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http://dx.doi.org/10.3340/jkns.2011.50.1.6

Clinical Features of Acute Subdural Hematomas Caused by Ruptured Intracranial Aneurysms  

Oh, Se-Yang (Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea)
Kwon, Jeong-Taik (Department of Neurosurgery, College of Medicine, Chung-Ang University)
Park, Yong-Sook (Department of Neurosurgery, College of Medicine, Chung-Ang University)
Nam, Taek-Kyun (Department of Neurosurgery, College of Medicine, Chung-Ang University)
Park, Seung-Won (Department of Neurosurgery, College of Medicine, Chung-Ang University)
Hwang, Sung-Nam (Department of Neurosurgery, College of Medicine, Chung-Ang University)
Publication Information
Journal of Korean Neurosurgical Society / v.50, no.1, 2011 , pp. 6-10 More about this Journal
Abstract
Objective : Spontaneous acute subdural hematomas (aSDH) secondary to ruptured intracranial aneurysms are rarely reported. This report reviews the clinical features, diagnostic modalities, treatments, and outcomes of this unusual and often fatal condition. Methods : We performed a database search for all cases of intracranial aneurysms treated at our hospital between 2005 and 2010. Patients with ruptured intracranial aneurysms who presented with aSDH on initial computed tomography (CT) were selected for inclusion. The clinical conditions, radiologic findings, treatments, and outcomes were assessed. Results : A total of 551 patients were treated for ruptured intracranial aneurysms during the review period. We selected 23 patients (4.2%) who presented with spontaneous aSDH on initial CT. Ruptured aneurysms were detected on initial 3D-CT angiography in all cases. All ruptured aneurysms were located in the anterior portion of the circle of Willis. The World Federation of Neurosurgical Societies grade on admission was V in 17 cases (73.9%). Immediate decompressive craniotomy was performed 22 cases (95.7%). Obliteration of the ruptured aneurysm was achieved in all cases. The Glasgow outcome scales for the cases were good recovery in 5 cases (21.7%), moderate disability to vegetative in 7 cases (30.4%), and death in 11 cases (47.8%). Conclusion : Spontaneous aSDH caused by a ruptured intracranial aneurysm is rare pattern of aneurysmal subarachnoid hemorrhage. For early detection of aneurysm, 3D-CT angiography is useful. Early decompression with obliteration of the aneurysm is recommended. Outcomes were correlated with the clinical grade and CT findings on admission.
Keywords
Acute subdural hematoma; Subarachnoid hemorrhage; Intracranial aneurysm; CT angiography;
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1 Yuh EL, Gean AD, Manley GT, Callen AL, Wintermark M : Computer-aided assessment of head computed tomography (CT) studies in patients with suspected traumatic brain injury. J Neurotrauma 25 : 1163-1172, 2008   DOI   ScienceOn
2 Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, et al. : The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 9 Suppl 1 : S287-S292, 1992
3 McLaughlin MR, Jho HD, Kwon Y : Acute subdural hematoma caused by a ruptured giant intracavernous aneurysm : case report. Neurosurgery 38 : 388-392, 1996   DOI
4 Meyer F, Sandvoss G : Acute subdural hematoma associated with nontraumatic aneurysm rupture. Zentralbl Neurochir 58 : 66-70, 1997
5 Missori P, Fenga L, Maraglino C, Rocchi G, Nardacci B, Calderaro G, et al. : Spontaneous acute subdural hematomas. A clinical comparison with traumatic acute subdural hematomas. Acta Neurochir (Wien) 142 : 697-701, 2000   DOI   ScienceOn
6 Nizzoli V, Brambilla P, Tonnarelli GP : Acute subdural hematoma. Spontaneous forms of arterial origin. Eur Neurol 20 : 4-8, 1981   DOI   ScienceOn
