Iatrogenic Pseudoaneurysm-Associated Cerebral Hemorrhage: A Rare Complication of Burr Hole Drainage – A Case Report

Background Non-traumatic intracranial hemorrhage most commonly occurs due to hypertension and is treated nonoperatively. Iatrogenic pseudoaneurysm from prior neurosurgical therapy represents a rarely described etiology for intracranial hemorrhage that may require emergent surgical therapy. Case Report An elderly female patient was brought to the ED with fatigue but no recent trauma. Subsequent computed tomography of the brain discovered right sided intraparenchymal hematoma. Prior history included burr-hole drainage of subdural hematoma near the site, so additional imaging was performed which demonstrated arteriovenous malformation, later discovered on operative findings to be pseudoaneurysm, as the cause of the current bleeding episode. Why should an emergency physician be aware of this?: Awareness of prior neurosurgical treatment, even including minor procedures, in patients with apparent spontaneous intracranial bleeding should prompt angiographic evaluation for arteriovenous malformation. If found, these lesions are more likely to benefit from surgical treatment.