PMC9699883_01
Computed tomography (CT) without contrast of the head at initial presentation. (a) Coronal image with bilateral subdural hematoma (SDH) inferior to the tentorium with more blood product being on the right side. (b) Sagittal image with SDH inferior to the tentorium and dorsal to the clivus with extension into the ventral cervical spine.
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F2
Computed tomography (CT) of the head without contrast demonstrated an acute SDH posterior to the clivus with extension into the upper cervical spine and along the tentorium bilaterally [Figure 2].
Sagittal CT head without contrast (a) and CT angiogram (b) demonstrating SDH inferior to the tentorium with an inferiorly projecting posterior communicating artery (PComA) aneurysm (red arrow). This figure highlights the anatomical orientation of this aneurysm and how its rupture can lead to a pure SDH in the infratentorial compartment.
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F3
The relationship of the aneurysm dome to the clinoids, tentorial edge, clivus, and tentorial leaflets is shown in [Figure 3] and this was deemed to be the etiology of the peculiar SDH.
Digital subtraction angiogram demonstrating orientation of aneurysm. (a) Anterior-posterior (AP) view demonstrates the AP aneurysm projection as the aneurysm (black arrow) is projecting parallel to ICA. (b) LAO view demonstrates the anterior-inferior projection of the aneurysm (white arrow).
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F4
The anterior-posterior (AP) and left anterior oblique (LAO) views demonstrate the anterior-inferior projection of the aneurysm [Figure 4].
An AP (a) and LAO (b) digital subtraction angiogram demonstrating effective coil embolization of aneurysm (black arrow).
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F5
The aneurysm was successfully secured with endovascular coil embolization [Figure 5].