1984 Volume 24 Issue 8 Pages 622-627
A case of resolved chronic subdural hematoma associated with acute subdural hematoma in moyamoya disease is reported. This 57-year-old housewife was hospitalized in 1983, because of the sudden onset of unconsciousness and vomiting. The patient had been in good health until 1963, when she had the first attack of vertigo and headache. Similar attacks recurred in 1965, 1973, and 1975. One year before admission she had suffered recurrent vertigo and ataxia. On admission she was semicomatose without focal neurological signs. Computerized tomography (CT) scan revealed a subdural hematoma in the left frontoparietal region with a low-density layer on its outer side. Cerebral angiography disclosed narrowing of the bilateral internal carotid arteries with moyamoya networks in the area of the basal ganglia. Emergent left craniotomy was performed to find the subdural hematoma with the resolved chronic subdural hematoma. Bleeding from a transdural cortical anastomosis of the middle meningeal artery was found in the parietal area and was coagulated. The postoperative course was uneventful except for mild right hemiparesis and motor aphasia.
The mechanism involved in the development of subdural hematoma due to rupture of transdural cortical anastomosis in moyamoya disease is discussed.
