1
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Aladawi M, Elfil M, Najdawi ZR, Ghaith H, Sayles H, Thorell W, Hawkes MA. Aneurysmal Subdural Hematoma: A Systematic Review. Neurocrit Care 2024:10.1007/s12028-024-01938-y. [PMID: 38332336 DOI: 10.1007/s12028-024-01938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Aneurysmal subdural hematoma (aSDH) is a rare complication of aneurysm rupture, affecting between 0.5 and 7.9% of patients with aneurysmal subarachnoid hemorrhage (aSAH). The clinical presentation, course, and outcomes of these patients are largely unknown. OBJECTIVE This study aims to systematically review the literature to evaluate the demographics, clinical presentation, aneurysm location, treatment options, and outcomes of patients with aSDH with and without aSAH. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review of three databases (PubMed, EMBASE, and Google Scholar). From identified reports, we extracted data on patients' demographics, clinical presentation, imaging findings, surgical interventions, and clinical outcomes. We compared clinical outcomes, need for surgical treatment, and aneurysm location between patients with aSDH with and without concurrent aSAH using χ2 and Fisher's exact tests. We used simple and multivariable logistic regression models to further examine the association between the presence of aSAH and surgical treatment with clinical outcomes. RESULTS We identified 112 articles with a total of 270 patients (70% women, mean age 52.8 [± 15.5] years). The most common aneurysm locations were the middle cerebral artery, followed by the posterior communicating artery, and the internal carotid artery. Patients with isolated aSDH fully recovered more frequently than those with concomitant aSAH (38% vs. 6%). The presence of aSAH increased the odds of unfavorable outcome (odds ratio [OR] 2.68, 95% confidence interval [CI] 1.34-5.37). Surgical treatment was inversely associated with unfavorable outcome in the univariable (OR 0.48, 95% CI 0.28-0.84) but not in the multivariable analysis (OR 0.76, 95% CI 0.35-1.66). CONCLUSION aSDH occurs infrequently. Simultaneous presence of both aSDH and aSAH from an aneurysmal source is associated with poor outcomes. Surgical treatment is associated with lower rates of unfavorable outcomes including death and severe disability.
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Affiliation(s)
- Mohammad Aladawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zaid R Najdawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hazem Ghaith
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Harlan Sayles
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - William Thorell
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Maximiliano A Hawkes
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Neurology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA.
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2
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Hashiguchi A, Tashima K, Tonegawa T, Moroki K, Tokuda H. Subarachnoid Hemorrhage From Ruptured Aneurysms at the Internal Carotid Artery-Posterior Communicating Artery Bifurcation Not Detectable on Preoperative Imaging Studies. Cureus 2024; 16:e53691. [PMID: 38455832 PMCID: PMC10918616 DOI: 10.7759/cureus.53691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Since subarachnoid hemorrhage (SAH) due to the re-rupture of cerebral aneurysms severely worsens the prognosis, an accurate initial diagnosis is essential. Computed tomography (CT) and magnetic resonance imaging (MRI) usually detect aneurysmal subarachnoid hemorrhage (aSAH). However, in rare cases, its identification on CT- and MRI scans is difficult, and a cerebrospinal fluid (CSF) examination is required. We present preoperative imaging and intraoperative findings in patients whose aSAH detection necessitated a CSF examination. Of 225 aSAH patients who underwent preoperative imaging studies at our institution between April 2010 and August 2019, 3 females (1.3%, mean age 57.3 years) harbored undetectable aSAH due to the rupture of an internal carotid artery-posterior communicating artery (ICA-PcomA) aneurysm. The aneurysmal orientation was inferolateral. Intraoperatively, the anterior petroclinoid ligament hampered the detection of the aneurysms that firmly adhered to the surrounding arachnoid membrane. Sustained arterial pulsation and successive minor hemorrhage can lead to the gradual adhesion of an ICA-PcomA aneurysm to the surrounding arachnoid membrane and explain their atypical rupture undetectable on imaging studies and the development of acute subdural hematoma without SAH.
