Acute subdural hematoma without subarachnoid hemorrhage caused by ruptured A1-A2 junction aneurysm.

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Acute subdural hematoma without subarachnoid hemorrhage caused by ruptured A1-A2 junction aneurysm.

Neurol Med Chir (Tokyo). 2012;52(6):430-4

Authors: Takada T, Yamamoto T, Ishikawa E, Zaboronok A, Kujiraoka Y, Akutsu H, Ihara S, Nakai K, Matsumura A

Abstract A 54-year-old man was admitted to our hospital with complaint of sudden headache. The patient had suffered two episodes of transient headache before admission. Computed tomography (CT) revealed acute subdural hematoma (ASDH) on the right side of the cerebral convexity with bilateral extension along the tentorium cerebelli without signs of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH). Three-dimensional CT angiography and conventional cerebral angiography revealed a left A1-A2 junction aneurysm. Neck clipping of the aneurysm was performed. The aneurysm extended inferiorly, with the dome embedded in the chiasmatic cistern and tightly adhered to the arachnoid membrane. There was no evidence of hematoma in the subarachnoid space. The patient was discharged without neurological deficit. Ruptured aneurysms resulting in ASDH without SAH or ICH are very rare. Radiological investigation such as three-dimensional CT angiography should be performed to find the causative aneurysm in a patient with ASDH with a history of repeated headaches and without traumatic signs or episodes, and the appropriate treatment should be planned with expediency.

PMID: 22729076 [PubMed - in process]

Superficial temporal artery to middle cerebral artery double bypass via a small craniotomy: technical note.

Superficial temporal artery to middle cerebral artery double bypass via a small craniotomy: technical note.

Neurol Med Chir (Tokyo). 2010;50(10):956-9

Authors: Yoshimura S, Egashira Y, Enomoto Y, Yamada K, Yano H, Iwama T

Frontotemporal craniotomy is usually necessary to perform superficial temporal artery (STA)-middle cerebral artery (MCA) double bypass for cerebrovascular occlusive disease. This report describes a less invasive technique of double bypass through a small craniotomy with minimum skin incision. Thirty-four consecutive patients underwent an elective STA-MCA double bypass via a small craniotomy from January 2006 to October 2009. The parietal and frontal branches of the STA were divided through a minimum linear or y-shaped skin incision, and these branches were anastomosed to the supra- and infrasylvian portions of the MCA. No periprocedural complication such as subdural hematoma or cutaneous necrosis occurred. Postoperative cerebral angiography within 6 months showed that the bypasses were patent in all 34 patients. Double STA-MCA bypass via a small craniotomy might be less invasive, especially for patients at high risk for postoperative hemorrhagic complication or cutaneous necrosis.

PMID: 21030817 [PubMed - in process]

Rapid reduction of acute subdural hematoma and redistribution of hematoma: case report.

Rapid reduction of acute subdural hematoma and redistribution of hematoma: case report.

Neurol Med Chir (Tokyo). 2010;50(10):924-7

Authors: Watanabe A, Omata T, Kinouchi H

An 88-year-old woman presented with acute subdural hematoma (ASDH) which showed rapid resolution on computed tomography (CT) and magnetic resonance (MR) imaging. She was transferred to our hospital after falling out of bed. On admission, she was comatose with Japan Coma Scale score of 200 and Glasgow Coma Scale score of E1V1M2. Brain CT showed a thick left frontotemporal ASDH. Conservative treatment consisted of 200 ml of glycerol administered intravenously twice a day, and maintenance in the approximately 20 degree head-up position to reduce intracranial pressure. Three days later, her consciousness recovered to Japan Coma Scale score of 30 and Glasgow Coma Scale score of E2V4M5. CT showed obvious reduction of the hematoma without brain or scalp swelling. Spinal MR imaging detected no redistribution of hematoma to the spine. The present case illustrates that rapid spontaneous reduction of ASDH may occur by redistribution of hematoma, mainly to the supratentorial subdural space because of brain atrophy.

PMID: 21030807 [PubMed - in process]