Shekarchizadeh Ahmad, Masih Saburi, Reza Pourkhalili, Seif Bahram
Department of Neurosurgery, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurosurgery, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2017 Apr 17;6:46. doi: 10.4103/2277-9175.204589. eCollection 2017.
The present report describes an acute subdural hematoma (ASDH) associated with subarachnoid hemorrhage (SAH), due to ruptured cortical aneurysm. To our knowledge, extremely rare cases of this sort have been reported so far. A 23-year-old male patient without previous trauma presented with severe headache and rapidly decreasing level of consciousness to decerebrate status. Computed tomography (CT) scan has demonstrated an ASDH together with SAH. Hematoma has immediately been evacuated without any evaluation by angiography. After evacuation of the thick subdural clot, a 10-mm aneurysm was revealed on a precentral artery of frontal cortex, which was ligated. However, after 35 days the patient discharged with left side hemiparesis and dysphasia, and just after several months of admission he got symptom free. Ruptured cortical aneurysm should be considered as one of the causes of spontaneous ASDH. Vascular anomaly investigations are suggested for these cases, thus CT angiography or digital subtraction angiography has to be considered if clinical condition allows.
本报告描述了一例因皮质动脉瘤破裂导致的急性硬膜下血肿（ASDH）合并蛛网膜下腔出血（SAH）。据我们所知，迄今为止，此类极其罕见的病例已有报道。一名23岁既往无外伤史的男性患者，出现严重头痛，意识水平迅速下降至去大脑状态。计算机断层扫描（CT）显示存在急性硬膜下血肿及蛛网膜下腔出血。未进行血管造影评估，血肿即被立即清除。清除厚的硬膜下血凝块后，在额叶皮质中央前动脉上发现一个10毫米的动脉瘤，并予以结扎。然而，35天后患者出院时仍有左侧偏瘫和言语障碍，入院几个月后症状才消失。破裂的皮质动脉瘤应被视为自发性急性硬膜下血肿的病因之一。对于这些病例，建议进行血管异常检查，因此如果临床情况允许，必须考虑进行CT血管造影或数字减影血管造影。
