J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):315-321. 10.7461/jcen.2016.18.3.315.

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

• Han J
• Lim DJ
• Kim SD
• Ha SK
• Lee SH
• Kim SH

• KMID: 2355661
• DOI: http://doi.org/10.7461/jcen.2016.18.3.315

Abstract

Pure subdural hematomas caused by a ruptured intracranial aneurysm are extremely rare. We describe the case of a 42-year-old woman who presented with headache without evidence of head trauma. Magnetic resonance angiography and conventional cerebral angiography revealed a ruptured aneurysm at the right middle cerebral artery bifurcation. The patient underwent surgical treatment and had a good outcome without any neurological deficit. The mechanisms and clinical characteristics of this condition are discussed.

Keyword

Cerebral aneurysm; Subdural hematoma; Middle cerebral artery

MeSH Terms

Adult
Aneurysm, Ruptured
Cerebral Angiography
Craniocerebral Trauma
Female
Headache
Hematoma, Subdural*
Humans
Intracranial Aneurysm*
Magnetic Resonance Angiography
Middle Cerebral Artery*
Rupture*
Subarachnoid Hemorrhage*

Figure

• 

  Fig. 1 Initial brain imaging findings of case. Computed tomography scans (A, B) shows no evidence of subarachnoid hemorrhage at the basal cistern and the sylvian fissure and there is only acute subdural hematoma on the right fronto-temporo-parietal area.

• 

  Fig. 2 Magnetic resonance angiography (A, B; white arrows) and conventional cerebral angiography (C, D; white arrows) show the presence of the right middle cerebral artery bifurcation aneurysm extending antero-inferiorly and laterally.

• 

  Fig. 3 Intraoperative photographs shows the aneurysmal sac penetrating into subdural space (A; white arrow). Permanent 7 mm straight mini-clip was introduced to the neck portion of the aneurysm successfully (B).

• 

  Fig. 4 Follow-up computed tomography angiography 1-year after the operation. The clip is observed in the source image of the computed tomography angiography (A), and there was no evidence of the remnant aneurysm (A, B).

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