2023 Volume 51 Issue 2 Pages 135-138
We describe a very rare case of subarachnoid hemorrhage (SAH) due to a right internal carotid-posterior communicating artery (IC-PC) aneurysm simultaneously associated with a left temporal intracerebral hemorrhage (ICH).
A 73-year-old woman suffered from sudden-onset headache and vomiting, and subsequently her consciousness gradually deteriorated. On admission, she presented with severe disturbances of consciousness and anisocoria (right 6 mm ＞ left 3 mm). Computed tomography (CT) on admission revealed a diffuse SAH and massive ICH in the left temporal lobe, including the left choroidal fissure. Three-dimensional computed tomography angiography (3D-CTA) revealed a small aneurysm at the right IC-PC and an irregularly shaped left internal carotid artery. First, we performed a left fronto-temporal craniotomy and observed the left carotid artery using the distal transsylvian approach; however, we could not detect a ruptured aneurysm at the left carotid artery. Therefore, after removal of the left temporal hematoma, we performed a right craniotomy, found a ruptured right IC-PC aneurysm, and then performed clipping of the aneurysm. Because CT findings strongly suggested the existence of a ruptured left carotid artery aneurysm, we first performed a left-side craniotomy despite the absence of an obvious aneurysm at the left carotid artery. However, ICH was not associated with aneurysm rupture. Therefore, a right-sided craniotomy was performed.
The simultaneous occurrence of aneurysmal SAH and remote ICH has been reported in only eight cases. We reviewed the literature on these eight patients, focusing on mechanism of simultaneous occurrence of aneurysmal SAH and remote hematoma mechanism.
