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

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.

Infratentorial retroclival and tentorial subdural hematoma from posterior communicating artery aneurysm rupture: A case report and systematic review of literature

“…[4] Others in the past have estimated the incidence of mixed AnSDH/SAH to be anywhere from 0.5% to 7.9%. [1] e incidence of isolated AnSDH is certainly much lower and only represented in the literature in case reports and small case series PcomA location is a recurrent theme among risk factors for developing SDH following aneurysmal rupture. [2] Hypotheses for SDH formation Multiple hypotheses have been proposed but the most common involves the formation of adhesions between the aneurysmal wall, arachnoid membrane, and dura.…”

“…[ 7 ] Only three studies were identified that met the inclusion criteria of having an aSDH involving the infratentorial fossa with no associated SAH [ Figure 1 ]. [ 1 , 5 , 6 ] The age, sex, race, comorbidities, hematoma location, radiographic data, clinical presentation, medical and surgical management, complications, and outcomes were analyzed and are presented in Table 1 .…”

“…Kim et al [5] 83/F PcoA Al-Abdulwahhab et al [1] 34/F PcoA through smaller aneurysmal wall defects in the direction of the arachnoid membrane produces a high-velocity flow that could perforate into the subdural space. [3] is mechanism is theoretically more likely to result in concurrent SAH.…”

“…In our case, as well as in the Al-Abdulwahhab et al in Table 1, the SDH had both tentorial and clival or spinal components. [1] possible rupture points could have been the petroclinoid ligaments and/or the tentorial edge. is contrasts with the other two infratentorial PcomA AnSDH cases shown in Table 1 which presented with purely clival SDHs.…”

“…However, a pure acute SDH, without associated SAH, in the infratentorial compartment is very rare entity. [ 1 , 5 , 6 ] Given the rarity of this presentation, the clinical sequelae as well as the prognosis have not been well elucidated in the literature. We present a case of a ruptured posterior communicating artery (PcomA) aneurysm presenting with isolated and infratentorial AnSDH and provide a systematic review of to identify presentation, management, and outcomes of infratentorial AnSDH.…”