J Korean Neurosurg Soc.  2015 Dec;58(6):547-549. 10.3340/jkns.2015.58.6.547.

Acute Spontaneous Subdural Hematoma due to Rupture of a Tiny Cortical Arteriovenous Malformation

• Choi HJ
• Lee JI
• Nam KH
• Ko JK

• KMID: 2151157
• DOI: http://doi.org/10.3340/jkns.2015.58.6.547

Abstract

Acute subdural hematoma (SDH) of arterial origin is rare, especially SDH associated with an arteriovenous malformation (AVM) is extremely rare. The authors report a case of acute spontaneous SDH due to rupture of a tiny cortical AVM. A 51-year-old male presented with sudden onset headache and mentality deterioration without a history of trauma. Brain CT revealed a large volume acute SDH compressing the right cerebral hemisphere with subfalcine and tentorial herniation. Emergency decompressive craniectomy was performed to remove the hematoma and during surgery a small (5 mm sized) conglomerated aciniform mass with two surrounding enlarged vessels was identified on the parietal cortex. After warm saline irrigation of the mass, active bleeding developed from a one of the vessel. The bleeding was stopped by coagulation and the vessels were removed. Histopathological examination confirmed the lesion as an AVM. We concluded that a small cortical AVM existed at this area, and that the cortical AVM had caused the acute SDH. Follow up conventional angiography confirmed the absence of remnant AVM or any other vascular abnormality. This report demonstrates rupture of a cortical AVM is worth considering when a patient presents with non-traumatic SDH without intracerebral hemorrhage or subarachnoid hemorrhage.

Keyword

Acute subdural hematoma; Arteriovenous malformation; Surgical resection

MeSH Terms

Angiography
Arteriovenous Malformations*
Brain
Cerebral Hemorrhage
Cerebrum
Decompressive Craniectomy
Emergencies
Follow-Up Studies
Headache
Hematoma
Hematoma, Subdural*
Hematoma, Subdural, Acute
Hemorrhage
Humans
Male
Middle Aged
Rabeprazole
Rupture*
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 Computed tomography scan on admission showing right acute subdural hematoma and midline shift.

• 

  Fig. 2 In the operative field view showing small (5 mm sized) aciniform mass in the right inferior parietal lobule that active pulsatile bleeding focus.

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  Fig. 3 Photomicrograph demonstrating the cerebral AVM that contained the artery with abnormal muscle wall (white arrow) and the vein with hyalinized wall (black arrow). HE stain, original magnification ×100.

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