• Xianfeng Gao, Fagui Yue, Fenglei Zhang, Yang Sun, Yang Zhang, Xiaobo Zhu, and Wei Wang.
• Department of Neurosurgery.
• Medicine (Baltimore). 2020 Jul 31; 99 (31): e21434.

RationaleIntracranial aneurysm with the first manifestation of acute subdural hematoma (aSDH) is rare in the field of neurosurgery. Usually subarachnoid hemorrhage or intracranial hematoma happens after the rupture of an intracranial aneurysm, whereas trauma is the primary cause of aSDH.Patient ConcernsHere, we present the case of a 71-year-old woman who presented with spontaneous aSDH with progressive headache and vomiting.DiagnosisUrgent head computed tomography (CT) identified an aSHD, but the patient had no history of trauma. CT angiography (CTA) identified the cause of the aSDH as rupture of an intracranial aneurysm in the left middle cerebral artery.InterventionsEmergent craniotomy with hematoma evacuation was performed.OutcomesDue to prompt diagnosis and appropriate intervention, the patient recovered fully with no disability.LessonsThis unique case demonstrates that aSDH caused by intracranial aneurysm rupture requires timely identification and appropriate action to prevent adverse outcomes. We performed a comprehensive systematic literature review to examine the etiology and pathogenesis of non-traumatic aSDH. Furthermore, digital subtraction angiography should be considered in patients diagnosed with an aSDH with no known cause.

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