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Affiliation(s)
| | - Kozo Tashima
- Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN
| | - Takeshi Tonegawa
- Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN
| | - Koichi Moroki
- Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN
| | - Hajime Tokuda
- Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN
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3
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Claassen J, Park S. Convexity subarachnoid haemorrhage - Authors' reply. Lancet 2023; 401:194. [PMID: 36681414 PMCID: PMC9987592 DOI: 10.1016/s0140-6736(23)00007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Jan Claassen
- Department of Neurology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY 10032, USA.
| | - Soojin Park
- Department of Neurology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY 10032, USA
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4
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Al-Abdulwahhab AH, Al-Sharydah AM, Al-Suhibani SS, Almulhim AS, Al-Dhafeeri OM, Al-Jubran SA. A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: a case report and literature review. BMC Neurol 2020; 20:102. [PMID: 32188416 PMCID: PMC7081678 DOI: 10.1186/s12883-020-01682-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/11/2020] [Indexed: 11/26/2022] Open
Abstract
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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Affiliation(s)
- Abdulrahman Hamad Al-Abdulwahhab
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 4398, Al-Khobar City, Eastern Province, 31952, Saudi Arabia
| | - Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 4398, Al-Khobar City, Eastern Province, 31952, Saudi Arabia
| | - Sari Saleh Al-Suhibani
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 4398, Al-Khobar City, Eastern Province, 31952, Saudi Arabia.
| | | | - Obaied M Al-Dhafeeri
- Diagnostic Imaging Radiology department, Royal Commission Health Services, Jubail, Saudi Arabia
| | - Saeed A Al-Jubran
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 4398, Al-Khobar City, Eastern Province, 31952, Saudi Arabia
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5
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Okar S, Arat A, Arsava EM, Peker A, Berker M, Topcuoglu MA. Can Convexity Subarachnoid Hemorrhage be Caused by Rupture of a Saccular Aneurysm? JOURNAL OF VASCULAR AND INTERVENTIONAL NEUROLOGY 2018; 10:1-3. [PMID: 30746001 PMCID: PMC6350862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Serhat Okar
- Department of Neurology and Neurological Intensive Care Unit, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey
| | - Anıl Arat
- Department of Interventional Neuroradiology, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey
| | - E. Murat Arsava
- Department of Neurology and Neurological Intensive Care Unit, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey
| | - Ahmet Peker
- Department of Interventional Neuroradiology, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey
| | - Mustafa Berker
- Department of Neurosurgery, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey
| | - Mehmet Akif Topcuoglu
- Department of Neurology and Neurological Intensive Care Unit, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey
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Thapa A, Kc B, Shakya B. Pure Acute-on-Chronic Subdural Hematoma Due to Ruptured Posterior Communicating Artery Aneurysm: Unsuspecting Entity. World Neurosurg 2018; 114:335-338. [PMID: 29631078 DOI: 10.1016/j.wneu.2018.03.211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Even though rarely reported as a cause of pure subdural hematoma (SDH), aneurysmal rupture should be suspected in patients with spontaneous SDH without coagulopathy. CASE DESCRIPTION We report a case of acute-on-chronic SDH in a 55-year-old lady with cerebral herniation due to a ruptured posterior communicating artery aneurysm. She was managed with single-stage SDH evacuation along with clipping of the aneurysm. CONCLUSIONS Computed tomography angiography of the head is advisable in patients with spontaneous SDH without coagulopathy. Pure SDH as compared with SDH associated with subacute hemorrhage, intraventricular hemorrhage, or intracerebral hemorrhage due to aneurysmal rupture has a good outcome.
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Affiliation(s)
- Amit Thapa
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
| | - Bidur Kc
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Bikram Shakya
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
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7
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Shekarchizadeh A, Masih S, Reza P, Seif B. Acute Subdural Hematoma and Subarachnoid Hemorrhage Caused by Ruptured Cortical Artery Aneurysm: Case Report and Review of Literature. Adv Biomed Res 2017; 6:46. [PMID: 28503501 PMCID: PMC5414414 DOI: 10.4103/2277-9175.204589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The present report describes an acute subdural hematoma (ASDH) associated with subarachnoid hemorrhage (SAH), due to ruptured cortical aneurysm. To our knowledge, extremely rare cases of this sort have been reported so far. A 23-year-old male patient without previous trauma presented with severe headache and rapidly decreasing level of consciousness to decerebrate status. Computed tomography (CT) scan has demonstrated an ASDH together with SAH. Hematoma has immediately been evacuated without any evaluation by angiography. After evacuation of the thick subdural clot, a 10-mm aneurysm was revealed on a precentral artery of frontal cortex, which was ligated. However, after 35 days the patient discharged with left side hemiparesis and dysphasia, and just after several months of admission he got symptom free. Ruptured cortical aneurysm should be considered as one of the causes of spontaneous ASDH. Vascular anomaly investigations are suggested for these cases, thus CT angiography or digital subtraction angiography has to be considered if clinical condition allows.
