Location of hemorrhage with nontraumatic acute subdural hematoma due to ruptured microaneurysm

Abstract

Background: Nontraumatic acute subdural hematoma (ASDH) may be caused by rupture of a microaneurysm of a cortical artery. In some cases, microaneurysms may have been caused by earlier trauma. Although it is difficult to detect microaneurysms on contrast-enhanced computed tomography (CT) angiography or digital subtraction angiography, it may be suspected based on the plain CT scan results and the clinical course. Case Description: We experienced three cases presumed to be ASDH due to rupture of a microaneurysm. Plain CT scan showed that the midline shift was smaller than the hematoma thickness, and we judged from the clinical course that there was no trauma immediately before the onset. All three patients had decreased consciousness after arrival and underwent craniotomy for hematoma removal. The source of hemorrhage was in the distal part of the cortical artery, and a microaneurysm was found. In one case, histopathological examination was performed, and traumatic pseudoaneurysm was diagnosed. The postoperative course was good in all three cases. Conclusion: If nontraumatic ASDH is suspected, the source of hemorrhage may be located more distally to the middle cerebral artery than in traumatic ASDH; hence, extensive craniotomy is required to search for the location of hemorrhage.

Bleeding-Source Exploration in Subdural Hematoma: Observational Study on the Usefulness of Postmortem Computed Tomography Angiography

“…The rupture hole in the cortical artery is so minute that it can only be seen under microscopic surgery [ 57 , 58 , 59 , 60 ]. Alternatively, a thin thread-like spurting bleeding from a cortical artery during surgery alerts to the presence of a rupture [ 48 , 51 , 54 ]; however, such a tiny rupture of a cortical artery is difficult to notice at autopsy because, of course, arterial bleeding does not occur at autopsy [ 38 ].…”

Detection and Morphological Analysis of Micro-Ruptured Cortical Arteries in Subdural Hematoma: Three-Dimensional Visualization Using the Tissue-Clearing Clear, Unobstructed, Brain/Body Imaging Cocktails and Computational Analysis Method

“…One of the sources of bleeding in this type of SDH is the rupture of a cortical artery. Although 198 cases of SDH due to ruptured cortical arteries have been reported in 49 publications [ 3 , 5 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], only eight cases in two publications were subjected to detailed histopathological examination by autopsy [ 8 , 52 ]. Therefore, the pathogenesis of th...…”