gms | German Medical Science

Objective: In most cases the history of SAH begins with the sudden onset of severe headache often with a short period of loss of consciousness, nausea and vomiting. The knowledge of the history of onset may be vital to the diagnosis for successful treatment right in time. In our 4 cases a subdural hemorrhage with mass effect and suspicious cerebral aneurysm requires different ways of treatment.

Methods: 2 patients were admitted of grade V Hunt and Hess; both showed a dilated pupil at admission. The CT-scan showed in one case a SDH right and ventricular dilation. In the other case a SDH left with midline shift was presented. Another two patients admitted with Hunt and Hess II respectively III suffered severe headache and nuchal rigidity, in the last case confusion and aphasia were presented. In the first both cases the urgent operative treatment was performed whereas in the other cases in better clinical condition in suspicious of an aneurysm an angiogram conducted before operation.

Results: Because of the poor clinical condition with coma caused by SDH the first patient got an external drainage followed by a decompressive craniectomie and evacuation of the SDH and an aneurysm was clipped. In the other case the decompression was performed. An angiogram after the operation detected an aneurysm, which could be treated intravascular with coils. One of two patients in good clinical condition first underwent the operative evacuation of the SDH then angiogram was performed and the aneurysm was clipped in a second operation. In the other patient the angiogram was performed first followed by evacuation the SDH and clipping the aneurysm in one operation.

Conclusions: SDH caused by a cerebral aneurysm is rare but it requires due to its mass-effect and clinical condition different ways of treatment. The operative procedure should be urgent evacuation of the haematoma and eventually decompressive craniectomie. The surgeon should think of an aneurysm and be ready to occlude it with clips or obtain the angiogram when possible with the option of intravascular occlusion with coils.