- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
Myoung Soo Kim
Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
DOI:10.4103/2152-7806.94287Copyright: © 2012 Kim MS. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Kim MS, Jung JR, Yoon SW, Lee CH. Subdural hematoma of the posterior fossa due to posterior communicating artery aneurysm rupture. Surg Neurol Int 24-Mar-2012;3:39
How to cite this URL: Kim MS, Jung JR, Yoon SW, Lee CH. Subdural hematoma of the posterior fossa due to posterior communicating artery aneurysm rupture. Surg Neurol Int 24-Mar-2012;3:39. Available from: http://sni.wpengine.com/surgicalint_articles/subdural-hematoma-of-the-posterior-fossa-due-to-posterior-communicating-artery-aneurysm-rupture/
Background:We describe an unusual presentation of a ruptured aneurysm of the posterior communicating artery with an acute subdural hematoma (SDH) located in the posterior fossa. We also reviewed the literature, focusing on the location of this intracranial hematoma.
Case Description:An 83-year-old woman was admitted to our institution with recent sudden headache and dizziness. Magnetic resonance imaging showed a thin collection of blood in the subdural space adjacent to the clivus, along the wall of the posterior fossa, and at the cervical spine level. A right posterior communicating artery aneurysm was diagnosed using computed tomography angiography and digital subtraction angiography. The aneurysm had two lobes, one of which was attached to the right dorsum sellae. The aneurysm was occluded by stent-assisted coil embolization. The patient was discharged 3 weeks after admission with absence of neurological deficit.
Conclusion:A ruptured aneurysm of the posterior communicating artery may cause an acute SDH.
Keywords: Aneurysm, posterior fossa, subdural hematoma
Rupture of a cerebral aneurysm into the subdural space is a rare but well-known occurrence.[
We present a case with an SDH that developed in the posterior fossa due to rupture of a posterior communicating artery aneurysm. We present our opinion regarding the location of this hematoma.
An 83-year-old woman presented to another hospital complaining of sudden headache, dizziness, and nausea. Magnetic resonance imaging (MRI) performed at this hospital 13 days after the onset of symptoms was interpreted as a normal finding. The patient was transferred to our unit.
On admission, 15 days after the symptom onset, neurological examination was normal, with the exception of mild confused mentality. We reviewed outside first MRI, which revealed the presence of a thin blood collection along the dural lining of the posterior dorsum sellae, clivus, and occipital bone down to the whole border of the foramen magnum. This blood accumulation extended to the cervical spine level with cerebrospinal fluid intensity inside the subarachnoid space [
Magnetic resonance imaging performed 13 days after the symptom onset. (a) T2-weighted axial image at the mid-pons level demonstrating a thin blood collection adjacent to the clivus and both petrous bones. (b) T1-weighted axial image at the lower medulla level showing a thin blood collection at the retroclival area. (c) T1-weighted sagittal image showing a thin blood collection located in the retroclival and the dural lining along the occipital bone
Twenty-one days after ictus, the patient underwent stent-assisted coil embolization (using a 4.5 mm × 28 mm Enterprise stent; Cordis Endovascular, Miami Lakes, FL, USA). The aneurysm was embolized successfully [
Cases with clival hematoma similar to the one described here have been reported in the literature.[
The cranial dura mater is a composite structure of the cranial periosteum and dura propia (meningeal dura layer); the latter is composed of fibroblasts and a large amount of extracellular collagen, and the innermost part of the dura is formed by the dural border cell layer.[
Some authors reported interdural or intralaminar dural hematomas.[
Using sagittal MRI [
We think that our case including Brock et al.'s[
This was an interesting case showing an uncommon SDH after intracranial aneurysm rupture. Although other authors suggested that the location of hematoma was interdural, we think that the hematomas in our case and two other cases[
1. Ayberk G, Ozveren MF. Could infraclinoidal aneurysm cause interdural hemorrhage. Acta Neurochir (Wien). 2011. 153: 1331-
2. Ayberk G, Ozveren MF, Aslan S, Yaman ME, Yaman O, Kavaci S. Subarachnoid, subdural and interdural spaces at the clival region: An anatomical study. Turk Neurosurg. 2011. 21: 372-7
3. Bartoli A, Kotowski M, Pereira VM, Schaller K. Acute spinal epidural hematoma and cranial interdural hematoma due to a rupture of a posterior communicating artery aneurysm: Case report. Neurosurgery. 2011. 69: E1000-4
4. Brock S, Prada F, Maccagnano E, Giombini S. Interdural haemorrhage of the posterior fossa due to infraclinoidal carotid artery aneurysm rupture. Acta Neurochir (Wien). 2010. 152: 1543-6
5. Chung CK, Kim YM, Chi JG. Intralaminar dural haematoma developing in the contralateral convexity after temporal lobectomy. J Neurol Neurosurg Psychiatry. 1999. 66: 248-9
6. Haines DE, Harkey HL, Al-Mefty O. The “subdural” space: A new look at an outdated concept. Neurosurgery. 1993. 32: 111-20
7. Ishibashi A, Yokokura Y, Sakamoto M. Acute subdural hematoma without subarachnoid hemorrhage due to ruptured intracranial aneurysm--Case report. Neurol Med Chir (Tokyo). 1997. 37: 533-7
8. Ishikawa E, Sugimoto K, Yanaka K, Ayuzawa S, Iguchi M, Moritake T. Interhemispheric subdural hematoma caused by a ruptured internal carotid artery aneurysm: Case report. Surg Neurol. 2000. 54: 82-6
9. Kondziolka D, Bernstein M, ter Brugge K, Schutz H. Acute subdural hematoma from ruptured posterior communicating artery aneurysm. Neurosurgery. 1988. 22: 151-4
10. Miyajima K, Hayashi N, Kurimoto M, Kuwayama N, Hirashima Y, Endo S. Idiopathic interdural hematoma looking like a “Chinese dumpling”-Case report. Neurol Med Chir (Tokyo). 2004. 44: 75-6
11. Ozveren MF, Kayaci S, Ayberk G. Interdural hematoma extending from the clivus to the spinal epidural space in an intracranial aneurysm case. Neurosurgery. 2011. 69: E1339-41
12. Schievink WI, Thompson RC, Loh CT, Maya MM. Spontaneous retroclival hematoma presenting as a thunderclap headache.Case report. J Neurosurg. 2001. 95: 522-4
13. Tomaras C, Horowitz BL, Harper RL. Spontaneous clivus hematoma: Case report and literature review. Neurosurgery. 1995. 37: 123-4