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Affiliation(s)
- Ahmad Shekarchizadeh
- Department of Neurosurgery, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saburi Masih
- Department of Neurosurgery, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pourkhalili Reza
- Department of Neurosurgery, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Seif
- Department of Neurosurgery, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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8
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Ruptured berry aneurysm with minimal subarachnoid hemorrhage. J Forensic Leg Med 2017; 47:35-38. [DOI: 10.1016/j.jflm.2017.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/21/2017] [Accepted: 02/26/2017] [Indexed: 11/23/2022]
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Han J, Lim DJ, Kim SD, Ha SK, Lee SH, Kim SH. Subdural Hematoma without Subarachnoid Hemorrhage Caused by the Rupture of Middle Cerebral Artery Aneurysm. J Cerebrovasc Endovasc Neurosurg 2016; 18:315-321. [PMID: 27847781 PMCID: PMC5104862 DOI: 10.7461/jcen.2016.18.3.315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/30/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022] Open
Abstract
Pure subdural hematomas caused by a ruptured intracranial aneurysm are extremely rare. We describe the case of a 42-year-old woman who presented with headache without evidence of head trauma. Magnetic resonance angiography and conventional cerebral angiography revealed a ruptured aneurysm at the right middle cerebral artery bifurcation. The patient underwent surgical treatment and had a good outcome without any neurological deficit. The mechanisms and clinical characteristics of this condition are discussed.
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Affiliation(s)
- Jinsol Han
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang-Dae Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung-Hwan Lee
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Se-Hoon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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10
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Lee YW, Nam TM, Kim JS, Hong SC, Yeon JY. Pure Subdural Hemorrhage Caused by Internal Carotid Artery Dorsal Wall Aneurysm Rupture. J Cerebrovasc Endovasc Neurosurg 2016; 18:302-305. [PMID: 27847779 PMCID: PMC5104860 DOI: 10.7461/jcen.2016.18.3.302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 11/23/2022] Open
Abstract
A 37-year-old woman was admitted to our hospital with altered mentality. The patient was diagnosed an internal carotid artery (ICA) dorsal wall aneurysm leading to acute subdural hemorrhage (SDH) without occurring subarachnoid hemorrhage and/or internal parenchymal hemorrhage. An aneurysmal neck clipping and hematoma evacuation were performed at once. A pure SDH by ruptured aneurysm is unusual, but it is important to consider it if a SDH patient has no other medical history.
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Affiliation(s)
- Young Woon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Min Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Soo Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Chyul Hong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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Song TW, Kim SH, Jung SH, Kim TS, Joo SP. Rupture of distal anterior cerebral artery aneurysm presenting only subdural hemorrhage without subarachnoid hemorrhage: a case report. SPRINGERPLUS 2016; 5:73. [PMID: 26844020 PMCID: PMC4726640 DOI: 10.1186/s40064-016-1727-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/15/2016] [Indexed: 11/21/2022]
Abstract
Intracranial aneurysm rupture usually manifests with subarachnoid hemorrhage, often combined with intracerebral hemorrhage with intraventricular hemorrhage extension. In rare cases, however, these aneurysms present only as subdural hematomas. Recently, we treated a 48-years-old female patient who presented only with subdural hematoma. Interestingly, she did not have a history of trauma. Computed tomography angiography and digital subtraction angiography revealed a 5 × 3 mm sized aneurysm at the A3–A4 junction of the left anterior cerebral artery. On admission, emergency operation (clipping and hematoma evacuation) was performed to protect against re-bleeding. Along with postoperative intensive care, the patient returned to normal daily life with only a mild headache. Given that patients may present with atraumatic acute subdural hematoma, the clinician must bear in mind the possibility of intracranial vascular pathology and obtain angiographic scans to evaluate for any underlying conditions to prevent patient deaths.
