Abstract
We encountered a patient with internal carotid artery-posterior communicating artery aneurysm rupture which manifested as acute subdural hematomas not accompanied by subarachnoid hemorrhage. A 92-year-old female suddenly developed severe pain in the area from the left cheek to the forehead. At the time of the first visit to our hospital, neurological examination showed mild left blepharoptosis. Head CT and MRI revealed acute subdural hematomas in the posterior cranial fossa and an interhemispheric fissure, but no subarachnoid hemorrhage. Head MRA showed a left internal carotid artery-posterior communicating artery aneurysm, which had not been present two years previously. There was no history of head injury despite repeated history-taking from the patient and her family. Based on the disease history and findings from imaging and neurological examinations, a diagnosis of acute subdural hematomas due to a ruptured cerebral aneurysm was made, and coil embolization for the aneurysm was performed. Acute subdural hematomas not accompanied by subarachnoid hemorrhage, which are due to ruptured cerebral aneurysms, are rarely observed. In patients with acute subdural hematomas, in the absence of a history of injury, head CT, head MRI and evaluation of cerebral blood vessels may be necessary.
