Acute spontaneous subdural hematoma of arterial origin

A patient is described who had a history of sudden vomiting and rapidly becoming deeply unconscious. There was no history of head trauma. The cause turned out to be an acute spontaneous subdural hematoma from arterial rupture. Comparable cases in the literature are reviewed and the etiological possibilities are discussed.     

Acute spontaneous subdural hematoma of arterial origin

Acute spontaneous subdural hematoma of arterial origin is very rare. We have encountered two such cases and verified the arterial origin of the bleeding at operation. Both patients had no history of head trauma and developed progressive neurological deficits, becoming comatose. The source of bleeding was identified as a cortical artery located on the temporal lobe near the Sylvian region. This type of lesion is reviewed in the literature and the etiology is discussed.     

Acute spontaneous subdural haematoma of arterial origin

Spontaneous arterial subdural haematoma is arguably a rare condition. We report on three patients who presented with progressive neurological deficit or coma and who had been initially diagnosed as strokes. Explanations for the development of this condition are reviewed and it is suggested that it is not as rare as previously thought.     

Acute spontaneous subdural hematoma

A review of the literature reveals 20 reported cases of acute spontaneous subdural hematoma. We present an additional case with a tabulation of pertinent data. The prototype case is described, emphasizing the benign and insidious onset followed, invariably, by a deteriorating neurological status leading, almost always, to surgical evacuation. A high index of suspicion for this entity is of great importance, because a delay in diagnosis may lead to an increase in the morbidity and the mortality of this condition.     

Acute intracranial subdural hematoma of arterial origin after spinal anesthesia

A case of an acute intracranial subdural haematoma occurring shortly after spinal anaesthesia is reported. A 67 year old poorly controlled hypertensive man, ASA II, underwent removal of a prostatic adenoma under spinal anaesthesia. He complained of postural headache on the third day after surgery. Unresponsive to the usual analgesics, his headache became severe, persistent and non postural on the fifth day. Twenty-four hours later, he suddenly presented with a left hemiplegia and became comatose. Computed axial tomography showed a large left-sided subdural haematoma, lying over the left hemisphere. During the immediate surgical removal, a pulsatile arterial bleeding originating from a small cortical artery was discovered, and stopped. The patient slowly recovered consciousness, but the hemiplegia remained. He finally died six months later of bronchopneumonia. The link between the haematoma and the spinal anaesthetic is not proven; the possible relationship between the two is discussed.     

Acute subdural hematoma of arteriolar origin. Traumatic or spontaneous?

Acute subdural hematomas are usually related to the rupture of a bridging vein with or without tearing of brain matter. In some instances the origin of the hemorrhage is due to the shearing of a cortical arteriole bleeding directly into the subdural space, generally after a minor head trauma. Ten cases were reviewed at Geneva's Neurosurgical clinic over a period of thirteen years (1973-1986). They represent less than 5% of all acute and subacute subdural hematomas treated during that period. Subdural hematomas of venous origin are usually encountered on previously normal brain whereas those of arteriolar origin are thought to result from the disruption of a small arteriolar knuckle adhering to the arachnoid and dura. While the majority of arteriolar hematomas reported here and in the literature are of traumatic origin, some are undoubtedly spontaneous. The clinical features of these hematomas are characterized by a high incidence of falsely localising motor signs, presumably due to the so called Kernohan's phenomenon. Their treatment requires a wide exposure, allowing identification and coagulation of the bleeding source located in most instances around the Sylvian fissure. Although a rare entity, the existence of arteriolar subdural hematomas must be emphasized, since any delay in their treatment may result in a dramatic outcome.     

Acute spontaneous subdural hematoma associated with multiple aneurysms--a case report

A case of acute spontaneous subdural hematoma associated with three aneurysms is reported. On March 12, 1984, a 47-year-old woman experienced the sudden onset of severe headache over the bilateral frontal region and vomiting. Three hours later, she was transferred to our hospital by ambulance car because of continuous headache and vomiting. She had no history of head trauma. She had been medicated hypertension for five years. On admission she suffered from headache and nausea. But there was no clinical sign in physical and neurological examinations. The meningeal irritation was not present, but lumbar puncture showed slightly pinky CSF with normal pressure. A plain computed tomographic scan showed a thin high density mass in the left temporal extra-axial region and the slight deviation of the midline structures to the right. Left carotid arteriogram showed an avascular region over the left cerebral convexity, an aneurysm of the left A2-A3 junction and a questionable aneurysm of the bifurcation of left middle cerebral artery. Right carotid arteriogram showed an aneurysm of the bifurcation of right middle cerebral artery. We diagnosed this case as an acute subdural hematoma by CT scan and arteriogram. We were perplexed preoperatively whether this bleeding was spontaneous or secondary to the rupture of aneurysm, and we could not deny the possibility of a ruptured aneurysm. On March 15, 1984, three days after onset, operation was performed. At operation, a small subdural hematoma was removed, and the underlying cortex was normal.(ABSTRACT TRUNCATED AT 250 WORDS)