True Cortical Saccular Aneurysm Presenting as an Acute Subdural Hematoma

Subdural hematoma, without any radiographic evidence of subarachnoid hemorrhage, is a rare presentation of a ruptured intracranial aneurysm. Even more rare is the occurrence of a pure subdural hematoma caused by a ruptured cortical saccular aneurysm. We report the eighth case of pure subdural hematoma secondary to a ruptured nonmycotic cortical berry aneurysm.

We report a case of pure subdural hematoma secondary to a ruptured true saccular aneurysm of a cortical artery branch. The lesion was carefully delineated with computed tomography (CT) angiography (CTA) and cerebral angiography, and successfully treated with hematoma evacuation and clip ligation. The patient demonstrates no neurologic deficits 6 months after surgery, and CTA results remain negative.

In the context of a presentation of spontaneous subdural hematoma, intracerebral aneurysm rupture should be considered as a possible etiology. Prompt vascular imaging with careful evaluation of the entire cerebral vasculature, including the cortical vessels, should be considered.