J Korean Neurosurg Soc.  2012 Feb;51(2):91-93. 10.3340/jkns.2012.51.2.91.

Acute Spontaneous Subdural Hematoma of Arterial Origin

• Sung SK
• Kim SH
• Son DW
• Lee SW

• KMID: 1441416
• DOI: http://doi.org/10.3340/jkns.2012.51.2.91

Abstract

Acute spontaneous subdural hematoma (SDH) of arterial origin is very rare. We report a case of acute spontaneous SDH that showed contrast media extravasation from cortical artery on angiograms. A 58-year-old male patient developed sudden onset headache and right hemiparesis. Brain CT scan demonstrated acute SDH at left convexity. The patient was drowsy mentality on admission. He had no history of head trauma. Cerebral angiography was performed and revealed a localized extravasation of the contrast media from distal cortical MCA branch. After angiography, the patient deteriorated to comatose mentality. Decompressive craniectomy for removal of SDH was performed. We verified the arterial origin of the bleeding and coagulated the bleeding focus. The histological diagnosis was aneurysmal artery. He recovered after surgery with mild disability. In a case of acute spontaneous SDH, the possibility of a cortical artery origin should be considered.

Keyword

Acute subdural hematoma; Spontaneous; Cortical artery

MeSH Terms

Aneurysm
Angiography
Arteries
Brain
Cerebral Angiography
Coma
Contrast Media
Craniocerebral Trauma
Decompressive Craniectomy
Extravasation of Diagnostic and Therapeutic Materials
Headache
Hematoma, Subdural
Hematoma, Subdural, Acute
Hemorrhage
Humans
Male
Middle Aged
Paresis
Contrast Media

Figure

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  Fig. 1 Computed tomography scan on admission (A) and after angiograph (B) revealing left acute subdural hematoma and shift of the midline structures.

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  Fig. 2 Left carotid angiography, an extravasation of contrast medium from a branch of distal middle cerebral artery in noted (arrow).

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  Fig. 3 Operative magnified view showing a small round shape hole at cortical artery, which projects out blood (arrow).

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  Fig. 4 Photomicrographs of the cortical arterial wall shows thining of tunica media and degenerative change of tunica intima. HE stain, original magnification ×100 (A) and ×400 (B).

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