Middle Meningeal Haemorrhage Demonstrated Angiographically

Abstract

Haemorrhage from the middle meningeal artery is a surgical emergency which does not usually call for examination by carotid arteriography. Head injury followed by deepening unconsciousness (with or without a lucid interval), the onset of hemiplegia, the falling pulse rate, and the eye signs are the well known features of a clinical picture which calls for immediate craniotomy. Occasionally, the case history is unusual and, with the increasing tendency to utilise carotid arteriography in patients suffering from head injuries, extra-dural haematomata are demonstrated by the resulting vascular displacement. The actual demonstration by angiography of the haemorrhage occurring from the middle meningeal artery must be a very rare occurrence. The author has only been able to find one example in the literature (Jamieson, 1952). The following case history and arteriographic studies of a patient suffering from haemorrhage from the posterior branch of the right middle meningeal artery is presented. The bleeding point was demonstrated by carotid arteriography, together with radiological evidence of a large extra-dural haematoma. A female, aged 70 years, had suffered a cerebral vascular accident one year previously with a resulting right-sided hemiplegia from which she had only partially recovered. During the previous year there were five attacks of temporary unconsciousness, followed by a period of disorientation. During the last attack, the patient had fallen out of bed, being rendered unconscious.