Acute non-traumatic subdural hematoma induced by intracranial aneurysm rupture

Abstract

Rationale: Intracranial aneurysm with the first manifestation of acute subdural hematoma (aSDH) is rare in the field of neurosurgery. Usually subarachnoid hemorrhage or intracranial hematoma happens after the rupture of an intracranial aneurysm, whereas trauma is the primary cause of aSDH. Patient concerns: Here, we present the case of a 71-year-old woman who presented with spontaneous aSDH with progressive headache and vomiting. Diagnosis: Urgent head computed tomography (CT) identified an aSHD, but the patient had no history of trauma. CT angiography (CTA) identified the cause of the aSDH as rupture of an intracranial aneurysm in the left middle cerebral artery. Interventions: Emergent craniotomy with hematoma evacuation was performed. Outcomes: Due to prompt diagnosis and appropriate intervention, the patient recovered fully with no disability. Lessons: This unique case demonstrates that aSDH caused by intracranial aneurysm rupture requires timely identification and appropriate action to prevent adverse outcomes. We performed a comprehensive systematic literature review to examine the etiology and pathogenesis of non-traumatic aSDH. Furthermore, digital subtraction angiography should be considered in patients diagnosed with an aSDH with no known cause.

Spontaneous subdural hematoma in a young COVID-19-confirmed patient without comorbidities: A case report

“…1 Clinical symptoms of subdural hematoma include vomiting, headache, conscious disturbance, visual impairment, and brain herniation. 2 Spontaneous subdural hematoma has not been previously associated with any viral infection such as COVID. Although COVID-19 is a respiratory disease, several studies have reported neurological complications in COVID-19 patients.…”

Letter: Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1—Craniotomy

“…Patients with aSDHs have a significantly higher morbidity and mortality rate than the general population at 90 days. 2 The etiology and pathophysiology of aSDHs of nontraumatic origin remains uncertain but has been related to some coagulation defects, iatrogenic, arteriovenous malformations, and intravenous drug abuse; however, there are other associated factors that should be considered in the development of aSDHs. [2][3][4] The aim of this letter to the editor was to mention other important causes associated with the development and recurrence of aSDHs despite surgical management.…”

“…So far there are few cases reported in the literature of the development of aSDHs associated with rupture of an aneurysm; however, its presence should not be ruled out. 2…”

“…So far there are few cases reported in the literature of the development of aSDHs associated with rupture of an aneurysm; however, its presence should not be ruled out. 2 High altitudes have been related to the development of aSDHs mainly from 2400 m above sea level because the body undergoes a series of physiological adaptations to maintain tissue oxygenation, increasing venous and even arterial pressure. Thus, it has been described that the cerebral vasculature under stressful conditions may increase venous pressure, thus failing the intrinsic regulation mechanisms of the brain causing rupture of the arterial or venous beds; for this reason, it is recommended that altitude changes be progressive and not sudden to avoid such complications.…”