracted. We conclude that the arterial injury like an AChA rupture should be considered in the differential diagnosis of severe traumatic SAH. |
| Keywords: | Traumatic subarachnoid hemorrhage Anterior choroidal artery Transection Angiography Cadaver |