Abstract
There are many cases of subarachnoid, intracerebral and intraventricular hemorrhage among intracranial hemorrhage caused by the rupture of cerebral aneurysm, but there are only a few cases in which massive subdural hematoma is a main lesion. We had a case of the rupture of intracarotid aneurysm complicated with massive acute subdural hematoma. Since CT findings and the process of formation of hematoma were confirmed by surgery and autopsy, we present the case.
An 84-year-old female patient had been diagnosed as high blood pressure, but she had not taken any drugs. During a conversation in the morning of April 16, 1985, she suddenly fell unconsious. She received emergency treatment by a nearby doctor, who found a subdural hematoma by CT. The patient was transferred to our hospital 6 hours after attack. Her conditions on arrival were ; consciousness level: 200 (3-3-9 degrees), blood pressure: 112/86mmHg, pulserate: 86/min, respiration: 30/min, irregular, pupil 2mm anisocoria (—)· light reflex (—) and left hemiplegia: CT disclosed a subdural hematoma with a prominent midline shift accompanied by intracerebral hematoma in the left temporal lobe and intraventricular hemorrhage, but we suspected vascular accident since there was no history of trauma, and carried out the cerebral angiography, when multiple aneurysms were recognized in the left internal carotid artery.
By emergency surgery the hematoma was removed and ruptured aneurysm was clipped. The postoperative conditions became temporarily better, but cerebral edema, which were probably caused by ischemic brain damage, progressed. The patient died on the 8th day after surgery. Autopsy showed the aneurysm of internal carotid artery whose fundi were buried in the left temporal lobe, ruptured in the cerebral tissue and the blood flowed 1) from the inferior horn to the inside of ventricle and 2) from the temporal lobe to the subdural space in the middle fossa through the ruptured arachnoid membrane of cerebral surface. There was no trace of subarachnoid hemorrhage.
By presenting the above case in which massive subdural hematoma was the main lesion of the rupture of cerebral aneurysm and autopsy confirmed the direction of development of hematoma, we discuss the clinical characteristics of subdural hematoma caused by the rupture of cerebral aneurysm.
