Introduction: Traumatic intracranial aneurysms (TICA) are rare in occurrence and equally rare in the literature. Less than 1% of intracranial aneurysms are caused by blunt trauma, while even fewer are caused by penetrating trauma. Penetrating trauma creates a unique type of aneurysm that does not incorporate all three vessel wall layers. Because of their rarity, the natural history and management of TICAs are not well defined in the literature. Here we present a case report of a gunshot wound to the head leading to multiple TICAs. A review of the current literature was performed with a discussion of potential TICA management.

Methods: A Pubmed search of the literature was performed with the search terms “penetrating brain injury,” “traumatic intracranial aneurysm,” “traumatic pseudoaneurysm,” “traumatic intracranial aneurysm management,” and “traumatic pseudoaneurysm management.” The literature was reviewed for case reports and management recommendations.

Results: Traumatic intracranial aneurysm formation is the most commonly described vascular injury after penetrating brain injury. Histologically, traumatic aneurysms can be described as true (incorporating intima, media, adventitia), false (incorporating one or two vessel wall layers), or mixed. False aneurysms, or pseudoaneurysms are the most common histologic type seen after penetrating brain injury. Of the penetrating injuries, stab wounds appear to be the mechanism with the highest incidence of aneurysm formation with one series finding 14.9% of patients with intracranial stab wounds developing aneurysms versus only 4% with projectile missile injuries.

Conclusions: There is scarce published data defining management of traumatic intracranial aneurysms. With a higher mortality and morbidity rate compared to congenital aneurysms, TICAs present a need for aggressive management in the acute setting. Medical intervention includes management of blood pressure to prevent rupture, control of intracranial hypertension, and prevention of vasospasm. Surgical intervention involves aneurysm occlusion via craniotomy with clipping or endovascular embolization via coiling or stenting.

Patient Care: This research will increase awareness of traumatic intracranial aneurysms and help readers better understand their management.

Learning Objectives: Identification of traumatic intracranial aneurysms Classification of traumatic intracranial aneurysms Treatment and management of traumatic intracranial aneurysms

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