Bastiana Dewi Setyaning, Sani Achmad Firdaus, Ardhi Mohammad Saiful, Kurniawan Dedy, Suharto Ade Pambayu
Department Neurology, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya 60286, East Java, Indonesia.
Radiol Case Rep. 2023 Jan 17;18(3):1316-1319. doi: 10.1016/j.radcr.2023.01.009. eCollection 2023 Mar.
Patients with an acute subdural hematoma (aSDH) usually have a history of head trauma, but some patients may present with spontaneous aSDH due to a ruptured aneurysm. Spontaneous aSDH is a rare manifestation of aneurysmal rupture. However, aneurysmal rupture remains a major cause of spontaneous aSDH. A 42-year-old man was brought to the emergency room because of a sudden loss of consciousness during sexual intercourse. The patient has seizures and weakness on the right side of his body. The patient has no history of trauma and has never taken anticoagulant or antiplatelet drugs, sexual aphrodisiacs, or other drugs. Physical examination revealed the Glasgow Coma Scale of E2V1M3, ptosis on the left eye, left pupil mydriasis, right central facial palsy, and right hemiparesis. Laboratory results showed hypercoagulopathy. Noncontrast head computed tomography scan revealed subdural hematoma with no subarachnoid or intraparenchymal hemorrhage. The patient underwent an emergency craniotomy, and the hematoma was evacuated. Cerebral angiography was performed 1 week later, revealing a saccular aneurysm in the left posterior communicating artery. The patient has successfully undergone endovascular coiling and was discharged from the hospital in good condition, fully conscious, with no weakness in half side of the body, but there is still third nerve palsy. Patients with pure aSDH without a history of trauma should consider the possibility of aneurysm rupture and perform an angiographic examination to rule out vascular malformations so that the patient can receive appropriate treatment.
急性硬膜下血肿（aSDH）患者通常有头部外伤史，但部分患者可能因动脉瘤破裂出现自发性aSDH。自发性aSDH是动脉瘤破裂的罕见表现。然而，动脉瘤破裂仍是自发性aSDH的主要原因。一名42岁男性因性交过程中突然意识丧失被送往急诊室。患者有癫痫发作及右侧身体无力症状。患者无外伤史，从未服用过抗凝药、抗血小板药物、性壮阳药或其他药物。体格检查显示格拉斯哥昏迷量表评分为E2V1M3，左眼上睑下垂，左侧瞳孔散大，右侧中枢性面瘫及右侧偏瘫。实验室检查结果显示高凝状态。头颅非增强计算机断层扫描显示硬膜下血肿，无蛛网膜下腔或脑实质内出血。患者接受了急诊开颅手术，血肿被清除。1周后进行脑血管造影，显示左侧后交通动脉有一个囊状动脉瘤。患者成功接受了血管内栓塞治疗，出院时情况良好，意识完全清醒，半身无无力症状，但仍有动眼神经麻痹。无外伤史的单纯aSDH患者应考虑动脉瘤破裂的可能性，并进行血管造影检查以排除血管畸形，以便患者能接受适当治疗。
