Although three-dimensional computed tomographic angiography (3D-CTA) is less complicated and time-consuming than conventional cerebral angiography (CCA) and represents a reliable alternative for evaluating cerebral aneurysms, some patients experience aneurysmal rerupture during 3D-CTA. Two women, 79 and 71 years old, who presented with severe subarachnoid hemorrhage (SAH) underwent 3D-CTA within 3 h after SAH onset. Their images clearly indicated extravasation from their aneurysms. Neither patient recovered from deep coma, and both died within 2 days. We reviewed the literature with special reference to the condition of SAH patients at admission and the interval between SAH onset and 3D-CTA, and discuss serious complications of 3D-CTA study. Although aneurysmal rerupture may reflect the natural course, rerupture during 3D-CTA, especially in SAH patients who are in poor clinical condition during the acute stage, should be recognized as a potentially fatal complication. Their blood pressure must be strictly controlled and factors such as their clinical condition and the interval from the ictus must be considered.

Dural arteriovenous fistulas (DAVFs) at the cervicomedullary junction are rare and have a wide variation in presentation. We report a case of occipital neuralgia (ON) as a rare presenting symptom of cervicomedullary DAVF causing intramedullary hemorrhage at the C1 level. It is important to consider the underlying causes of ON, and precise neurological examinations and radiological evaluations are needed.

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A 67-year-old man presented with devastating intracranial hemorrhage (ICH) from an anterior cranial fossa dural arteriovenous fistula (DAVF). Four years earlier, digital subtraction angiography had disclosed a DAVF at the right anterior cranial fossa fed mainly by the ethmoidal branches of the bilateral sphenopalatine arteries and slightly by the ethmoidal arteries of the bilateral ophthalmic arteries, and drained primarily by the sphenoparietal and cavernous sinuses via two dilated cortical veins and slightly by the superior sagittal sinus via a frontal ascending vein. Three-dimensional computed tomography angiography revealed the development of a venous aneurysm on the main draining vein over a 4-year period, but no other changes. Venous aneurysm development may be part of the natural history of DAVF with cortical venous drainage and may contribute to the occurrence of ICH.

An 11-month-old boy presented with a huge subdural empyema in the left hemisphere associated with a subsequent contralateral chronic subdural hematoma. Burr-hole drainage and antibiotic therapy achieved a successful outcome. Subdural empyema may result from hematogenous seeding of infection into a pre-existing chronic subdural hematoma.