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Affiliation(s)
- Tae-Wook Song
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
| | - Sung-Hyun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
| | - Seung-Hoon Jung
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, 42, Jebong-ro, Donggu, Gwangju, 501-757 Republic of Korea
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12
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Inokuchi G, Makino Y, Yajima D, Motomura A, Chiba F, Torimitsu S, Hoshioka Y, Iwase H. A case of acute subdural hematoma due to ruptured aneurysm detected by postmortem angiography. Int J Legal Med 2015; 130:441-6. [PMID: 26362305 DOI: 10.1007/s00414-015-1262-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022]
Abstract
Acute subdural hematoma (ASDH) is mostly caused by head trauma, but intrinsic causes also exist such as aneurysm rupture. We describe here a case involving a man in his 70s who was found lying on the bedroom floor by his family. CT performed at the hospital showed ASDH and a forensic autopsy was requested. Postmortem cerebral angiography showed dilatation of the bifurcation of the middle cerebral artery, which coincided with the dilated part of the Sylvian fissure. Extravasation of contrast medium into the subdural hematoma from this site was suggestive of a ruptured aneurysm. Autopsy revealed a fleshy hematoma (total weight 110 g) in the right subdural space and findings of brain herniation. As indicated on angiography, a ruptured saccular aneurysm was confirmed at the bifurcation of the middle cerebral artery. Obvious injuries to the head or face could not be detected on either external or internal examination, and intrinsic ASDH due to a ruptured middle cerebral artery aneurysm was determined as the cause of death. One of the key points of forensic diagnosis is the strict differentiation between intrinsic and extrinsic onset for conditions leading to death. Although most subdural hematomas (SDH) are caused by extrinsic factors, forensic pathologists should consider the possibility of intrinsic SDH. In addition, postmortem angiography can be useful for identifying vascular lesions in such cases.
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Affiliation(s)
- Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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13
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Shepherd D, Kapurch J, Datar S, Lanzino G, Wijdicks EFM. Sphenoid and subdural hemorrhage as a presenting sign of ruptured clinoid aneurysm. Neurocrit Care 2015; 20:489-93. [PMID: 23893075 DOI: 10.1007/s12028-013-9866-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aneurysm rupture presenting as an isolated or pure subdural hematoma (SDH) without subarachnoid hemorrhage is an extremely rare radiographic presentation. We present a case of a ruptured internal carotid artery aneurysm with a pure SDH and concurrent sphenoid sinus hemorrhage. METHODS Case report and review of the literature. RESULTS We describe a case of a 48-year-old right-handed woman found comatose brought by emergency medical services to an outside hospital. A non-contrast head CT scan demonstrated bilateral acute SDHs without evidence of intraparenchymal or subarachnoid hemorrhage. A CT angiogram of the head showed a focal hyperdensity in the distal left internal carotid artery (ICA) and was confirmed by conventional cerebral angiography to be a 7-mm left supraclinoid ICA aneurysm. On repeat CT scan a new hemorrhage was seen in the sphenoid sinus indicating a re-bleeding. The aneurysm was treated with coil embolization and complete occlusion was confirmed with subsequent angiograms. The patient had an eventful hospital course complicated by a Takotsubo cardiomyopathy and pulmonary edema. She was medically treated with successful recovery of her cardiopulmonary function. She remained markedly disabled and was transferred to an inpatient rehabilitation center for continued convalescence. CONCLUSIONS Acute subdural hematoma may be due to a ruptured clinoid carotid aneurysm. Acute hemorrhage into the sphenoid sinus can be an important clue.
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Affiliation(s)
- Daniel Shepherd
- Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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14
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Abstract
Spontaneous “pure acute subdural hematoma (SDH)” is arguably a rare condition. We report on a pregnant female patient presenting as spontaneous acute SDH without subarachnoid hemorrhage (SAH) due to rupture of distal (M5 segment) middle cerebral artery aneurysm. We hereby discuss the diagnostic dilemma of this rare condition, along with the need for watchful evaluation of acute SDH without preceding head injury presenting in emergency outpatient departments, especially when it is first encountered by a trainee resident.
