• Patrick J Maher, Channing Hui, Francisco Brun, and Soren Singel.
• Department of Critical Care, O'Connor Hospital, San Jose, California. Electronic address: patrick.maher@mountsinai.org.
• J Emerg Med. 2024 Sep 1; 67 (3): e245e248e245-e248.

BackgroundNontraumatic intracranial hemorrhage occurs most commonly 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 ReportAn elderly female patient was brought to the emergency department with fatigue but no recent trauma. Subsequent computed tomography of the brain revealed a right-sided intraparenchymal hematoma. Her history included burr hole drainage of a subdural hematoma near the site, so additional imaging was performed and revealed an arteriovenous malformation, later discovered on operative findings to be a 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.Copyright © 2024 Elsevier Inc. All rights reserved.

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