Pure acute subdural hematoma on the tentorium cerebelli and posterior interhemispheric fissure caused by ruptured internal carotid artery aneurysm: two cases report and review of literature.

Abstract

We present 2 cases of ruptured cerebral aneurysms without subarachnoid hemorrhage and acute subdural hematoma surrounding the tentorium. Case 1: A 57-year-old man’s MRI revealed hematomas around the interhemispheric fissure, posterior cranial fossa, and cerebellar tentorium. Angiography revealed an aneurysm at the junction of the right internal carotid and anterior choroidal arteries, which was clipped on the third day after onset. Case 2: A 62-year-old man has a hematoma around his cerebellar tentorium. Angiography revealed an aneurysm at the junction of the right internal carotid artery and the posterior communicating artery, which was clipped on the fourth day after onset. In both cases, the dome of the internal carotid artery aneurysm came into contact with the dura of the posterior clinoid process beyond the tentorial incisura, and a subdural hematoma was found around the aneurysm, which was confirmed to be the origin of the bleeding. Even in cases of only acute subdural hematoma, the location of the aneurysm and the dome projection can be used to diagnose a ruptured aneurysm.