Acute Subdural Hematoma Without Subarachnoid Hemorrhage Caused by Ruptured A1-A2 Junction Aneurysm

Abstract

A 54-year-old man was admitted to our hospital with complaint of sudden headache. The patient had suffered two episodes of transient headache before admission. Computed tomography (CT) revealed acute subdural hematoma (ASDH) on the right side of the cerebral convexity with bilateral extension along the tentorium cerebelli without signs of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH). Three-dimensional CT angiography and conventional cerebral angiography revealed a left A1-A2 junction aneurysm. Neck clipping of the aneurysm was performed. The aneurysm extended inferiorly, with the dome embedded in the chiasmatic cistern and tightly adhered to the arachnoid membrane. There was no evidence of hematoma in the subarachnoid space. The patient was discharged without neurological deficit. Ruptured aneurysms resulting in ASDH without SAH or ICH are very rare. Radiological investigation such as three-dimensional CT angiography should be performed to find the causative aneurysm in a patient with ASDH with a history of repeated headaches and without traumatic signs or episodes, and the appropriate treatment should be planned with expediency.

Subdural hematoma caused by rupture of a posterior cerebral artery aneurysm

“…But the clinical incidence of SDH complication is very low, which was reported to be 0.5-7.9% 1,2. And the most frequently reported site of aneurysm location is the internal carotid artery (ICA)-posterior communicating artery, which is followed by aneurysms of middle cerebral artery and distal anterior cerebral artery 2,5. We described a case of ruptured PCA aneurysm presenting as subdural hematoma, which is relatively rare.…”

“…Several mechanisms have been proposed to explain the occurrence of SDH after aneurysm rupture:1,2,5,6 1)Successive minor bleedings case the developing of adhesions, resulting in final rupture into the subdural space; 2) high-pressure hemorrhage may lead to rapid accumulation of blood from the leaking aneurysm, rupturing the arachnoid membrane; 3) intracerebral hemorrhage may rupture through the cortex and cause a tear of the arachnoid membrane; 4) a carotid artery aneurysm arising from the part of carotid artery within the subdural space may rupture and cause subdural hematoma directly; and 5) the acute enlargement of the intracavernous aneurysm may erode the cavernous sinus wall. As in this case, the patient had suffered headache since 4 days before he was admitted to hospital, this warning sign may reflect the presence of successive small bleedings.…”

Pure Subdural Hemorrhage Caused by Internal Carotid Artery Dorsal Wall Aneurysm Rupture

“…Reported incidence of acute aneurysmal SDH varies from 0.5 to 7.9% 14)17). However, pure subdural hemorrhage caused by intracranial aneurysm is extremely rare 10)16)…”

“…intracerebral bleeding may rupture the cortex and tear the arachnoid membrane 5)6). 4) enlargement of the intra-cavernous aneurysm could erode the wall of the cavernous sinus 8)16). 5) an aneurysm located in the subdural space may cause subdural hematoma directly 6)11)…”

Pure subdural haematoma caused by rupture of middle cerebral artery aneurysm: Case report and literature review

“…An additional 40 similar cases of pure subdural haematoma caused by intracranial aneurysm have been reported since 1980 (Table 1). [3][4][5][6][7][8] The average age at presentation was 46.6 years, with 27/41 patients (65.9%) being female. The site of aneurysm included ICA-posterior communicating artery (PcomA; 16 cases, 39.0%), MCA (10 cases, 24.4%; including the present case), anterior communicating artery (AcomA; six cases, 14.6%), distal ACA (four cases, 9.8%) and other sites (five cases, 12.2%).…”