[A case of septic aneurysm complicated with simultaneous subdural and intracerebral hematoma].

A case of septic aneurysms complicated with simultaneous subdural and intracerebral hematoma is presented. A 13-year-old girl had been operated on for endocardial cushion defect when she was 5 years old, and residual mitral regurgitation was followed up. She suddenly complained of headache, vomited and lost consciousness. She was brought to the Tokyo Women's Medical College Hospital by an ambulance. On arrival, she was semicomatose. Her left pupil was mydriatic and did not react to light. Right hemiparesis was noted. Systolic murmur was audible in the apical region of the heart. Laboratory data showed a mild anemia and a white cell count of 23,000. CT scan showed a subdural hematoma in the left frontotemporoparietal region and a small subcortical hematoma in the left occipital lobe. An emergency operation was carried out for the subdural hematoma. When the dura was opened, about 10 ml bloody CSF flowed out. A hematoma weighing about 50 g was removed. A bleeding point or an aneurysm could not be discovered on the dura, arachnoid membrane or surface of the brain at the operation. On the 15th day after the operation, when the fever was decreased, cerebral angiography was done. The left vertebral angiogram showed an aneurysm on a peripheral branch of the calcarine artery, which was considered the origin of the subcortical hematoma in the left occipital lobe. The left carotid angiogram showed no aneurysm. On the seventh day after that study, the aneurysm did not appear by left vertebral angiography. She was discharged with no neurological deficit. One month later, she was admitted again with a high fever.(ABSTRACT TRUNCATED AT 250 WORDS)