J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):302-305. 10.7461/jcen.2016.18.3.302.

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

• Lee YW
• Nam TM
• Kim JS
• Hong SC
• Yeon JY

• KMID: 2355659
• DOI: http://doi.org/10.7461/jcen.2016.18.3.302

Abstract

A 37-year-old woman was admitted to our hospital with altered mentality. The patient was diagnosed an internal carotid artery (ICA) dorsal wall aneurysm leading to acute subdural hemorrhage (SDH) without occurring subarachnoid hemorrhage and/or internal parenchymal hemorrhage. An aneurysmal neck clipping and hematoma evacuation were performed at once. A pure SDH by ruptured aneurysm is unusual, but it is important to consider it if a SDH patient has no other medical history.

Keyword

Pure subdural hemorrhage; Intracranial aneurysm; Internal carotid artery dorsal wall; Clipping

MeSH Terms

Adult
Aneurysm*
Aneurysm, Ruptured
Carotid Artery, Internal*
Female
Hematoma
Hematoma, Subdural*
Hemorrhage
Humans
Intracranial Aneurysm
Neck
Rupture*
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 Brain CT shows acute subdural hemorrhage causing 14 mm midline shifting and transtentorial herniation in the absence of subarachnoid hemorrhage. CT = computed tomography.

• 

  Fig. 2 CT angiography demonstrates an aneurysm (arrow) originating from the left internal carotid artery in close proximity to the anterior communicating artery complex. CT = computed tomography.

• 

  Fig. 3 An operative view of rotational 3D angiography shows a large right-angled aneurysm arising from the dorsal wall of the left internal carotid artery.

• 

  Fig. 4 An intraoperative photo reveals the AN, ICA, ON, and thick clots covering the aneurysm dome. Note that there is no evidence of subarachnoid hemorrhage around the aneurysm neck (arrowheads). AN = aneurysm; ICA= internal carotid artery; ON = optic nerve.

• 

  Fig. 5 An intraoperative photo obtained after neck clipping and clot removal demonstrates the aneurysm dome (AN) breaking through the gyrus rectus. An arrow indicates the presumed ruptured point. ICA = internal carotid artery.

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