NEUROLOGICAL PICTURE

Spontaneous occipital subdural haematoma A case of spontaneous occipital subdural haematoma due to ruptured aneurysm is described. A 70 year old woman was admitted on 20 July 2000, because of spontaneous severe occipitalgia. She had no neurological deficits. Several years before she had had a similar episode of severe headache, but she had not sought medical attention. Initial CT on admission showed a subtentorial high density area indicating a subdural haematoma. Brain MRI showed an occipital subtentorial subdural haematoma, successive flow void indicating an internal carotid artery aneurysm in the basal cistern, but no subarachnoid haemorrhage (fig 1 upper). Three dimensional CT angiography disclosed a large left internal carotid artery aneurysm extending posteromedially (fig 1 lower), and no abnormal vessel