Gao Xianfeng, Yue Fagui, Zhang Fenglei, Sun Yang, Zhang Yang, Zhu Xiaobo, Wang Wei
Department of Neurosurgery.
Center for Reproductive Medicine and Center for Prenatal Diagnosis.
Medicine (Baltimore). 2020 Jul 31;99(31):e21434. doi: 10.1097/MD.0000000000021434.
Intracranial aneurysm with the first manifestation of acute subdural hematoma (aSDH) is rare in the field of neurosurgery. Usually subarachnoid hemorrhage or intracranial hematoma happens after the rupture of an intracranial aneurysm, whereas trauma is the primary cause of aSDH.
Here, we present the case of a 71-year-old woman who presented with spontaneous aSDH with progressive headache and vomiting.
Urgent head computed tomography (CT) identified an aSHD, but the patient had no history of trauma. CT angiography (CTA) identified the cause of the aSDH as rupture of an intracranial aneurysm in the left middle cerebral artery.
Emergent craniotomy with hematoma evacuation was performed.
Due to prompt diagnosis and appropriate intervention, the patient recovered fully with no disability.
This unique case demonstrates that aSDH caused by intracranial aneurysm rupture requires timely identification and appropriate action to prevent adverse outcomes. We performed a comprehensive systematic literature review to examine the etiology and pathogenesis of non-traumatic aSDH. Furthermore, digital subtraction angiography should be considered in patients diagnosed with an aSDH with no known cause.
颅内动脉瘤首发表现为急性硬膜下血肿（aSDH）在神经外科领域较为罕见。通常颅内动脉瘤破裂后会发生蛛网膜下腔出血或颅内血肿，而创伤是aSDH的主要原因。
在此，我们报告一例71岁女性患者，其表现为自发性aSDH，伴有进行性头痛和呕吐。
急诊头颅计算机断层扫描（CT）发现了aSHD，但患者无创伤史。CT血管造影（CTA）确定aSDH的病因是左大脑中动脉颅内动脉瘤破裂。
急诊行开颅血肿清除术。
由于诊断及时且干预得当，患者完全康复，无残疾。
这个独特的病例表明，由颅内动脉瘤破裂引起的aSDH需要及时识别并采取适当措施以防止不良后果。我们进行了全面的系统文献综述，以研究非创伤性aSDH的病因和发病机制。此外，对于诊断为不明原因aSDH的患者，应考虑进行数字减影血管造影。
