Acute intraparenchymal hemorrhage caused by rupture of a traumatic pseudoaneurysm of the middle meningeal artery: A case report

Background: Traumatic pseudoaneurysm of the middle meningeal artery (TPMMA) is uncommon. Intraparenchymal hemorrhage (IPH) caused by rupture of a TPMMA is extremely rare. Such ruptures are associated with high mortality, so an early diagnosis of this risky condition is recommended. We report a case of TPMMA giving rise to an acute IPH. Case description: A 60-year-old man suffered an IPH after a head injury. Computed tomography revealed a large hematoma in the right temporal lobe, small epidural hemorrhage in the right temporal area, and a small cerebral contusion in right frontal lobe. External carotid angiogram also demonstrated a suspicious TPMMA in right side, which was treated successfully by surgery. We observed rapid epidural bleeding from the base of the temporal bone during bone removal and a 2 cm linear dural tear beneath a temporal skull fracture. And we identified that the TPMMA was connected to the IPH via the dural tear. These findings indicate one mechanism for an acute IPH development caused by a TPMMA. Conclusion: Acute IPH caused by rupture of a TPMMA is rare. A rupture of TPMMA contacted with dural tear could cause IPH via this dural defect. Clinicians should suspect this clinical manifestation, which can be an emergency.