Caton Michael Travis, Wiggins Walter F, Nuñez Diego
Department of Radiology, Brigham and Women's Hospital, 15 Francis St, Boston, MA, 02115, USA.
Emerg Radiol. 2019 Oct;26(5):567-571. doi: 10.1007/s10140-019-01691-2. Epub 2019 Apr 29.
Acute subdural hemorrhage (SDH) is commonly encountered by emergency radiologists in the setting of trauma. When history or imaging evidence of trauma is absent, the differential diagnosis for SDH should be expanded. Intracranial aneurysm rupture is a rare and underrecognized cause of SDH which may present without concurrent subarachnoid hemorrhage. The mechanism of aneurysmal SDH is controversial, but understanding the anatomic microenvironment of the aneurysm provides insight and clarifies aneurysm features predisposing to subdural compartment rupture. Aneurysmal SDH is a neurosurgical emergency and its treatment strategies differ from traumatic SDH. Outcomes are poor if treatment is delayed; thus, radiologists play a central role in recognizing this uncommon but potentially devastating complication of aneurysm rupture. The goal of this article is to familiarize radiologists with clinical and imaging characteristics of aneurysmal SDH and review pertinent anatomy, risk factors, and potential etiologies. Aneurysmal rupture can easily be overlooked in the routine workup of atraumatic SDH, and radiologists must know when to recommend vascular imaging to avoid the catastrophic consequences of a missed diagnosis.
急性硬膜下血肿（SDH）在创伤情况下是急诊放射科医生常见的病症。当缺乏创伤病史或影像学证据时，SDH的鉴别诊断范围应扩大。颅内动脉瘤破裂是SDH的一种罕见且未被充分认识的病因，可能在没有并发蛛网膜下腔出血的情况下出现。动脉瘤性SDH的机制存在争议，但了解动脉瘤的解剖微环境有助于深入理解并阐明易导致硬膜下腔破裂的动脉瘤特征。动脉瘤性SDH是一种神经外科急症，其治疗策略与创伤性SDH不同。如果治疗延迟，预后较差；因此，放射科医生在识别这种罕见但可能具有毁灭性的动脉瘤破裂并发症方面起着核心作用。本文的目的是使放射科医生熟悉动脉瘤性SDH的临床和影像学特征，并回顾相关解剖结构、危险因素和潜在病因。在非创伤性SDH的常规检查中，动脉瘤破裂很容易被忽视，放射科医生必须知道何时建议进行血管成像，以避免漏诊带来的灾难性后果。
