• Makoto Katsuno, Yasuo Murai, and Akira Teramoto.
• Department of Neurosurgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
• No To Shinkei. 2003 May 1;55(5):435-8.

AbstractAcute subdural hematoma (ASDH) without subarachnoid or intracerebral hemorrhage following rupture of an intracranial aneurysm is rare. Only 34 cases of pure ASDH resulting from rupture of an intracranial aneurysm, and 5 cases of pure ASDH secondary to rupture of an anterior cerebral artery (ACA) aneurysm, have been reported in the literature. We report a case of a patient with a ruptured distal ACA aneurysm who presented pure ASDH on CT. A 63-year-old woman was admitted with the acute onset of severe headache, nausea, and dizziness. CT showed a right convexity and interhemispheric ASDH in the absence of subarachnoid or intracerebral hemorrhage. Cerebrospinal fluid was clear by lumbar puncture. However, we still suspected a ruptured intracranial aneurysm as the diagnosis. Angiography was performed and demonstrated a right distal ACA aneurysm with a daughter aneurysm. Evacuation of the subdural hematoma, with the clipping of the aneurysm was performed. Intraoperatively, adhesion between the dome of aneurysm and the falx cerebri was observed. The patient was discharged from the hospital without neurological deficits.

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