Images in Intensive Medicine
Spontaneous acute subdural hematoma. An unusual presentation of ruptured cerebral aneurysm
Hematoma subdural agudo espontáneo. Presentación infrecuente de aneurisma cerebral roto
M.D. Freire Aragón
, M. Adriaensens Pérez, A.J. Marín Caballos
Corresponding author
Unidad de Gestión Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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An unusual presentation of ruptured cerebral aneurysm" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "190" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.D. Freire Aragón, M. Adriaensens Pérez, A.J. Marín Caballos" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.D." "apellidos" => "Freire Aragón" "email" => array:1 [ 0 => "lola_freire@ono.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Adriaensens Pérez" ] 2 => array:2 [ "nombre" => "A.J." "apellidos" => "Marín Caballos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hematoma subdural agudo espontáneo. Presentación infrecuente de aneurisma cerebral roto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 681 "Ancho" => 905 "Tamanyo" => 90513 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cranial CTA. Aneurysmal lesion dependent on the bifurcation of the right middle cerebral artery (arrowhead).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A fifty-three-year-old woman with no significant medical history was admitted due to sudden decreased level of consciousness preceded by headache and vomit. Her Glasgow Coma Scale Score was 5, the patient offered motor response in the extension prone position and right mydriasis. We proceeded with airway isolation. The cranial computed tomography (CT) scan conducted showed an extensive right acute subdural hematoma with a 9<span class="elsevierStyleHsp" style=""></span>mm midline shift (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and no associated subarachnoid hemorrhage. Since the patient had not sustained any traumas, the CT scan was followed by a CTA that confirmed the presence of one 10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm oval-shaped aneurysm independent from the bifurcation of the right middle cerebral artery responsible for the bleeding in an atypical location such as the subdural space (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We proceeded with the urgent evacuation of the subdural hematoma and the direct clipping of the aneurysm with a favorable clinical course.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Freire Aragón MD, Adriaensens Pérez M, Marín Caballos AJ. Hematoma subdural agudo espontáneo. Presentación infrecuente de aneurisma cerebral roto. Med Intensiva. 2019;43:190.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 976 "Ancho" => 905 "Tamanyo" => 64188 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cranial CT scan (axial slice). Right hemispheric extra-axial hyperdense collection consistent with an extensive acute subdural hematoma with significant mass effect.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 681 "Ancho" => 905 "Tamanyo" => 90513 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cranial CTA. Aneurysmal lesion dependent on the bifurcation of the right middle cerebral artery (arrowhead).</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000003/v1_201903300628/S2173572719300189/v1_201903300628/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000003/v1_201903300628/S2173572719300189/v1_201903300628/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300189?idApp=WMIE" ]
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