Acute subdural hematoma associated with distal anterior cerebral artery aneurysm: Report of two cases

• Published in: Japanese Journal of Stroke Vol. 27; no. 2; pp. 322 - 326
• Main Authors: Kato, Kyozo, Okamoto, Takeshi, Naito, Takehiro, Nagasaka, Tohru, Hayashi, Shigemasa, Inao, Suguru
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2005
• Subjects: 3D-CT angiography; acute subdural hematoma; distal anterior cerebral artery aneurysm
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.27.322

We report two cases of acute subdural hematoma (ASDH) associated with distal anterior cerebral artery (ACA) aneurysm. Both patients were comatose on admission and underwent surgery for hematoma evacuation immediately. In both cases, distal ACA aneurysm was noted on the angiography which was performed after the surgery. One case then underwent neck clipping of the aneurysm, and the other case underwent trapping of the aneurysm. The first case revealed a remarkable recovery; however, the other case fell into a vegetative state. The former case had undergone 3D CT angiography before the evacuation surgery, although the aneurysm was not detected because the scanning range was too narrow. Although 3D CT angiog-raphy is a convenient and timesaving useful tool, there are evident pitfalls for the diagnosis of distal ACA aneurysms. In total, 27 cases of ASDH associared with distal ACA aneurysms have been reported including our cases. Nineteen cases were of grade 4 or 5 on the Hunt and Kosnik classification at admission, and 8 cases among these cases achiered a good recovery or were mildly disabled on the Glasgow outcome scale. It is considered that although a case may be in a poor neurological condition, urgent surgery has the possibility to provide a better prognosis.