ASNR22/SNR XXII Proceedings
Purpose 36-year-old female who presented to our emergency department for worsening headache and new onset left sided diplopia. Physical exam confirmed a left 3rd nerve palsy. A CT of the head was obtained which showed a subdural hemorrhage which ultimately resulted in coil embolization of a ruptured aneurysm. The patient tolerated the procedure well and was closely followed for vasospasm development with routine transcranial ultrasounds which were negative. Patient remained stable and reported resolution of her headache symptoms on discharge. However, she continued to have a left 3rd nerve palsy. Materials and Methods CT of the head was obtained which showed a subdural hemorrhage. Subsequent CTA of the head was positive for an 8 x 4 mm posterior communicating artery (PcomA) aneurysm. MRA and MRI of the head both demonstrated a posterior fossa subdural hemorrhage that was most predominant along the margins of the tentorium and cerebellum. The patient was diagnosed with aneurysmal subdural hemorrhage (AnSDH) and underwent endovascular embolization of the left PcomA aneurysm with multiple detachable platinum coils. Results Spontaneous aneurysmal subdural hemorrhage (AnSDH) without any subarachnoid hemorrhage, interventricular hemorrhage, or intracerebral hemorrhage is an extremely rare entity with only 30 cases reported in the literature(1). The most common location was ICA-PcomA aneurysms (15 cases) followed by MCA aneurysms (6 cases) (2). Although the pathogenesis of AnSDH remains a subject of controversy, the perianeurysmal environment, along with the variations of aneurysm location, may help further our understanding of AnSDH(5) Subdural hemorrhage without antecedent trauma or coagulopathy should raise suspicion for an intracranial aneurysm rupture. Protocols have been proposed for a suspected AnSDH(4). Patients with AnSDH have more profound deficits on presentation, recent evidence suggests they have better outcomes than those with non-AnSDH (5). Hematoma evacuation and aneurysm coiling or clipping are most common modalities of treatment, with better outcomes associated with early intervention. Our case highlights that an aneurysm rupture should be included in the differential for a patient who presents with an otherwise unexplainable subdural hemorrhage. Conclusions 1. Present a case of a spontaneous aneurysmal subdural hemorrhage (AnSDH) without concomitant subarachnoid hemorrhage (SAH) 2. Discuss relevant anatomical considerations in patients with AnSDH 3. Discuss management and overall prognosis.
Rizk M, Khan A, Ghannam J, Waheed M. Spontaneous aneurysmal subdural hemorrhage: a rare entity. ASNR22/SNR XXII Proceedings. 2022 May 16-18:434-435.
Presented at American Society of Neuroradiology (ASNR) Annual Meeting, May 16-18, 2022, New York, NY.