Introduction: Acute spontaneous subdural hematoma (ASSDH) due to ruptured arteriovenous malformation (AVM) is exceptional. There were only four reported cases. In this paper, we present a successful multimodality treatment of the ASSDH secondary to ruptured AVM.
Case Presentation: A 21-year-old healthy man with no history of trauma presented to our hospital with complaints of severe headache for 12 hours before admission. On examination, he was alert and oriented. He had no intracranial hypertension, meningismus, and neurological deficits. Computed tomography illustrated a right acute subdural hematoma 8mm in thickness with a 5mm midline shift and a right frontal intraparenchymal hemorrhage 40 × 25mm in size. Digital subtraction angiography showed a 2 × 3 cm right frontal AVM, Spetzler-Martin grade I. The feeding arteries were cortical branches of the right anterior cerebral artery, and drain veins were cortical veins. He received emergency preoperative embolization followed by hematoma evacuation and total excision of the malformation. His headache was relieved and disappeared after a week. No postoperative neurological deficits were reported.
Clinical Discussion: Elective surgical resection of AVM after 4-6 weeks was preferred in patients with no risk factors of rebleeding. Emergent surgery was only indicated for significant mass effect or acute hydrocephalus. Preoperative embolization is helpful for the presence of intra-nidal or peri-nidal aneurysm, AVM with high grades, reducing intraoperative blood loss and occlusion of deep vessels.
Conclusion: ASSDH due to ruptured AVM is rare and easy to omit in clinical settings. Preoperative embolization and surgical excision are effective treatments.
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http://dx.doi.org/10.1016/j.amsu.2021.102613 | DOI Listing |
J Neurol Surg A Cent Eur Neurosurg
December 2024
Division of Neurosurgery, University of Rome Tor Vergata, Rome, Italy.
Background: Chronic subdural hematoma (cSDH) is a common pathology in daily practice of neurosurgery. Surgical management usually offers a significant clinical recovery. However, the recurrence rate is still high.
View Article and Find Full Text PDFJ Neurosurg Case Lessons
December 2024
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Background: Parafalcine subdural hematomas (pSDHs) are a subtype of subdural hematoma (SDH) that occur most frequently in older patients after blunt trauma. The literature primarily describes two clinical courses for patients with pSDH: those who are neurologically intact with stable examinations and imaging and those with focal deficits, with or without hematoma progression. Surgical management is undoubtedly required for the latter group; however, there are no evidence-based guidelines specifically for pSDH.
View Article and Find Full Text PDFJ Belg Soc Radiol
December 2024
Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Although computed tomography (CT) is the diagnostic gold standard for acute subdural hematoma, the absence of clear trauma should prompt the use of computed tomography angiography (CTA) to identify potential underlying causes, such as ruptured aneurysms, which can significantly influence treatment decisions.
View Article and Find Full Text PDFWorld Neurosurg
December 2024
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Nuevo León, México. Electronic address:
World Neurosurg
December 2024
Department of Neurosurgery, The Jinyang Hospital Affiliated to Guizhou Medical University, Guiyang, China. Electronic address:
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