Acute Pure Spontaneous Subdural Haematoma from Ruptured Intracranial Aneurysms

Abstract

<jats:p> Acute subdural haematoma (ASDH) is rarely caused by an aneurysmal rupture. We report four cases of pure acute subdural haematomas caused by ruptured intracranial aneurysms. Aneurysms were localized in the posterior communicating artery in two cases, in the anterior communicating artery in one case and in the middle cerebral artery in one other case. Possible mechanisms for this type of aneurysmal bleeding are discussed. A good prognosis for these patients can be expected with rapid evacuation of the haematoma (in case of high intracranial pressure and midline structure shift), and treatment of the aneurysm (surgical clipping or endovascular treatment). </jats:p><jats:p> Our report demonstrates the utility of angiography in the evaluation of nontraumatic acute subdural haematomas. Angiography has to be performed before haematoma evacuation or just after if the patient requires urgent surgery in case of intracranial hypertension. Aneurysms may require surgical clipping or endovascular treatment. </jats:p>

Pure subdural haematoma caused by rupture of middle cerebral artery aneurysm: Case report and literature review

“…An additional 40 similar cases of pure subdural haematoma caused by intracranial aneurysm have been reported since 1980 (Table 1). [3][4][5][6][7][8] The average age at presentation was 46.6 years, with 27/41 patients (65.9%) being female. The site of aneurysm included ICA-posterior communicating artery (PcomA; 16 cases, 39.0%), MCA (10 cases, 24.4%; including the present case), anterior communicating artery (AcomA; six cases, 14.6%), distal ACA (four cases, 9.8%) and other sites (five cases, 12.2%).…”

“…The rarity of this condition can lead to delays in diagnosis and treatment, as occurred in the present case. 4,7,26,30,31 In addition, the mild symptoms (which may occur several days before admission) are unusual for aneurysm rupture, and intracranial aneurysm bleeding is often ruled out in the absence of subarachnoid haemorrhage. Aneurysm rupture should be strongly considered, however, if a patient presents with a pure subdural haematoma without history of trauma or coagulopathy.…”

“…Pure subdural haematoma (occurring without detectable subarachnoid haemorrhage) caused by intracranial aneurysm rupture is uncommon. 3,4 We report a case of pure subdural haematoma secondary to MCA aneurysm rupture.…”

Pure Subdural Hemorrhage Caused by Internal Carotid Artery Dorsal Wall Aneurysm Rupture

“…Occasionally, aneurysm rupture may accompany acute subdural hemorrhage (SDH) 15). However, pure SDH occurring without detectable SAH is very unusual 2)13). We report a case of pure SDH secondary to internal carotid artery (ICA) dorsal wall aneurysm rupture.…”

Rupture of distal anterior cerebral artery aneurysm presenting only subdural hemorrhage without subarachnoid hemorrhage: a case report

“…Aneurysm rupture usually presents as a subarachnoid hemorrhage (SAH), often in combination with intracerebral hemorrhage (ICH) and extension into the ventricle (intraventricular hemorrhage, IVH) (Barton and Tudor 1982 ; Mansour et al 2014 ). In rare cases, acute subdural hematoma (aSDH) combined with SAH due to aneurysm rupture has been reported (Biesbroek et al 2012 , 2013 ; Kocak et al 2009 ; Marbacher et al 2010 ; Nozar et al 2002 ), with only a few cases reported since the first case was reported in 1855 (Kocak et al 2009 ; Marbacher et al 2010 ). According to the literature, the incidence of aSDH due to aneurysmal rupture varies from 0.5 to 22 % (Barton and Tudor 1982 ; Biesbroek et al 2012 ; Marbacher et al 2010 ).…”