Abstract
The authors report three cases of subdural hematoma of acute onset in association with the rupture of intracranial aneurysms. Although all were in critical condition, two patients recovered after emergency surgery, which entailed removal of the hematoma and aneurysmal neck clipping. Acute subdural hematoma most often results from the tearing of bridging and cortical veins. Much less frequently, subdural bleeding may be secondary to the rupture of an intracranial aneurysm. In these instances, the subdural clot may be massive and immediately life-threatening. Currently, computed tomography (CT) is the examination of choice for the diagnosis of acute subdural hematoma. However, CT does not reliably depict blood vessels and so is of little value in ruling out such vascular abnormalities as aneurysms. The dilemma is whether or not to perform angiography prior to surgery in the presence of dire neurological signs. The authors conclude that, if the patient's condition allows, angiography should be performed, for the following reasons: 1) rebleeding from the aneurysm can be adequately controlled; 2) in skillful hands, angiography can be accomplished within the time required for other preoperative examinations; and 3) the aneurysm can be treated after evacuation of the hematoma, thereby such complications as vasospasm can be adequately managed.
