Acute subdural hematomas due to rupture of cortical arteries: A study of the points of rupture in 19 cases

Abstract

Several cases of acute subdural hematomas (ASDHs) due to rupture of cortical arteries are reported. They have several characteristic features: (1) their outcome is relatively good; (2) the cause is a trivial head injury; (3) patients are elderly; (4) a lucid interval is recognized; (5) hypertension is associated in many cases; and (6) cerebral contusion is absent. However, there has been no report about the points of rupture in the cortical arteries. In 19 of the 125 patients with ASDHs admitted to our department, the cause of ASDH was bleeding from cortical arteries. The bleeding points were detected at surgery. Cases associated with cerebral contusion during or after the operation were excluded. In this article, we describe the clinical findings and the sites of bleeding from arteries in 19 cases of ASDH due to rupture of cortical arteries. The sites of ruptured arteries were as follows: prefrontal artery in one of 23 identified arteries (4.3%); precentral artery in five (21.7%); central artery in four (17.3%); anterior parietal artery in four (17.3%); angular artery in three (13.0%); middle temporal artery in four (17.3%); and posterior temporal artery in two arteries (8.7%). Two ruptured arteries in the same craniotomy were observed in four patients (17.3%). All points of rupture were located near the sylvian fissure (within 3 cm length around the sylvian fissure) and none in the base or vertex of the brain. If an ASDH occurs following a trivial head injury, rupture of cortical arteries should be considered as a possible cause. Wide craniotomy sufficiently covering the region surrounding the sylvian fissure should be performed to obtain hemostasis of bleeding points.