Takada Tomoya, Yamamoto Tetsuya, Ishikawa Eiichi, Zaboronok Alexander, Kujiraoka Yuji, Akutsu Hiroyoshi, Ihara Satoshi, Nakai Kei, Matsumura Akira
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Neurol Med Chir (Tokyo). 2012;52(6):430-4. doi: 10.2176/nmc.52.430.
A 54-year-old man was admitted to our hospital with complaint of sudden headache. The patient had suffered two episodes of transient headache before admission. Computed tomography (CT) revealed acute subdural hematoma (ASDH) on the right side of the cerebral convexity with bilateral extension along the tentorium cerebelli without signs of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH). Three-dimensional CT angiography and conventional cerebral angiography revealed a left A1-A2 junction aneurysm. Neck clipping of the aneurysm was performed. The aneurysm extended inferiorly, with the dome embedded in the chiasmatic cistern and tightly adhered to the arachnoid membrane. There was no evidence of hematoma in the subarachnoid space. The patient was discharged without neurological deficit. Ruptured aneurysms resulting in ASDH without SAH or ICH are very rare. Radiological investigation such as three-dimensional CT angiography should be performed to find the causative aneurysm in a patient with ASDH with a history of repeated headaches and without traumatic signs or episodes, and the appropriate treatment should be planned with expediency.
一名54岁男性因突发头痛入院。该患者入院前曾有两次短暂性头痛发作。计算机断层扫描（CT）显示大脑凸面右侧急性硬膜下血肿（ASDH），沿小脑幕双侧延伸，无蛛网膜下腔出血（SAH）或脑出血（ICH）迹象。三维CT血管造影和传统脑血管造影显示左A1 - A2交界处动脉瘤。对该动脉瘤进行了颈部夹闭术。动脉瘤向下延伸，瘤顶嵌入视交叉池并紧密附着于蛛网膜。蛛网膜下腔无血肿迹象。患者出院时无神经功能缺损。导致ASDH而无SAH或ICH的破裂动脉瘤非常罕见。对于有反复头痛病史且无创伤体征或发作史的ASDH患者，应进行三维CT血管造影等影像学检查以发现病因性动脉瘤，并应迅速制定适当的治疗方案。
