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Ruptured distal anterior cerebral artery aneurysms presenting as acute subdural hematoma--report of three cases
K Watanabe1, S Wakai, S Okuhata
1Department of Neurosurgery, Dokkyo University School of Medicine.
Insights
Distal anterior cerebral artery aneurysms can present as acute subdural hematoma (SDH). This rare presentation, observed in 9.4% of cases, highlights the need for prompt diagnosis and treatment of these specific cerebral aneurysms.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Radiology
Background:
- Distal anterior cerebral artery (ACA) aneurysms are uncommon cerebrovascular lesions.
- Acute subdural hematoma (SDH) is a critical neurosurgical emergency.
- The presentation of distal ACA aneurysms with SDH is rare.
Observation:
- Three cases of distal ACA aneurysms presenting with acute SDH are reported.
- A characteristic computed tomography (CT) finding was a convexity SDH continuous with a wedge-shaped interhemispheric SDH.
- One case presented as a pure SDH without associated subarachnoid or intracerebral hemorrhage.
Findings:
- Two patients with massive SDH experienced fatal outcomes.
- One patient successfully underwent aneurysmal neck clipping and achieved a normal daily life.
- These cases represent 9.4% of ruptured distal ACA aneurysms treated at the institute over 14 years, a higher incidence than previously documented.
Implications:
- This presentation of distal ACA aneurysms as SDH, though rare, warrants consideration in the differential diagnosis of acute SDH.
- Early recognition and surgical intervention may improve patient outcomes.
- Further research is needed to understand the pathophysiology and optimal management strategies for this specific aneurysm subtype.
Abstract:
The authors report three cases of distal anterior cerebral artery aneurysm presenting as acute subdural hematoma (SDH). Two patients were comatose on admission and died of massive SDH. One patient underwent aneurysmal neck clipping in the chronic stage and returned to normal daily life. A convexity SDH continuous with a wedge-shaped interhemispheric SDH was the characteristic computed tomographic appearance in all cases. There was no accompanying subarachnoid or intracerebral hemorrhage in one case (pure SDH). These cases are 9.4% of 32 ruptured distal ACA aneurysms treated in our institute in the last 14 years, a higher incidence than reported previously.