Abstract
Spontaneous pure acute bilateral subdural haematoma (ASDH) without intraparenchymal or subarachnoid haemorrhage caused by a ruptured cerebral aneurysm is extremely rare. It can follow rupture of different aneurysms specially located in anterior incisural space; the most frequently encountered location is the PcoA aneurysms as demonstrated in the present case. We present a case report of a PcoA aneurysm presenting as pure bilateral ASDH. A high level of suspicion for bleeding of arterial origin should be maintained in all cases of acute subdural haematoma without history of trauma. The neurological status on admission dictates the appropriate timing and methodology of the neuroradiological investigations.
Highlights
In the majority of cases, acute subdural haematomas (ASDHs) are related to head trauma and are typically caused by disruption of superficial cerebral or cortical bridging veins
We report a case of a spontaneous bilateral pure ASDH due to rupture of an aneurysm of the left posterior communicating aneurysm (PcoA) with reviewing of literature
ASDHs develop spontaneously in patients without history of trauma or coagulopathy and an aneurysm rupture is responsible for the majority of such cases with incidence of about 0.5% to 7.9% [3,4,5,6]
Summary
In the majority of cases, acute subdural haematomas (ASDHs) are related to head trauma and are typically caused by disruption of superficial cerebral or cortical bridging veins. Arteriovenous malformations [1], cocaine abuse [1], and many other causes have been proposed for this pathology [2]. Hemorrhage of aneurysms often presents as subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH); the ASDH is rare. ASDHs constitute neurosurgical emergencies and immediate treatment must be conducted before neurological deficits become irreversible. We report a case of a spontaneous bilateral pure ASDH due to rupture of an aneurysm of the left posterior communicating aneurysm (PcoA) with reviewing of literature
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