Subdural hematoma of the posterior fossa due to posterior communicating artery aneurysm rupture

Kim, Myoung Soo; Jung, Jong Rak; Yoon, Sang Won; Lee, Chae Heuck

doi:10.4103/2152-7806.94287

Cited by 16 publications

(14 citation statements)

References 13 publications

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“…However, the commonly accepted mechanism involves a breach of the arachnoid membrane due to the rapid accumulation of blood under local stress conditions. This could then lead to adhesion of the arachnoid to the aneurysmal dome, thereby inducing a direct rupture of the aneurysm into the subdural space [8,9]. In our patient, because of her aneurysmal configuration, we believe that the posterior communicating artery aneurysm expanded more into the Fig.…”

Section: Discussionmentioning

confidence: 78%

A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: a case report and literature review

et al. 2020

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Background: Ruptured intracranial aneurysms are often associated with subarachnoid or intraparenchymal hemorrhage. However, the prevalence of subdural hemorrhage post aneurysmal rupture is low and rarely reported in scientific studies. Here, we report an unusual case of a ruptured posterior communicating artery aneurysm resulting in an isolated subdural hematoma located in the tentorial and spinal canal without subarachnoid or intraparenchymal hemorrhage. Case presentation: In this case, a 34-year-old woman with no history of trauma or coagulopathy was diagnosed with a subdural hematoma in the tentorium cerebellum tracing to the subdural space of the spinal column. Computed tomography angiography was used to identify the source of the bleeding, which revealed a ruptured left-sided posterior communicating artery saccular aneurysm. The aneurysm was clipped, and the hematoma was evacuated. The patient recovered without any neurological complications. Conclusions: Our results suggest that a diagnosis of ruptured intracranial aneurysm should be considered in patients with nontraumatic subdural hematoma. Prompt diagnostic imaging and interventional diagnostic procedures are required to ensure proper management of these patients and to avoid unnecessary complications.

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Section: Discussionmentioning

confidence: 78%

A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: a case report and literature review

et al. 2020

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“…Hemorrhage can spread through the diaphragm sella into the subdural space, constrained by the posterior arachnoid membrane of the prepontine cistern [ 1 , 23 ]; on the other hand, a defect in the dorsum can permit blood flow into the epidural space [ 24 ]. Rare cases of rcSDH have been associated with aneurysmal rupture [ 25 , 26 ]. Moreover, pressure changes (spontaneous intracranial hypotension [ 7 ] and posterior fossa decompressive craniectomy [ 27 ]), thrombocytopenia [ 28 ], and hemophilia [ 29 ] have been linked with rcSDH.…”

Section: Discussionmentioning

confidence: 99%

Isolated traumatic retroclival hematoma: case report and review of literature

2016

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BackgroundRetroclival hematomas are a rare entity. The pathology can be categorized into epidural hematoma or subdural hematoma based on the anatomy of the tectorial membrane. Frequently, the etiology is related to accidental trauma, though other mechanisms have been observed, including coagulopathy, non-accidental trauma, and pituitary apoplexy. There have been only 2 prior cases where both epidural and subdural hematoma co-present.Case presentationAn 8-year-old male was involved in a high-speed motor vehicle accident. He presented with a Glasgow Coma Score (GCS) of 14 with bilateral abducens nerve palsies. Computed tomography (CT) revealed a hemorrhage along the dorsum sella, clivus, and dens. Magnetic resonance imaging (MRI) demonstrated the retroclival hematoma in both the subdural and epidural space. At discharge, 19 days after the accident, the abducens nerve palsies had resolved without medical or operative intervention.ConclusionRetroclival hematoma may present after trauma. Although most cases exhibit a benign clinical course with conservative management, significant and profound morbidity and mortality have been reported. Prompt diagnosis with close observation is prudent. Surgical management is indicated in the presence of hydrocephalus, symptomatic brainstem compression, and occipito-cervical instability.

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“…There is a slight sex predominance toward males (60%), and the average age in surgical series is 50 years. [6][7][8][9][10][11]15,16 Arita et al found that over a 5-year follow-up period, pituitary apoplexy developed in 9.5% of patients with known pituitary adenoma.…”

Section: Discussionmentioning

confidence: 99%

“…Fifty percent of patients also experience various forms of ophthalmoplegia, including diminished visual acuity, visual field defects, or diplopia. [6][7][8][9][10][11][12][13][14] In our series, all patients reported experiencing headache, and all but 1 patient had ophthalmoplegia of some kind. The recommended management-either conservative medical treatment 19 or surgical decompression 4,19 -remains controversial depending on the presence of associated cranial nerve palsies and level of consciousness.…”

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confidence: 93%

Spontaneous retroclival hematoma in pituitary apoplexy: case series

Azizyan¹,

Miller²,

Azzam³

et al. 2015

JNS

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OBJECT Pituitary apoplexy is a rare and potentially life-threatening disorder that is most commonly characterized by a combination of sudden headache, visual disturbance, and hypothalamic/hormonal dysfunction. In many cases, there is hemorrhagic infarction of an underlying pituitary adenoma. The resulting clinical symptoms are due to compression of the remaining pituitary, cavernous sinuses, or cranial nerves. However, there are only 2 case reports in the literature describing spontaneous retroclival expansion of hemorrhage secondary to pituitary apoplexy. Ten cases of this entity with a review of the literature are presented here. METHODS This is a single-institution retrospective review of 2598 patients with sellar and parasellar masses during the 10-year period between 1999 and 2009. The pituitary and brain MRI and MRI studies were reviewed by 2 neuroradiologists for evidence of apoplexy, with particular attention given to retroclival extension. RESULTS Eighteen patients (13 men and 5 women; mean age 54 years) were identified with presenting symptoms of sudden onset of headache and ophthalmoplegia, and laboratory findings consistent with pituitary apoplexy. Ten of these patients (8 men and 2 women; mean age 55 years) had imaging findings consistent with retroclival hematoma. CONCLUSIONS Retroclival hemorrhage was seen in the majority of cases of pituitary apoplexy (56%), suggesting that it is more common than previously thought.

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Subdural hematoma of the posterior fossa due to posterior communicating artery aneurysm rupture

Cited by 16 publications

References 13 publications

A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: a case report and literature review

A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: a case report and literature review

Isolated traumatic retroclival hematoma: case report and review of literature

Spontaneous retroclival hematoma in pituitary apoplexy: case series

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