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Affiliation(s)
- Navneet Singla
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Rajesh Chhabra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
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15
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Coombs JB, Coombs BL, Chin EJ. Acute Spontaneous Subdural Hematoma in a Middle-Aged Adult: Case Report and Review of the Literature. J Emerg Med 2014; 47:e63-8. [DOI: 10.1016/j.jemermed.2014.04.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 02/08/2014] [Accepted: 04/28/2014] [Indexed: 11/25/2022]
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16
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Acute Aneurismal Bilateral Subdural Haematoma without Subarachnoid Haemorrhage: A Case Report and Review of the Literature. Case Rep Neurol Med 2014; 2014:260853. [PMID: 25045554 PMCID: PMC4086224 DOI: 10.1155/2014/260853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/17/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022] Open
Abstract
Spontaneous pure acute bilateral subdural haematoma (ASDH) without intraparenchymal or subarachnoid haemorrhage caused by a ruptured cerebral aneurysm is extremely rare. It can follow rupture of different aneurysms specially located in anterior incisural space; the most frequently encountered location is the PcoA aneurysms as demonstrated in the present case. We present a case report of a PcoA aneurysm presenting as pure bilateral ASDH. A high level of suspicion for bleeding of arterial origin should be maintained in all cases of acute subdural haematoma without history of trauma. The neurological status on admission dictates the appropriate timing and methodology of the neuroradiological investigations.
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Gong J, Sun H, Shi XY, Liu WX, Shen Z. Pure subdural haematoma caused by rupture of middle cerebral artery aneurysm: Case report and literature review. J Int Med Res 2014; 42:870-8. [PMID: 24691457 DOI: 10.1177/0300060514524929] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/30/2014] [Indexed: 11/15/2022] Open
Abstract
Pure subdural haematoma (occurring without detectable subarachnoid haemorrhage) caused by intracranial aneurysm rupture is uncommon and is usually associated with delayed diagnosis and treatment. We describe the case of a 43-year-old man who presented with ongoing headache. Computed tomography and magnetic resonance imaging of the brain revealed subdural haematoma in the left fronto–temporo–parietal region, without subarachnoid haemorrhage. Digital subtraction angiography showed an aneurysm measuring ≤5 mm in diameter, arising from the distal region of the left middle cerebral artery. During hospitalization, an acute change in mental status accompanied by slurred speech and narcolepsy prompted an emergency CT scan. This revealed an enlargement of the subdural haematoma. The patient underwent an emergency craniotomy, during which a large amount of bloody fluid was evacuated, and the aneurysm was coagulated and resected. The patient had a good outcome without neurological deficit. The incidence, mechanisms and treatment of this condition are discussed.
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Affiliation(s)
- Jie Gong
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
| | - Hu Sun
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
| | - Xiao-Yong Shi
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
| | - Wei-Xian Liu
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
| | - Zheng Shen
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
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18
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Takada T, Yamamoto T, Ishikawa E, Zaboronok A, Kujiraoka Y, Akutsu H, Ihara S, Nakai K, Matsumura A. Acute subdural hematoma without subarachnoid hemorrhage caused by ruptured A1-A2 junction aneurysm. Case report. Neurol Med Chir (Tokyo) 2013; 52:430-4. [PMID: 22729076 DOI: 10.2176/nmc.52.430] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Tomoya Takada
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
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19
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Acute Subdural Hematoma without Subarachnoid Hemorrhage or Intraparenchymal Hematoma Caused by Rupture of a Posterior Communicating Artery Aneurysm: Case Report and Review of the Literature. J Emerg Med 2013; 44:e369-73. [DOI: 10.1016/j.jemermed.2012.11.073] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/19/2012] [Accepted: 11/06/2012] [Indexed: 11/23/2022]
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20
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Biesbroek JM, Rinkel GJ, Algra A, van der Sprenkel JWB. Risk Factors for Acute Subdural Hematoma From Intracranial Aneurysm Rupture. Neurosurgery 2012; 71:264-8; discussion 268-9. [DOI: 10.1227/neu.0b013e318256c27d] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
An acute subdural hematoma (aSDH) is a rare complication of aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor clinical condition on admission and poor outcome. Risk factors for the development of an aSDH from aneurysmal rupture are unknown and may help our understanding of how an aSDH develops.
