Journal of forensic and legal medicine
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Cerebral artery aneurysm rupture is usually associated with significant subarachnoid hemorrhage; however, there are rare cases where there is a lack of hemorrhage into the subarachnoid space. While subdural hemorrhage can occur with ruptured aneurysms, isolated subdural hemorrhage is more often associated with trauma. In this case, a 51-year-old obese woman, who recently visited an Urgent Care Center for elevated blood pressure, was found dead roughly a month later. ⋯ There was cardiomegaly (510 gm), and mild to moderate atherosclerosis in multiple vessels. The classic clinical presentation of a ruptured cerebral artery berry aneurysm involves the sudden onset of an excruciating headache.1 While angiography provides the most conclusive image-based antemortem evidence of an aneurysm, CT scans are used frequently in an emergency setting to identify basilar subarachnoid hemorrhage, a very common associated finding, thus allowing for a diagnosis of probable ruptured aneurysm.1 Depending on the circumstances of a given case, the presence of subdural hemorrhage with absence of subarachnoid hemorrhage on CT scan may suggest a different underlying process, such as trauma. The presented case serves to remind clinicians that ruptured berry aneurysms do not always produce significant subarachnoid hemorrhage.