A Case of Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Associated with Acute Subdural Hematoma, Extending from the Interhemispheric Space to the Posterior Fossa Hiroaki OTSUKA 1 , Yuhtaka FUKUDA 2 , Shouta YOSHIMURA 1 , Chika SOMAGAWA 1 , Takeshi HIU 2 , Tomonori ONO 2 , Ryujirou USHIJIMA 2 , Keisuke TODA 2 , Keisuke TSUTSUMI 2 1Residency Program, National Hospital Organization Nagasaki Medical Center 2Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center Keyword: internal carotid-posterior communicating artery aneurysm , acute subdural hematoma , interhemispheric space , posterior fossa , retroclival space pp.517-524
Published Date 2016/6/10
DOI https://doi.org/10.11477/mf.1436203321
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 A 69-year-old woman was admitted to our hospital because of a sudden severe headache without a history of head trauma. CT and MRI revealed an acute subdural hematoma(ASDH)extending from the right interhemispheric space to the posterior fossa bilaterally, with a small amount of subarachnoid hemorrhage that was predominantly localized to the left side of the basal cistern. CT angiogram demonstrated a long protruding ruptured aneurysm at the junction of the right internal carotid and posterior communicating arteries(IC/PC AN)with a posteroinferior projection, associated with a small bleb located near the tentorial edge close to the ipsilateral posterior clinoid process, for which she received clipping surgery.

 Though rare, IC/PC AN could cause pure or nearly pure ASDH in the above-mentioned distribution. Therefore, in patients with such ASDH, especially without a history of head injury or precise information regarding the situation at the time of onset, urgent imaging evaluation and early intervention are essential to prevent devastating re-rupture events.

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