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Mycotic intracranial aneurysms rupture presenting as pure acute subdural hematoma in infectious endocarditis. Report of 2 cases and review of the literature.

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April 2019

Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat University Hospital, 46 rue Henri Huchard, 75018 Paris, France; INSERM U738, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France. Electronic address:

Acute subdural hematoma (ASDH) revealing mycotic aneurysm (MA) is an exceptional occurrence. We report 2 cases of MA-related pure ASDH in the course of infective endocarditis (IE) without history of head trauma, hypertension or coagulopathy. Case 1: A 54-year-old man presented with a 10-day history of headache, fever.

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From the history of 15 personal patients--8 reported here in extenso--and from 63 patients in the literature with the diagnosis of posterior fossa subdural haemorrhage during life, we discuss the possibility of detecting tentorial damage on computed tomography (CT) and ultrasound (US) scan. The association of a (peri)cerebellar haemorrhage with peritentorial bleeding around the straight sinus and a subdural haemorrhage between both occipital cerebral lobes is suggestive of tentorial laceration(s). Both coronal CT scan and sagittal US scan are very helpful in locating these haemorrhages near the falco-tentorial junction.

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