Simultaneous subdural, subarachnoideal and intracerebral haemorrhage after rupture of a peripheral middle cerebral artery aneurysm

Katalin Anna Béres-Molnár, András Folyovich, Péter Szloboda, Zsolt Szendrey-Kiss, Dániel Bereczki, Mária Bakos, György Várallyay, Huba Szabó, István Nyári

Research output: Contribution to journalArticle

Abstract

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo-gical examination excluded mycotic etiology of the aneu-rysm and "normal aneurysm wall" was described. The brain stem haemorrhage - Duret bleeding - was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

Original languageEnglish
Pages (from-to)213-216
Number of pages4
JournalIdeggyogyaszati szemle
Volume73
Issue number05-06
DOIs
Publication statusPublished - May 30 2020

Keywords

  • Duret haemorrhage
  • distal aneurysm of middle cerebral artery
  • intracranial haemorrhage

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Béres-Molnár, K. A., Folyovich, A., Szloboda, P., Szendrey-Kiss, Z., Bereczki, D., Bakos, M., Várallyay, G., Szabó, H., & Nyári, I. (2020). Simultaneous subdural, subarachnoideal and intracerebral haemorrhage after rupture of a peripheral middle cerebral artery aneurysm. Ideggyogyaszati szemle, 73(05-06), 213-216. https://doi.org/10.18071/isz.73.0213