OBJECTIVE:
To identify risk factors for the development of an aSDH from intracranial aneurysm rupture.
METHODS:
Patients were selected from our prospectively collected single-center SAH database. From all 1757 patients fulfilling prespecified inclusion criteria, 63 had an aSDH. We assessed sex, age, smoking, hypertension, history of SAH, sentinel headache, location of the ruptured aneurysm, and intracerebral hemorrhage (ICH) as risk factors for an aSDH. Univariable and multivariable risk ratios with corresponding 95% confidence intervals (CIs) were calculated for characteristics with Poisson regression.
RESULTS:
Multivariable risk ratios were 1.021 (95% CI: 1.001-1.042) for each year increase in age, 2.3 (95% CI: 1.3-3.8) for posterior communicating artery aneurysms, 3.0 (95% CI: 1.5-6.0) for sentinel headache, and 5.2 (95% CI: 3.1-8.9) for ICH. None of the 95 patients (0%; 95% CI: 0%-3.8%) with a ruptured vertebrobasilar aneurysm had an aSDH, which was statistically significantly lower than at other sites (P = .02 for basilar aneurysm; P = .04 for vertebral aneurysm). None of the other studied characteristics had a statistically significant association with an aSDH.
CONCLUSION:
Increasing age, sentinel headache, ICH, and aneurysms at the posterior communicating artery are independent risk factors for an aSDH. Patients with a basilar or vertebral aneurysm have a low risk of an aSDH.
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Affiliation(s)
- J. Matthijs Biesbroek
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gabriel J.E. Rinkel
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ale Algra
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Berkelbach van der Sprenkel
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
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21
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Management of Patients Presenting with Acute Subdural Hematoma due to Ruptured Intracranial Aneurysm. Int J Vasc Med 2012; 2012:753596. [PMID: 22500234 PMCID: PMC3303750 DOI: 10.1155/2012/753596] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/14/2011] [Accepted: 11/28/2011] [Indexed: 01/19/2023] Open
Abstract
Acute subdural hematoma is a rare presentation of ruptured aneurysms. The rarity of the disease makes it difficult to establish reliable clinical guidelines. Many patients present comatose and differential diagnosis is complicated due to aneurysm rupture results in or mimics traumatic brain injury. Fast decision-making is required to treat this life-threatening condition. Determining initial diagnostic studies, as well as making treatment decisions, can be complicated by rapid deterioration of the patient, and the mixture of symptoms due to the subarachnoid hemorrhage or mass effect of the hematoma. This paper reviews initial clinical and radiological findings, diagnostic approaches, treatment modalities, and outcome of patients presenting with aneurysmal subarachnoid hemorrhage complicated by acute subdural hematoma. Clinical strategies used by several authors over the past 20 years are discussed and summarized in a proposed treatment flowchart.
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22
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Oh SY, Kwon JT, Park YS, Nam TK, Park SW, Hwang SN. Clinical features of acute subdural hematomas caused by ruptured intracranial aneurysms. J Korean Neurosurg Soc 2011; 50:6-10. [PMID: 21892397 DOI: 10.3340/jkns.2011.50.1.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/02/2011] [Accepted: 07/01/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Spontaneous acute subdural hematomas (aSDH) secondary to ruptured intracranial aneurysms are rarely reported. This report reviews the clinical features, diagnostic modalities, treatments, and outcomes of this unusual and often fatal condition. METHODS We performed a database search for all cases of intracranial aneurysms treated at our hospital between 2005 and 2010. Patients with ruptured intracranial aneurysms who presented with aSDH on initial computed tomography (CT) were selected for inclusion. The clinical conditions, radiologic findings, treatments, and outcomes were assessed. RESULTS A total of 551 patients were treated for ruptured intracranial aneurysms during the review period. We selected 23 patients (4.2%) who presented with spontaneous aSDH on initial CT. Ruptured aneurysms were detected on initial 3D-CT angiography in all cases. All ruptured aneurysms were located in the anterior portion of the circle of Willis. The World Federation of Neurosurgical Societies grade on admission was V in 17 cases (73.9%). Immediate decompressive craniotomy was performed 22 cases (95.7%). Obliteration of the ruptured aneurysm was achieved in all cases. The Glasgow outcome scales for the cases were good recovery in 5 cases (21.7%), moderate disability to vegetative in 7 cases (30.4%), and death in 11 cases (47.8%). CONCLUSION Spontaneous aSDH caused by a ruptured intracranial aneurysm is rare pattern of aneurysmal subarachnoid hemorrhage. For early detection of aneurysm, 3D-CT angiography is useful. Early decompression with obliteration of the aneurysm is recommended. Outcomes were correlated with the clinical grade and CT findings on admission.
