Abstract
We report a case of ruptured distal anterior cerebral artery aneurysm with acute subdural hematoma (ASDH) located mainly at the cerebral convexity. A 67-year-old female was admitted in a coma. A CT scan taken before admission showed massive ASDH on the right convexity. Following emergency trepanation, emergency surgery was performed. After evacuation of ASDH, critical rebleeding from the intracranial space occurred. Postoperative 3D-CT angiography showed left distal anterior cerebral artery (ACA) aneurysm projecting to the upper right. We performed neck clipping of the aneurysm. Cases of ruptured distal ACA aneurysm with ASDH are not so rare, but a pattern of limited interhemispheric ASDH with massive convexity ASDH is rare. This finding tends to cause pitfalls and ruptured distal ACA aneurysm should be taken into consideration and preoperative cerebrovascular evaluations such as 3D-CTA should be performed wherever possible.
