Title:A Case of Subdural Hematoma without Subarachnoid Hemorrhage
Secondary to Rupture of Posterior Communicating Artery-infundibular
Dilatation
Volume: 19
Author(s): Ceylan Altintas Taslicay*, Isa Cam, Ozgur Cakir, Ercument Ciftci and Naci Kocer
Affiliation:
- Department of Radiology, Kocaeli University School of Medicine, 41100, Kocaeli, Turkey
Keywords:
Coil embolization, DSA, infundibular dilatation, MRA, subarachnoid hemorrhage, subdural hematoma.
Abstract:
Introduction: Subdural hematoma without subarachnoid hemorrhage secondary to intracranial
aneurysm rupture is rare and may complicate patient management due to delay in diagnosis and
subsequent treatment. Herein, we describe a case presenting with pure SDH secondary to the rupture of
a posterior communicating artery infundibular dilatation (PcoA-ID). To the best of our knowledge, this
is the first case of rupture of a PcoA-ID with SDH in the convexity and tentorium, which also tracked
into the upper cervical spine along the subdural space. Additionally, we briefly discuss the previously
published cases of pure SDH secondary to intracranial aneurysm rupture.
Case Report: A 44-year-old female presented with headache, dizziness, nausea and left-sided diplopia
to an outside institution. Initial diagnostic work-up showed no intracranial hemorrhage, however, magnetic
resonance angiography and subsequent digital subtraction angiography revealed left posterior
communicating artery infundibular dilatation. Two days later, the patient presented with a loss of consciousness.
Computed tomography was positive for bilateral hemispheric subdural hematoma with no
evidence of subarachnoid hemorrhage. Digital subtraction angiography showed left posterior communicating
artery infundibular dilatation and pseudoaneurysm originating from the inferior area of the
infundibular dilatation, concerning recent rupture. Balloon assisted coil embolization was performed
and the patient had a good outcome without any neurological deficit.
Conclusion: Subdural hematoma in a young adult without a history of trauma or coagulopathy warrants
additional vascular imaging to search for underlying vascular lesions. It should also be kept in
mind that infundibular dilatation may rupture and cause a pure subdural hematoma.
