Rupture of a large ophthalmic segment saccular aneurysm associated with closed head injury: Case report

OBJECTIVE AND IMPORTANCE: Although each year approximately 30,000 to 50,000 cases of subarachnoid hemorrhage in the United States are caused by the ru pture of intracranial saccular aneurysms, there is little information in th e literature documenting the association of aneurysmal rupture with closed head injury. CLINICAL PRESENTATION: A 61-year-old woman presented after a motor vehicle accident with multiple injuries, including a severe closed head injury. Com puted tomography revealed a diffuse basal subarachnoid hemorrhage. Angiogra phy revealed the source as a large aneurysm arising from the ophthalmic seg ment of the left carotid artery. INTERVENTION: After the patient was stabilized for her multiple injuries, s he underwent craniotomy and clipping of the aneurysm. She recovered without developing new neurological deficits. CONCLUSION: Although the association of head trauma and aneurysmal subarach noid hemorrhage is rave, the presence of significant basal subarachnoid blo od on a computed tomographic scan should alert the physician to the possibi lity of a ruptured aneurysm.