Bilateral acute subdural haematoma without subarachnoid haemorrhage secondary to rupture of an anterior communicating aneurysm. A case report and review of the literature

Introduction. Pure acute subdural haematomas caused by aneurysmal rupture are a highly infrequent event, with only 51 cases published in the literature to date, with only six cases due to the rupture of anterior communicating artery aneurysm. Aim. To describe a case of an acute subdural haematoma not associated with subarachnoid haemorrhage due to ruptured of an anterior communicating cerebral artery aneurysm. Case report. A 55-year-old woman without a traumatic history, who is found at home with a level of consciousness of 4 points on the Glasgow Coma Scale and a bilateral arreactive mydriasis, which are reversed with medical measures. Cranial CT shows an acute bi-hemispherical convexity and interhemispheric subdural haematoma with no evidence of associated subarachnoid haemorrhage. The angio-CT reveals an anterior communicating artery aneurysm. We proceed to urgent embolization of the aneurysm. The patient was admitted to the Intensive Care Unit, where intracranial pressure is monitored and controlled initially with medical treatment. Patient outcome was unfavorable, confirming in the control CT scan coincident with an increase of uncontrolled medically intracranial hypertension, established ischemic infarctions areas, which made any surgical treatment non-viable. Conclusion. In the case of an acute subdural haematoma without subarachnoid haemorrhage nor traumatic brain injury or its external stigmas, we must consider the rupture of a cerebral aneurysm as a possible cause. Likewise, the initial management of the acute subdural haematoma in patients with poor neurological condition should be priority and surgical.