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Journal of Korean Neurosurgical Society 2005;37(5): 329-335.
Acute Aneurysmal Subdural Hematoma: Clinical and Radiological Characteristics.
Sung Man Park, Young Min Han, Young Sup Park, Ik Sung Park, Min Woo Baik, Ji Ho Yang
1Department of Neurosurgery, Our Lady of Mercy Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. hymns@medimail.co.kr
2Department of Neurosurgery, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
3Department of Neurosurgery, Daejon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
Acute spontaneous subdural hematoma(SDH) secondary to a ruptured intracranial aneurysm is a rare event. The authors present nine cases with aneurysmal SDH.
We analyzed nine cases of aneurysmal SDH from 337 patients who underwent treatment for a ruptured aneurysm between January 1998 and May 2004. Clinical and radiological characteristics and postoperative course were evaluated by reviewing medical records, surgical charts and intraoperative videos. RESULTS: The nine patients comprised four males and five females with a mean age of 53years (range 15-67years). The World Federation of Neurosurgical Societies grades on admission were I in one patient, II in two patients, III in five patients and V in one patient. With respect to location, there were four internal carotid-posterior communicating artery(ICA-Pcom) aneurysms, one distal anterior cerebral artery(DACA) aneurysm, one anterior communicating artery and three middle cerebral artery aneurysms. CT scans obtained from the four patients with ICA-Pcom aneurysms revealed SDH over the convexity and along the tentorium, and two of these patients presented with pure SDH without subarachnoid hemorrhage(SAH). In three patients with ICA-Pcom aneurysm, the ruptured aneurysm domes adhered to the petroclinoid fold. In the patient with the DACA aneurysm, the domes adhered tightiy to the pia mater and the falx. CONCLUSION: Ruptured intracranial aneurysm may cause SDH with or without SAH. In the absence of trauma, the possibility of aneurysmal SDH should be considered.
Key Words: Cerebral aneurysm; Subdural hematoma
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