Left posterior communicating aneurysm presenting as subdural hemorrhage
Findings:
Axial CT images show sulcal effacement on the left, associated
with a small amount of hyperdensity posteriorly along the tentorium, indicative
of subdural hemorrhage. There is no evidence of recent subarachnoid hemorrhage.
Left common carotid arteriography shows a large aneurysm of the left posterior
communicating artery.
Discussion:
CTA/MRA or conventional angiography is indicated in cases of intracranial hemorrhage
without clear history of trauma to help exclude underlying AVM or aneurysm.
Subdural hemorrhage may be seen in 3-5% of bleeding aneurysms, but is rare
in isolation without subarachnoid hemorrhage. Prior hemorrhage with dural
adhesion formation may be responsible for this unusual presentation.