Background Pure subdural hematoma (without subarachnoid, intraventricular, or intraparenchymal hemorrhage) due to a rupture intracranial aneurysm is a rare pathology. Most reported cases involve an aneurysm along the internal carotid artery, posterior communicating artery, or middle cerebral artery. No reports have documented an aneurysm along the intracranial portion of a branch from the occipital artery.
Case presentation Patient is a 70 year old female, history of hypertension, congestive heart failure, renal artery stenosis, gout, who presented with sudden onset severe excruciating headaches, associated with spinning sensation, nausea, and emesis. No history of trauma. Neurological examination was unremarkable. CT head demonstrated a tentorial subdural hematoma. CTA head revealed a 4 mm aneurysm along the peripheral left inferior cerebelllum and 3 mm aneurysm adjacent to the right sigmoid sinus, both without clear visualization of the parent vessels. Diagnostic angiogram revealed bilateral aneurysms along the transmastoid branches of the intracranial portion of both occipital arteries. Consequently, these branches were embolized, with no residual filling of the aneurysms. Post-procedure, she remained neurologically well. She was monitored appropriately for vasospasm, and discharged home 10 days after presentation.
Conclusion Rupture of aneurysms along intracranial branches of the occipital artery can lead to pure subdural hematoma along the tentorium. For non-traumatic acute subdural hematoma, vigilance should be directed towards a vascular etiology.
Disclosures H. Nguyen: None. N. Doan: None. S. Shabani: None. M. Gelsomino: None. O. Zaidat: None.
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