Abstract
Three cases of acute subdural hematoma without head injury but attributable to surgically verified bleeding from a cortical artery are presented. Case 1: A 46-year-old male complained of a headache. Neurological examination revealed no abnormality. A subdural hematoma was found on computed tomography. Case 2: A 49-year-old male developed a consciousness disturbance. Removal of a hematoma was performed leaving mild confusion. Case 3: A 68-year-old female was admitted because of acute onset of confusion. An emergency operation was performed but profound hypotension occurred. Confusion persisted and the patient died from a complication. The previous reports on acute subdural hematoma caused by rupture of a cortical artery consisted of 17 cases with preceding trivial head trauma and 34 without. In most of the cases without head injury, the initial symptom was a headache mimicking that of subarachnoid hemorrhage which was followed by consciousness disturbance. Tearing of a cortical artery adhering to the dura mater by a trivial trauma or rapid head movement is proposed as a causative mechanism of the hematoma. In chronic subdural hematomas, only a negligible or no preceding head injury is often demonstrated. It is suggested, therefore, that a hemorrhage of the artery may cause an acute subdural hematoma if massive, and may also cause chronic subdural hematoma when it is minimal and subsequent bleeding from the hematoma membrane in the organizing process takes place.
