title: Uncommon presentation of ruptured intracranial aneurysm during surgical evacuation of chronic subdural hematoma: case report.
abstract: BACKGROUND
  There are many factors that predispose an aneurysm to rupture, but there are few real, demonstrable causes that lead to rupture of the aneurysmal sac with a precise cause-effect mechanism.
  
  
  METHODS
  We report a 74-year-old male patient with chronic subdural hematoma after head trauma, who underwent surgery for evacuation of the hematoma. During surgery, there was sudden copious loss of blood from the drainage tubes that were positioned subdurally. Immediate cerebral computed tomography scan and angiography revealed a subarachnoid hemorrhage at the level of the basal cisterns from a ruptured basilar apex aneurysm. We discuss the cause-effect relationship between the surgery with its positioning of subdural drains and the rupture of a previously unrecognized cerebral aneurysm.
  
  
  CONCLUSIONS
  The rupture of an unknown, previous "unruptured" aneurysm after craniotomy with subdural positioning of drainage, must be considered a possible complication.
authors.affiliation: Department of Neurosurgery, University of Brescia, 25100 Brescia, Italy. roberto.stefini@alice.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Stefini
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghitti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bergomi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Catenacci
authors.forename: Nicola
authors.initials: N
authors.lastname: Latronico
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D001930:Brain Injuries / Q000150:complications; D004322:Drainage / Q000009:adverse effects*; D020200:Hematoma, Subdural, Chronic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D007431:Intraoperative Complications; D008297:Male