Abstract
A case of acute spontaneous subdural hematoma with angiographic extravasation of contrast medium is reported. A 56-year-old man was admitted because he experienced a sudden severe headache, vomiting and a disturbance of consciousness while washing his car. He had no experience of head injury. On admission, computed tomography (CT) revealed an acute subdural hematoma in the right temporoparietal region. Cerebral angiography showed an extravasation of contrast medium from a branch of the angular artery at the edge of the hematoma. After these examinations, the hematoma volume showed no further enlargement and his neurological symptoms improved. Therefore, he was observed under conservative therapy. Twenty days after onset, hematoma evacuation with right craniotomy was performed because he complained of a headache and his CT demonstrated chronic subdural hematoma. During operation, bleeding from the cortical branch of the angular artery was found and it was coagulated. He was discharged after 37 days without any neurological deficit. The characteristic features of acute spontaneous subdural hematoma were retrospectively investigated in the literatures. Acute subdural hematoma with an unknown history of head injury should be treated in consideration of possible spontaneous subdural hematoma.
