Computed tomography of acute subdural hematomas from intracranial aneurysmal ruptures, as seen in relation to angiographic and clinical findings

Nine cases of acute subdural hematomas, as demonstrated by CT, resulting from cerebral aneurysmal ruptures were reviewed in a series of 450 cases of ruptured aneurysms between January, 1977, and December, 1985. They consisted of two males and seven females ranging in age from 36 to 66 years. Their CT examinations were performed from within 20 minutes to 17 hours from the onset. 1) From CT, cerebral angiographical, surgical, and/or autopsy findings, four of these cases were found to have ruptured aneurysms on the internal carotid artery, two on the middle cerebral artery, and three on the anterior cerebral artery. 2) Seven (78 %) of the cases showed a large aneurysm. 3) In addition to subdural hematomas with variable degrees of thickness and extension, intracerebral hemorrhage was present in all nine cases (100 %), ruptured intraventricular hemorrhage, in two (22 %), and subarachnoid hemorrhage, in six (67 %). 4) On admission, six cases (67 %) were in Grade IV and three (33 %) in Grade V, according to the classification of Hunt and Kosnik. Eight (89 %) had anisocoria, four (44 %) had decerebrate posture, and six (67 %) had fundal hemorrhage. 5) As to the outcome, six (67 %) of these cases died, while three (33 %) are still alive. Two of the survivors are in ADL 5, and one, in ADL 2. All of the fatalities and none of the survivors presented fundal hemorrhage. 6) Therefore, in the case of an acute subdural hematoma from an aneurysmal rupture it may be suggested that the evaluation of the primary brain damage, for which other, accompanying intracranial hemorrhages are also responsible, is important for prognosis and management. (author)