title: Bilateral acute subdural hematomas with intracerebral hemorrhage without subarachnoid hemorrhage, caused by rupture of an internal carotid artery dorsal wall aneurysm. Case report.
abstract: A 45-year-old man presented with bilateral acute subdural hematomas (ASDHs) without subarachnoid hemorrhage (SAH). He was found comatose in a parked car. Computed tomography showed left frontal intracerebral hemorrhage (ICH) and bilateral ASDHs but no signs of SAH. Magnetic resonance angiography demonstrated an internal carotid artery dorsal wall aneurysm. Emergent surgical intervention was performed. However, he died of cerebral herniation 6 days later. We inferred that massive intracranial bleeding might have ruptured through the cortex and lacerated the arachnoid membrane. Aneurysm rupture generally results in unilateral SDH, whereas trauma is the usual cause of bilateral ASDHs with ICH. Our case suggests that ruptured aneurysm should be considered in patients with non-traumatic bilateral ASDHs without SAH.
authors.affiliation: Department of Neurosurgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, Japan..
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Nishikawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ueba
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kajiwara
authors.forename: Kohsuke
authors.initials: K
authors.lastname: Yamashita
mesh_terms: D001099:Arachnoid / Q000000981:diagnostic imaging / Q000473:pathology; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D018450:Disease Progression; D017809:Fatal Outcome; D007839:Functional Laterality; D020199:Hematoma, Subdural, Acute / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D006547:Hernia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology; D013355:Subdural Space / Q000000981:diagnostic imaging / Q000473:pathology; D014474:Unconsciousness / Q000209:etiology