Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Acute Spontaneous Subdural Hematoma due to Rupture of a Tiny Cortical Arteriovenous Malformation

  • Choi, Hyuk Jin (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Lee, Jae Il (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Nam, Kyoung Hyup (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Ko, Jun Kyeung (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2014.04.24
  • Accepted : 2015.01.08
  • Published : 2015.12.28
Download PDF
⟨ Previous Next ⟩

Abstract

Acute subdural hematoma (SDH) of arterial origin is rare, especially SDH associated with an arteriovenous malformation (AVM) is extremely rare. The authors report a case of acute spontaneous SDH due to rupture of a tiny cortical AVM. A 51-year-old male presented with sudden onset headache and mentality deterioration without a history of trauma. Brain CT revealed a large volume acute SDH compressing the right cerebral hemisphere with subfalcine and tentorial herniation. Emergency decompressive craniectomy was performed to remove the hematoma and during surgery a small (5 mm sized) conglomerated aciniform mass with two surrounding enlarged vessels was identified on the parietal cortex. After warm saline irrigation of the mass, active bleeding developed from a one of the vessel. The bleeding was stopped by coagulation and the vessels were removed. Histopathological examination confirmed the lesion as an AVM. We concluded that a small cortical AVM existed at this area, and that the cortical AVM had caused the acute SDH. Follow up conventional angiography confirmed the absence of remnant AVM or any other vascular abnormality. This report demonstrates rupture of a cortical AVM is worth considering when a patient presents with non-traumatic SDH without intracerebral hemorrhage or subarachnoid hemorrhage.

Keywords

References

  1. Byun HS, Patel PP : Spontaneous subdural hematoma of arterial origin : report of two cases. Neurosurgery 5 : 611-613, 1979 https://doi.org/10.1227/00006123-197911000-00013
  2. Datta NN, Chan KY, Kwok JC, Poon CY : Posterior fossa subdural hematoma due to ruptured arteriovenous malformation. Case report. Neurosurg Focus 8 : ecp1, 2000
  3. Drake CG : Subdural haematoma from arterial rupture. J Neurosurg 18 : 597-601, 1961 https://doi.org/10.3171/jns.1961.18.5.0597
  4. Ernestus RI, Beldzinski P, Lanfermann H, Klug N : Chronic subdural hematoma : surgical treatment and outcome in 104 patients. Surg Neurol 48 : 220-225, 1997 https://doi.org/10.1016/S0090-3019(97)80031-6
  5. Guazzo EP, Xuereb JH : Spontaneous thrombosis of an arteriovenous malformation. J Neurol Neurosurg Psychiatry 57 : 1410-1412, 1994 https://doi.org/10.1136/jnnp.57.11.1410
  6. Kondziolka D, Bernstein M, ter Brugge K, Schutz H : Acute subdural hematoma from ruptured posterior communicating artery aneurysm. Neurosurgery 22 (1 Pt 1) : 151-154, 1988 https://doi.org/10.1227/00006123-198801000-00029
  7. Matsumura H, Makita Y, Someda K, Kondo A : Arteriovenous malformations in the posterior fossa. J Neurosurg 47 : 50-56, 1977 https://doi.org/10.3171/jns.1977.47.1.0050
  8. McCormick WF, Hardman JM, Boulter TR : Vascular malformations ("angiomas") of the brain, with special reference to those occurring in the posterior fossa. J Neurosurg 28 : 241-251, 1968 https://doi.org/10.3171/jns.1968.28.3.0241
  9. McDermott M, Fleming JF, Vanderlinden RG, Tucker WS : Spontaneous arterial subdural hematoma. Neurosurgery 14 : 13-18, 1984 https://doi.org/10.1227/00006123-198401000-00004
  10. Sambasivan M : An overview of chronic subdural hematoma : experience with 2300 cases. Surg Neurol 47 : 418-422, 1997 https://doi.org/10.1016/S0090-3019(97)00188-2

Cited by

  1. Acute Subdural Hematomas in Ruptured Brain Arteriovenous Malformations: Association with Distal Flow-Related Aneurysms vol.30, pp.2, 2020, https://doi.org/10.1007/s00062-019-00771-7
  2. Glioblastoma Presenting as Spontaneous Subdural Hematoma vol.7, pp.2, 2015, https://doi.org/10.21129/nerve.2021.7.2.110