急性硬膜下あるいは脳内血腫を合併した破裂脳動脈瘤の4手術例  [in Japanese] Four Cases of Ruptured Cerebral Aneurysm Presenting Acute Subdural Hematoma  [in Japanese]

Acute subdural hematoma(ASDH) due to ruptured cerebral aneurysm is relatively rare. In our institution, of the 210 patients with subarachnoid hemorrhage(SAH) seen between 2000 and 2006, only 6 (2.9%) revealed ASDH in association with cerebral aneurysm. The Hunt & Kosnik grade on admission was Grade III in 1, Grade IV in 3, Grade V in 2. Four patients with Grade III or IV underwent emergency hematoma removal and aneurysmal neck clipping. The outcome was good recovery in 3 and moderately disabled in 1 with Glasgow Outcome Scale. Two patients with Grade V treated conservatively died. We discuss the present cases with reference to a review of the literature.