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

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.

Subdural hematoma caused by rupture of a posterior cerebral artery aneurysm

“…But the clinical incidence of SDH complication is very low, which was reported to be 0.5-7.9% 1,2. And the most frequently reported site of aneurysm location is the internal carotid artery (ICA)-posterior communicating artery, which is followed by aneurysms of middle cerebral artery and distal anterior cerebral artery 2,5.…”

“…Several mechanisms have been proposed to explain the occurrence of SDH after aneurysm rupture:1,2,5,6 1)Successive minor bleedings case the developing of adhesions, resulting in final rupture into the subdural space; 2) high-pressure hemorrhage may lead to rapid accumulation of blood from the leaking aneurysm, rupturing the arachnoid membrane; 3) intracerebral hemorrhage may rupture through the cortex and cause a tear of the arachnoid membrane; 4) a carotid artery aneurysm arising from the part of carotid artery within the subdural space may rupture and cause subdural hematoma directly; and 5) the acute enlargement of the intracavernous aneurysm may erode the cavernous sinus wall. As in this case, the patient had suffered headache since 4 days before he was admitted to hospital, this warning sign may reflect the presence of successive small bleedings.…”

“…Subdural hematoma secondary to intracranial aneurysm rupture is uncommon, which account for 0.5-7.9% of all intracranial aneurysm rupture 1,2. Aneurysms of the posterior cerebral artery (PCA) comprise approximately 0.7-2.9% of all intracranial aneurysms 3,4.…”

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

“…Gong et al4) reviewed 40 similar cases of pure subdural hematoma caused by intracranial aneurysm have been reported since 1980. The site of aneurysm included ICA-posterior communicating artery (PcomA : 16 cases) MCA (10 cases) anterior communicating artery (AcomA : 6 cases) distal ACA (4 cases).…”

Subdural Hematoma without Subarachnoid Hemorrhage Caused by the Rupture of Middle Cerebral Artery Aneurysm

“…Spontaneous pure ASDH without concomitant SAH due to the rupture of a cerebral aneurysm is extremely rare and only 40 cases were reported between 1981 and 2012 9)23)35). We report a case of spontaneous ASDH without evidence of SAH caused by a ruptured aneurysm at the middle cerebral artery (MCA) bifurcation, presenting with repeated sentinel headaches.…”