Dietz Nicholas, Sheth Aashka, Ostrov Phil, Ham Edward, Mettille Jersey, Koenig Heidi, Abecassis Isaac, Williams Brian J, Ding Dale
Neurosurgery, University of Louisville Hospital, Louisville, USA.
Anesthesiology, University of Louisville Hospital, Louisville, USA.
Cureus. 2024 Oct 18;16(10):e71788. doi: 10.7759/cureus.71788. eCollection 2024 Oct.
Anterior communicating artery (ACom) aneurysm, one of the most frequent types of intracranial aneurysm rupture, usually results in a subarachnoid hemorrhage (SAH) with intraventricular hemorrhage. We describe a case of an ACom aneurysm rupture with subarachnoid, intraparenchymal, and subdural hemorrhages (SDH) with midline shift in a 55-year-old woman. Decompressive craniectomy was performed to evacuate the SDH with subsequent microsurgical clipping of the aneurysm. Postoperative angiogram showed occlusion of the ACom aneurysm without residual flow. Mechanisms to explain multimodal bleeding with SAH, intraparenchymal hemorrhage, and SDH include adhesion of aneurysm to arachnoid membrane, high pressure hemorrhage, and spontaneous laceration of the arachnoid membrane. Management of multifocal hemorrhage pattern including SDH after ACom aneurysm rupture is dependent on anatomical and radiographic features as well as the clinical condition of the patient on admission. Decompressive craniectomy is a suitable treatment option for patients with concurrent spontaneous SAH, intraparenchymal hemorrhage, and SDH.
前交通动脉（ACom）动脉瘤是颅内动脉瘤破裂最常见的类型之一，通常导致蛛网膜下腔出血（SAH）并伴有脑室内出血。我们描述了一例55岁女性的ACom动脉瘤破裂病例，伴有蛛网膜下腔、脑实质内和硬膜下出血（SDH）以及中线移位。实施了减压性颅骨切除术以清除SDH，随后对动脉瘤进行显微手术夹闭。术后血管造影显示ACom动脉瘤闭塞且无残余血流。解释SAH、脑实质内出血和SDH多模式出血的机制包括动脉瘤与蛛网膜粘连、高压出血以及蛛网膜自发撕裂。ACom动脉瘤破裂后包括SDH在内的多灶性出血模式的处理取决于解剖和影像学特征以及患者入院时的临床状况。减压性颅骨切除术是并发自发性SAH、脑实质内出血和SDH患者的合适治疗选择。
