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Case Reports
. 2014 Jul-Sep;9(3):165-7.
doi: 10.4103/1793-5482.142738.

Chronic subdural hematoma associated with moyamoya disease

Satoru Takeuchi  1 , Hiroshi Nawashiro  1 , Yoichi Uozumi  1 , Naoki Otani  1 , Hideo Osada  1 , Kojiro Wada  1 , Katsuji Shima  1
Affiliations
Case Reports

Chronic subdural hematoma associated with moyamoya disease

Satoru Takeuchi et al. Asian J Neurosurg. 2014 Jul-Sep.

Abstract

Chronic subdural hematomas (SDHs) associated with non-operated moyamoya disease are extremely rare. A 68-year-old woman underwent burr-hole surgery for a right SDH, which resolved completely. On day 3, however, the patient suffered cerebral infarction in the right parietal lobe. Cerebral angiography demonstrated total occlusion of the bilateral internal carotid arteries with transdural anastomoses via branches of the right occipital artery and middle meningeal artery, feeding the left parietal cortex. A branch of the right middle meningeal artery passed near the burr hole, but was preserved. The patient was diagnosed of moyamoya disease. We thought that the main cause of chronic SDH might be the disruption of transdural anastomoses. Furthermore, we also hypothesized that we might have coagulated the small vessels of the transdural anastomoses which were undetectable by postoperative angiography, and that cerebral infarction might occur.

Keywords: Burr-hole surgery; cerebral infarction; chronic subdural hematoma; moyamoya disease; transdural anastomosis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Head computed tomography scan on admission showing a chronic SDH in the right frontoparietal region; (b) Diffusion-weighted magnetic resonance imaging on day 11 showing elevated diffusion coefficients with high signal intensity in the right parietal cortex
Figure 2
Figure 2
Left (a); and right (b) carotid angiography (lateral view) on day 19 showing occlusion of the top of the bilateral internal carotid arteries, with ethmoidal moyamoya vessels
Figure 3
Figure 3
Right external carotid angiography (anterolateral views) demonstrating transdural anastomoses via branches of the right occipital artery and middle meningeal artery, feeding the left parietal cortex. (a) Early phase; (b) Late phase. Note the branch of the middle meningeal artery (arrow), occipital artery (arrow head), and the transdural anastomosis feeding the left parietal cortex (large arrow)
Figure 4
Figure 4
(a) Right external carotid angiography (lateral view) demonstrating that a branch of the right middle meningeal artery passes near a point of the burr hole, but is preserved; (b) Enlargement of the square area. Note the margin of the burr hole (circle), branch of the middle meningeal artery (arrow), and branch of the superficial temporal artery (arrow head)
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