Abstract
Acute and subacute subdural hematomas are commonly associated with brain contusions. These hematomas rarely result from rupture of a cortical artery without evidence of surrounding brain contusion. A case in which a spurting cortical artery was verified at the operation is described and possible mechanisms of the arterial rupture are discussed.
An 88-year-old man fell and hit the left side of his head. About 9 hours later, he gradually became drowsy and was comatose on admission 12 hours later. Computerized tomography scan demonstrated findings suggestive of a subdural hematoma in the right temporoparietal region and a small epidural hematoma in the contralateral temporal region. Right craniectomy was carried out on the same day. Evacuation of a large subdural hematoma revealed pulsating bleeding from a cortical branch of the middle cerebral artery. There was no subarachnoid hemorrhage or contusion of the surrounding cortex. The spurting artery was clipped. Postoperatively the patient regained consciousness and underwent cranioplasty 1 month after surgery.
