Pure Acute Subdural Hematoma without Subarachnoid Haemorrhage Caused by Rupture of Distal Anterior Cerebral Artery Aneurysm / 대한뇌혈관외과학회지

ABSTRACT

A 64-year-old female presented with unconscious state after sudden onset headache, nausea and vomiting. Computed tomography showed acute subdural hematoma (SDH) over the left convexity without subarachnoid hemorrhage. 3D-CT angiogram showed a saccular aneurysm at the junction of A2-A3 of the left anterior cerebral artery. Surgery for decompressive craniotomy and aneurysmal neck clipping was performed. In operative field, the left distal anterior cerebral artery was abnormally elongated toward the frontal pole and located not in the pericallosal cistern but on the cortical surface and the rupturing point was located in the adhesive portion of aneurysmal sac and arachnoid membrane near the falx. Pure acute SDH without subarachnoid hemorrhage (SAH) caused by ruptured aneurysm is extremely rare. Rupture of an aneurysm adhered to either the dura or falx and located in the subdural space may cause pure SDH. In our case, abnormally elongated location of artery may be related to this adhesion and rupture of aneurysm to subdural space. Therefore, ruptured intracranial aneurysm should be considered as a cause of non-traumatic SDH. Immediate removal of the SDH and aneurysmal clipping is recommended in such patients, even those in poor neurological condition.