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Affiliation(s)
- Se-Yang Oh
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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23
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Marbacher S, Fandino J, Lukes A. Acute subdural hematoma from ruptured cerebral aneurysm. Acta Neurochir (Wien) 2010; 152:501-7. [PMID: 19855924 DOI: 10.1007/s00701-009-0521-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 09/09/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE The combination of ruptured aneurysms with acute subdural hematomas (aSDHs) is a rare presentation. Patients with aSDH associated with aneurysmal bleeding represent a subgroup within the spectrum of aneurysmatic hemorrhage. We summarize the clinical characteristics, diagnostic evaluation, and management of a series of cases presenting with aSDH associated with aneurysmal subarachnoid hemorrhage (SAH). METHODS Medical records and surgical reports of 743 consecutive patients admitted to our institution with SAH from January 1995 to December 2007 were screened to detect cases of associated aSDH. Admission evaluations included the Glasgow Coma Scale (GCS) and the subarachnoid grade of the World Federation of Neurosurgical Societies (WFNS). Radiological assessment included computer tomography (CT) scan, CT angiography (CTA), and digital subtraction angiography (DSA). The presence and volume of SAH, intracerebral hemorrhage (ICH), and aSDH were documented. Outcome was measured in terms of Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) at 4-8 months. RESULTS A total of seven cases (0.9%) presenting with aSDH (mean width: 11.2 mm +/- 4.8 mm, range: 5-20 mm) attributable to SAH were documented. Three of these patients were admitted with a suspicion of trauma. Five patients presented with WFNS grade 5, one patient with WFNS grade 3, and one patient with WFNS grade 1. All patients underwent evacuation of the aSDH. In four patients, surgical obliteration of the aneurysm was achieved in the same procedure. Two patients underwent delayed occlusion of the aneurysm: one by coiling and one by clipping. Three of the seven patients recovered completely from their neurological deficits (GOS 5, mRS 0-1), three recovered with mild disability (GOS 4, mRS 2-3), and one died within 8 h after the decompressive procedure. CONCLUSIONS The incidence of aSDH associated with SAH is low. Most of the patients with aSDH due to a ruptured aneurysm present in exceptionally poor neurological condition. Nevertheless, rapid surgical treatment of the hematoma and aneurysm obliteration can lead to a favorable outcome. Routine CTA should be performed in all patients presenting with an aSDH associated with SAH and no clear history of trauma.
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MESH Headings
- Adult
- Aged
- Angiography, Digital Subtraction
- Comorbidity
- Embolization, Therapeutic/instrumentation
- Embolization, Therapeutic/methods
- Emergency Medical Services/methods
- Female
- Glasgow Coma Scale
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/epidemiology
- Hematoma, Subdural, Acute/pathology
- Humans
- Incidence
- Intracranial Aneurysm/diagnostic imaging
- Intracranial Aneurysm/epidemiology
- Intracranial Aneurysm/pathology
- Male
- Middle Aged
- Neurosurgical Procedures/instrumentation
- Neurosurgical Procedures/methods
- Outcome Assessment, Health Care/methods
- Predictive Value of Tests
- Prognosis
- Prosthesis Implantation/methods
- Retrospective Studies
- Severity of Illness Index
- Surgical Instruments
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Surgical Procedures/instrumentation
- Vascular Surgical Procedures/methods
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Inselspital, University of Bern, 3010 Bern, Switzerland.
