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

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.

Subarachnoid Hemorrhage with Subdural Hematoma due to Ruptured De Novo Aneurysm after Aneurysmal Clipping via Pterional Approach: An Autopsy Case

“…Most ruptures of intracranial aneurysm are SAH and complicated with intracerebral and intraventricular hemorrhage. However, aneurysmal rupture sometimes causes SAH with SDH or only SDH [2][3][4][5]. Three mechanisms were proposed to explain aneurysmal SAH with SDH.…”

A Importância do Conhecimento das Patologias Neurocirúrgicas na Perícia Médico Legal

“…A hemorragia intracraniana consequente à ruptura de um aneurisma cerebral é frequentemente observada como uma hemorragia subaracnóide (60%), hematoma intracerebral (30-40%) ou sangramento intraventricular (12-19%) 8,9 . O quadro clínico clássico diante desta circunstância é descrito como cefaleia intensa súbita, perda de consciência e rigidez de nuca, dados semelhantes ao que foi descrito no relatório médico do caso apresentado 5,8 .…”

“…O hematoma subdural não traumático é extremamente raro, e, assim como o hematoma subdural agudo espontâneo, é uma manifestação incomum de aneurisma cerebral, com incidência variando de 0,5-8% 8,9 .…”

Pure tentorial subdural hematoma from rupture of aneurysm along the transmastoid branches of the occipital artery

“…Rupture of an intracranial aneurysm predominantly leads to subarachnoid hemorrhage (SAH), with frequent associations with intraparenchymal hematoma (IPH) or intraventricular hemorrhage (IVH). [ 10 ] Seldom, an acute subdural hematoma (SDH) can also accompany SAH. According to the literature, the incidence of SDH due to aneurysmal rupture varies up to 10%.…”

“…According to the literature, the incidence of SDH due to aneurysmal rupture varies up to 10%. [ 2 9 10 ] On the other hand, pure SDH, without other types of hemorrhage (IVH, IPH, or SAH), from a ruptured aneurysm is rare. Approximately 40 such cases have been reported.…”