Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Case Report Pediatr Neurosurg 2008;44:397–401 DOI: 10.1159/000149908 Ruptured Middle Cerebral Artery Aneurysm in an Infant Presenting as Acute Subdural Hematoma: A Case Report Amos O. Adeleye Yigal Shoshan Jose E. Cohen Sergey Spektor Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel Introduction Cerebral arterial aneurysms are unusual in the pedi- atric age group and much rarer in infants. About 700 cas- es have been documented in children in the world litera- ture [1], including 131 in children under one year [2]. The great majority of cerebral arterial aneurysms in children present as acute subarachnoid hemorrhage [3, 4], and oc- casionally as mass lesions with focal neurological deficits or incidental findings [5]. Aneurysmal surgery in an in- fant poses great hazards and can lead to a fatal result if the team is not prepared, as demonstrated by the high rates of morbidity and mortality in published reports [2]. We present an eight-month-old male infant with a ruptured right middle cerebral artery (MCA) aneurysm who presented with a spontaneous acute subdural hema- toma. The infant was treated surgically in our depart- ment with a good neurological outcome. To the best of our knowledge, this is the first case in the literature of infantile intracranial aneurysm presenting as acute sub- dural hematoma without history of trauma [1, 3, 4] . Correct diagnosis of the etiology of the acute subdural hematoma and adequate preparation for acute cranio- vascular surgery were the keys to the successful treat- ment, in spite of the child’s very poor preoperative con- dition. Key Words Aneurysm  Infantile cerebral aneurysm  Intracranial aneurysm  Middle cerebral artery  Acute subdural hematoma Abstract We present an unusual case of ruptured infantile cerebral aneurysm. An eight-month-old infant was delivered to the hospital in poor condition, after convulsions, with no history of trauma. His emergent CT study revealed acute subdural hematoma. The clinical and radiological picture evoked sus- picion that the hematoma was of aneurysmal origin. The in- fant was operated with special preparations and precau- tions appropriate for aneurysmal surgery, and has shown a good recovery. It is important to consider the possibility of vascular accident in infants with subdural hematoma of non- traumatic origin. A good outcome may be achieved when appropriate preparations are made prior to surgery. Copyright © 2008 S. Karger AG, Basel Received: July 18, 2007 Accepted after revision: February 5, 2008 Published online: August 15, 2008 Sergey Spektor, MD, PhD Department of Neurosurgery, Hadassah-Hebrew University Medical Center Ein Kerem, PO Box 12000 Jerusalem 91120 (Israel) Tel. +972 2 677 7091/7092, Fax +972 2 644 9320, E-Mail spektor@hadassah.org.il © 2008 S. Karger AG, Basel 1016–2291/08/0445–0397$24.50/0 Accessible online at: www.karger.com/pne None of the authors has a financial relationship or other conflict with a company or product that is related in any way to this case presen- tation.