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24
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Boujemâa H, Góngora-Rivera F, Barragán-Campos H, Karachi K, Chiras J, Sourour N. Bilateral acute subdural hematoma from ruptured posterior communicating artery aneurysm. A case report. Interv Neuroradiol 2006; 12:37-40. [PMID: 20569549 DOI: 10.1177/159101990601200107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 02/15/2006] [Indexed: 11/17/2022] Open
Abstract
SUMMARY Brain tumors, hematological diseases and vascular malformations like fistulas or arteriovenous malformations are the most well known causes of non-traumatic subdural hematoma (SDH) (1). Although spontaneous subdural hematoma from ruptured intracranial aneurysm has been reported (2), SDH with non radiographic evidence of subarachnoid hemorrhage is very rare (3,4). Moreover, a patient with acute and bilateral spontaneous subdural hematoma secondary to ruptured left posterior communicating artery aneurysm has not been reported to date. The clinical findings and etiologic mechanisms are discussed.
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Affiliation(s)
- H Boujemâa
- Department of Neuroradiology, Pitié - Salpetrière Hospital; Paris, France -
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25
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Hori E, Ogiichi T, Hayashi N, Kuwayama N, Endo S. Case report: acute subdural hematoma due to angiographically unvisualized ruptured aneurysm. ACTA ACUST UNITED AC 2005; 64:144-6. [PMID: 16051008 DOI: 10.1016/j.surneu.2004.08.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 08/09/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND We report a case of acute subdural hematoma (SDH) due to angiographically unvisualized ruptured aneurysm. CASE DESCRIPTION A 57-year-old man presented with sudden-onset headache and nausea. Computed tomography revealed right acute SDH and cerebral angiography revealed no abnormal vessels, but at operation, we found an aneurysm arising from the precentral artery causing an acute SDH. CONCLUSION In a case of spontaneous acute SDH, the possibility of a cortical artery aneurysm should be considered even if no aneurysm is recognized at angiography.
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Affiliation(s)
- Emiko Hori
- Department of Neurosurgery, Toyama Medical and Pharmaceutical University, Toyama 930-0194, Japan.
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26
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Koerbel A, Ernemann U, Freudenstein D. Acute subdural haematoma without subarachnoid haemorrhage caused by rupture of an internal carotid artery bifurcation aneurysm: case report and review of literature. Br J Radiol 2005; 78:646-50. [PMID: 15961850 DOI: 10.1259/bjr/60601877] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spontaneous pure acute subdural haematoma (ASDH) without intraparenchymal or subarachnoid haemorrhage caused by a ruptured cerebral aneurysm is extremely rare. To our knowledge, the present case is the first report of an internal carotid artery bifurcation aneurysm presenting as pure ASDH. Suitable diagnostic investigations and therapeutic strategies are discussed. Arterial origin of bleeding should be considered in all cases of non-traumatic ASDH and a vascular anomaly has to be excluded. The neurological status on admission dictates the appropriate timing and methodology of the neuroradiological investigations.
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Affiliation(s)
- A Koerbel
- Department of Neurosurgery, University Hospital, Eberhard Karls University, D-72076 Tübingen, Germany
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27
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Hornyak M, Hillard V, Nwagwu C, Zablow BC, Murali R. Ruptured intrasellar superior hypophyseal artery aneurysm presenting with pure subdural haematoma. Case report. Interv Neuroradiol 2004; 10:55-8. [PMID: 20587264 DOI: 10.1177/159101990401000106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 02/03/2004] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Subdural haemorrhage from a ruptured intracranial aneurysm is a well-known entity when associated with subarachnoid haemorrhage. However, haemorrhage confined only to the subdural space is rare because there are limited anatomical sites where extravasation can be purely subdural. We report the rare case of a patient who suffered pure subdural haematoma after the rupture of a left superior hypophyseal artery aneurysm located within the sella turcica. The patient was treated with endovascular coil embolization of the aneurysm. Angiography immediately after treatment and one month later revealed complete obliteration of the aneurysm. Six months after treatment, the patient remained symptom free.
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Affiliation(s)
- M Hornyak
- Department of Neurosurgery, New York Medical College, Valhalla; New York, USA -
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