[An anterior communicating artery aneurysm complicated by chronic subdural hematoma--a case report (author's transl)]

A 53-year-old housewife was admitted to the Department of Neurosurgery, Toyama Medical and Pharmaceutical University on June 6, 1980, because of disorientation, urinary incontinence and left hemiparesis. She had experienced "a fit of severe headache" many times for five years. On May 12, 1980, she experienced an abrupt, severe headache in a lavatory and was immediately brought to a nearby hospital. Her symptom was recovered gradually for a week but she experienced sudden onset of severe headache again on May 20. Subsequently, her state of consciousness gradually worsened and left sided hemiparesis arose. On admission, cerebral angiograms revealed an aneurysm of an anterior communicating artery and a subdural hematoma over the right hemisphere. On the third hospital day, radical operation was performed by bifrontal craniotomy. Neck of aneurysm was ligated and clipped successfully and dark brownish semiliquid contents of chronic subdural hematoma was evacuated. The lacerated portion of arachnoid with some distance from the aneurysm was observed and subarachnoid hemorrhage was thought to enter subdural space through this portion. Post-operative course was uneventful. Nine cases of intracranial aneurysms complicated by chronic subdural hematoma were reported previously, but an anterior communicating artery aneurysm case was not in these cases. We have some discussion about cerebral aneurysms complicated by chronic subdural hematoma, especially about the pathogenesis of chronic subdural hematoma.