7 Nonaka Y, Kusumoto M, Mori K, Maeda M : Pure acute subdural haematoma without subarachnoid haemorrhage caused by rupture of internal carotid artery aneurysm. Acta Neurochir (Wien) 142 : 941-944, 2000   DOI   ScienceOn
8 Nowak G, Schwachenwald S, Kehler U, Muller H, Arnold H : Acute subdural haematoma from ruptured intracranial aneurysms. Acta Neurochir (Wien) 136 : 163-167, 1995   DOI
9 O'Sullivan MG, Whyman M, Steers JW, Whittle IR, Miller JD : Acute subdural haematoma secondary to ruptured intracranial aneurysm : diagnosis and management. Br J Neurosurg 8 : 439-445, 1994   DOI   ScienceOn
10 Rengachary SS, Szymanski DC : Subdural hematomas of arterial origin. Neurosurgery 8 : 166-172, 1981   DOI
11 Triantafyllopoulou A, Beaumont A, Ulatowski J, Tamargo RJ, Varelas PN : Acute subdural hematoma caused by an unruptured, thrombosed giant intracavernous aneurysm. Neurocrit Care 5 : 39-42, 2006   DOI   ScienceOn
12 Villablanca JP, Hooshi P, Martin N, Jahan R, Duckwiler G, Lim S, et al. : Three-dimensional helical computerized tomography angiography in the diagnosis, characterization, and management of middle cerebral artery aneurysms : comparison with conventional angiography and intraoperative findings. J Neurosurg 97 : 1322-1332, 2002   DOI   ScienceOn
13 Weir B, Myles T, Kahn M, Maroun F, Malloy D, Benoit B, et al. : Management of acute subdural hematomas from aneurysmal rupture. Can J Neurol Sci 11 : 371-376, 1984   DOI
14 Anderson GB, Steinke DE, Petruk KC, Ashforth R, Findlay JM : Computed tomographic angiography versus digital subtraction angiography for the diagnosis and early treatment of ruptured intracranial aneurysms. Neurosurgery 45 : 1315-1320; discussion 1320-1312, 1999   DOI   ScienceOn
15 Barton E, Tudor J : Subdural haematoma in association with intracranial aneurysm. Neuroradiology 23 : 157-160, 1982
16 Clarke E, Walton JN : Subdural haematoma complicating intracranial aneurysm and angioma. Brain 76 : 378-404, 1953   DOI   ScienceOn
17 Dehdashti AR, Rufenacht DA, Delavelle J, Reverdin A, de Tribolet N : Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography. Br J Neurosurg 17 : 46-53, 2003   DOI
18 Gelabert-Gonzalez M, Iglesias-Pais M, Fernandez-Villa J : Acute subdural haematoma due to ruptured intracranial aneurysms. Neurosurg Rev 27 : 259-262, 2004
19 Hatayama T, Shima T, Okada Y, Nishida M, Yamane K, Okita S, et al. : [Ruptured distal anterior cerebral artery aneurysms presenting with acute subdural hematoma : report of two cases]. No Shinkei Geka 22 : 577-582, 1994
20 Hop JW, Rinkel GJ, Algra A, van Gijn J : Case-fatality rates and functional outcome after subarachnoid hemorrhage : a systematic review. Stroke 28 : 660-664, 1997   DOI   ScienceOn
21 Inamasu J, Saito R, Nakamura Y, Ichikizaki K, Suga S, Kawase T, et al. : Acute subdural hematoma caused by ruptured cerebral aneurysms : diagnostic and therapeutic pitfalls. Resuscitation 52 : 71-76, 2002   DOI   ScienceOn
22 Ishibashi A, Yokokura Y, Sakamoto M : Acute subdural hematoma without subarachnoid hemorrhage due to ruptured intracranial aneurysm--case report. Neurol Med Chir (Tokyo) 37 : 533-537, 1997   DOI   ScienceOn
23 Ishikawa E, Sugimoto K, Yanaka K, Ayuzawa S, Iguchi M, Moritake T, et al. : Interhemispheric subdural hematoma caused by a ruptured internal carotid artery aneurysm : case report. Surg Neurol 54 : 82-86, 2000   DOI   ScienceOn
24 Kocak A, Ates O, Durak A, Alkan A, Cayli S, Sarac K : Acute subdural hematomas caused by ruptured aneurysms : experience from a single turkish center. Turk Neurosurg 19 : 333-337, 2009
25 Kondziolka D, Bernstein M, ter Brugge K, Schutz H : Acute subdural hematoma from ruptured posterior communicating artery aneurysm. Neurosurgery 22 : 151-154, 1988   DOI