A challenging problem. Vertebral pseudoaneurysm and arteriovenous fistula involving vertebral artery and ipsilateral internal jugular vein due to craniocervical penetrating trauma.

Vertebral pseudoaneurysm and arteriovenous fistulas are very rare and are commonly due to penetrating trauma to craniocervical region. A 20-year-old man was presented with progressive swelling and pulsatile mass on the left side of his face. He had been stabbed two weeks ago on the left side of his face. Doppler Ultrasound revealed large left vertebral pseudoaneursym and arteriovenous fistulisation with the ipsilateral internal jugulat vein. MR Angiography and conventional angiography confirmed arteriovenous fistula between left vertebral artery and ipsilateral internal jugular vein and large pseudoaneurysm formation on vertebral artery. Arteriovenous fistula was closed surgically and embolized with surgicell. But the pseudoaneurysm was treated with endovascular covered stent placement.