Acute Tentorial Subdural Hematoma Caused by Rupture of the Posterior Cerebral Artery after Minor Trauma—A Case Report

Abstract

Acute subdural hematoma (aSDH) is a common pathology encountered after head trauma. Only a minority of aSDHs have an arterial source. In this article, we report a case of aSDH originating from a traumatic pseudoaneurysm of the distal segment of posterior cerebral artery (PCA), diagnosed several days after the initial minor trauma and successfully treated with endovascular coiling. This case emphasizes the importance of searching for vascular pathology when the localization, severity or relapsing course of the intracranial hemorrhage does not fully correspond to the severity of initial trauma and when the bleeding has a delayed onset. Characteristics, diagnostics and treatment possibilities of traumatic cerebral aneurysms, an important cause of arterial aSDH, are described in the article.

Post-traumatic intracranial pseudo-aneurysms of posterior circulation: a comprehensive review of an under-diagnosed and rare entity

“…However, early recognition of a pseudo-aneurysm and adequate treatment seem to be the most important prognostic factor for this particular category of patients where the small collection does not allow for more in-depth statistical evaluations. A TIPC should be suspected in case of delayed deterioration in a head-injured patient and should be investigated with angiography [1,4,5,22,25,44,47]. Conservative management is worsened by poor prognosis [25,28,34].…”

Delayed Tentorial Subdural Hematoma Caused by Traumatic Posterior Cerebral Artery Aneurysm: A Case Report and Literature Review

“…TICA is associated with significant morbidity and mortality rates, as high as 50% [ 5 ]; therefore, early diagnosis and treatment are crucial. TICA is generally due to severe traumatic brain injury (TBI) [ 6 ]. Most such aneurysms occur near the skull base or falx cerebri.…”

“…A summary of the literature regarding patients with TICA in the PCA is shown in Table 1 [ 6 , 9 – 16 ]. The mean age of patients was 19.5±10.8 years.…”

“…Most aneurysms were located in the precommunicating segment (P1) and postcommunicating segment (P2) of the PCA. Ruptured aneurysm resulting in only SDH, without SAH, is quite rare in the posterior fossa [ 17 ], and we identified only 1 case attributable to ruptured TICA involving the PCA [ 6 ]. The generally accepted mechanisms by which a ruptured cerebral aneurysm results in SDH are as follows: (i) continuous small hemorrhages from an aneurysm causes adhesions that eventually rupture in the subdural space; (ii) the systolic pressure generated by a ruptured aneurysm can cause the adjacent arachnoid membrane to rupture locally, spilling both cerebrospinal fluid and blood into the subdural space; and (iii) massive bleeding causes laceration of the cortex and arachnoid membrane [ 18 ].…”

“…Teksam et al pointed out that CTA could not take the place of DSA for detecting intracranial aneurysms, despite the developments in imaging modalities over the past few years as non-invasive options [ 19 ]. Further, Ciochon et al reported that pseudoaneurysm appearing as a large, left-sided tentorial and falcine SDH with a contrast extravasation following CTA, termed the spot sign, was initially interpreted as blood of varying age, resulting in delayed discovery of the pseudoaneurysm [ 6 ]. CTA alone may not be sufficient to delineate TICA.…”