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Case Reports
. 2016 May 12;3(3):63-66.
doi: 10.2176/nmccrj.cr.2015-0151. eCollection 2016 Jul.

Nontraumatic Pure Acute Subdural Hematoma Caused by a Ruptured Cortical Middle Cerebral Artery Aneurysm: Case Report and Literature Review

Kentaro Awaji  1 , Ryota Inokuchi  1 , Ritsuko Ikeda  2 , Toshihiko Haisa  2
Affiliations
Case Reports

Nontraumatic Pure Acute Subdural Hematoma Caused by a Ruptured Cortical Middle Cerebral Artery Aneurysm: Case Report and Literature Review

Kentaro Awaji et al. NMC Case Rep J. .

Abstract

Nontraumatic or "spontaneous" acute subdural hematoma (SDH) is rare, and "pure" acute SDH without subarachnoid hemorrhage (SAH) due to aneurysmal rupture is extremely rare. We report a case of nontraumatic pure acute SDH caused by the rupture of a cortical middle cerebral artery (MCA) aneurysm. A 43-year-old man with no antecedents, except hypertension, presented to the emergency department with acute-onset moderate headache and nausea after swimming. He reported neither preceding head trauma nor dental check-up. Neurological examinations and laboratory tests were unremarkable. Computed tomography (CT) showed an acute SDH on the left convexity without SAH, but both magnetic resonance (MR) angiography and three-dimensional CT (3D-CT) angiography disclosed no vascular abnormality. As he became drowsy, the patient emergently underwent an evacuation of the SDH. Unexpectedly, a small saccular aneurysm of a cortical branch of the left MCA was recognized at surgery. Although indocyanine green (ICG) angiography revealed this aneurysm was thrombosed, a clip was applied on the aneurysmal base. He was discharged home without any complications 21 days after admission. To seek the cause of nontraumatic acute SDH, supplementary examinations including 3D-CT, MR, and/or catheter angiography are necessary. Even if angiography reveals no vascular lesions, the present case warrants that the cortical surface should be meticulously inspected at surgery, because a thrombosed cortical artery aneurysm might be an underlying cause.

Keywords: acute subdural hematoma; cerebral aneurysm; middle cerebral artery.

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Conflict of interest statement

Conflicts of Interest Disclosure The authors have no disclosure to report. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices in the article. All authors who are members of The Japan Neurosurgical Society (JNS) have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members.

Figures

Fig. 1.
Fig. 1.
Axial computed tomography scan of the head showing a subdural hematoma on the left convexity.
Fig. 2.
Fig. 2.
A: Intraoperative photograph demonstrating a saccular aneurysm of a cortical branch of the left middle cerebral artery (arrow). B: Indocyanine green (ICG) angiography showing the aneurysm is thrombosed. C: ICG angiography showing the aneurysm is successfully clipped.
Fig. 3.
Fig. 3.
Postoperative left internal carotid angiograms, lateral view. A: Digital subtraction angiogram revealing no vascular abnormalities. B: Digital angiogram of the square area showing the clip.
See this image and copyright information in PMC

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