female with unequal pupils, history of congenital heart disease and endocarditis

Ruptured pseudoaneurysm

Ruptured pseudoaneurysm

 

Ruptured pseudoaneurysm

Discussion

 

Findings

– Large acute subdural hematoma
– Subarachnoid hemorrhage
– Uncal and subfalcine herniation
– Lobular contrast collection

Differential

– Ruptured pseudoaneurysm, likely mycotic
– Ruptured aneurysm
– Arteriovenous malformation
– Trauma
– Nonaccidental trauma

 

Ruptured pseudoaneurysm

• Focally dilated arterial segment, not contained by all layers of the arterial wall
• Causes
– Trauma
– Infection (endocarditis in this case)
– Inflammation
• Atypical location
• Irregularly shaped
• Very rarely result in acute subdural hematoma
– Arachnoid tear may be adherent to aneurysm
– Jet effect may tear arachnoid

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