Acute subdural hematoma from ruptured posterior communicating artery aneurysm

Abstract

Acute spontaneous subdural hematoma is infrequent in association with rupture of intracranial saccular aneurysm. In the majority of cases, aneurysms of the middle cerebral artery along the convexity or of the anterior cerebral artery along the interhemispheric fissure are found to be the culprits. We present two recent cases of internal carotid-posterior communicating artery aneurysms causing acute subdural hematoma with little or no subarachnoid hemorrhage and discuss the possible mechanisms for this occurrence.

Spontaneous Acute Subdural Hemorrhage with Rupture of Intracranial Aneurysm: A Series of Two Cases and Review of Literature

“…[5][6][7][8][9][10][11] The three mechanisms are postulated for isolated. First, an aneurysm adherent to the arachnoid may bleed directly into the subdural space.…”

“…Third, aneurysms arising from part of carotid lying in subdural space will eventually cause SDH after rupture. 3,8 Barton and Tudor 3 studied various aneurysm locations contributing to SDH associated with aneurysmal bleed and SAH; 34.4% of SDH were due to anterior cerebral/A-Comm aneurysm bleeds. Although previous reports by Strang et al 2 in 1961 showed 17% of such cases associated with A-Comm/ anterior cerebral artery aneurysmal bleeds, the present cases exemplify the significance of aneurysmal etiology of nontraumatic SDH.…”

Anonimo: A V.I.P. Meeting

“…First theory: successive small bleeding or sentinel hemorrhages can cause the adhesion of the aneurysm to the adjacent arachnoid membrane, and the final rupture occurs into the subdural spaces 7 . Second theory: the stream of blood may rupture through the arachnoid membrane at some distant weak-point 12,13 . Lastly, the subdural hematoma may develop secondary to the decompression of an intracerebral hematoma into the subdural space following disruption of the arachnoid covering the cerebral cortex 18 .…”

“…Some cases with acute unilateral SDH due to ruptured IC-PC aneurysms have been reported 3,13,19 . The adhesion of the fundus of the IC-PC aneurysm with the tentorium cerebelli should permit the extension of the hemorrhage into the subdural space without SAH 3 .…”

Acute Subdural Hematoma Without Subarachnoid Hemorrhage Caused by Ruptured A1-A2 Junction Aneurysm

“…3,7,15,16,20,28) Spontaneous pure ASDH is extremely rare without common subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) due to cerebral aneurysm rupture, with only 29 reported cases (Table 1). Several mechanisms have been proposed to explain the occurrence of ASDH associated with aneurysm rupture, but little definite evidence of such mechanisms is known.…”