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[Ruptured aneurysms presenting with subdural hematoma: management without angiography].
C Fernández-Carballal1, E Muñoz-Fernández, F García-Salazar
1Departamento de Neurocirugía, Hospital General Gregorio Marañón, Madrid, Spain. carlosfercarballal@yahoo.es
Revista De Neurologia
|September 2, 2004
Summary
Ruptured aneurysms can cause acute subdural hematomas, leading to rapid neurological decline. Prompt surgical intervention, even without angiography, is crucial for favorable outcomes in these critical cases.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Intracranial aneurysms rarely rupture, causing subdural hematomas (SDH).
- Sudden deterioration and coma are characteristic, necessitating emergent surgical intervention.
Observation:
- Three cases of acute SDH with minimal subarachnoid hemorrhage from ruptured aneurysms presented with rapid neurologic decline.
- Urgent craniotomy and hematoma evacuation were performed without pre-operative angiography.
- Aneurysms were identified and treated surgically (clipping or embolization) in all patients.
Findings:
- Suspect ruptured aneurysms in spontaneous SDH, especially with disproportionate deterioration.
- Early surgical intervention is vital, even if angiography is unavailable.
- Posterior communicating artery aneurysms are associated with SDH formation.
Implications:
- Prompt surgical decompression can reverse severe neurological deficits and prevent uncal herniation.
- Angiography should not delay emergency surgery.
- Surgical exploration or delayed angiography is essential to confirm aneurysm presence.