ACUTE SUBDURAL HEMATOMAS DUE TO RUPTURE OF CORTICAL ARTERIES - A STUDY OF THE POINTS OF RUPTURE IN 19 CASES

BACKGROUND Several cases of acute subdural hematomas (ASDHs) due to ru pture of cortical arteries are reported. They have several characteris tic features: (1) their outcome is relatively good; (2) the cause is a trivial head injury; (3) patients are elderly; (4) a lucid interval i s recognized; (5) hypertension is associated in many cases; and (6) ce rebral contusion is absent. However, there has been no report about th e points of rupture in the cortical arteries. METHODS In 19 of the 125 patients with ASDHs admitted to our department, the cause of ASDH was bleeding from cortical arteries. The bleeding points were detected at surgery. Cases associated with cerebral contusion during or after the operation were excluded. In this article, we describe the clinical fi ndings and the sites of bleeding from arteries in 19 cases of ASDH due to rupture of cortical arteries. RESULTS The sites of ruptured arteri es were as follows: prefrontal artery in one of 23 identified arteries (4.3%); precentral artery in five (21.7%); central artery in four (17 .3%); anterior parietal artery in four (17.3%) angular artery in three (13.0%); middle temporal artery rn four (17.3%); and posterior tempor al artery in two arteries (8.7%). Two ruptured arteries in the same cr aniotomy were observed in four patients (17.3%). All points of rupture were located near the sylvian fissure (within 3 cm length around the sylvian fissure) and none in the base or vertex of the brain. CONCLUSI ON If an ASDH occurs following a trivial head injury, rupture of corti cal arteries should be considered as a possible cause. Wide craniotomy sufficiently covering the region surrounding the sylvian fissure shou ld be performed to obtain hemostasis of bleeding points. (C) 1997 by E lsevier Science Inc.