Death in a postpartum woman caused by an exceptionally rare case of concurrently rupture of bilateral non-traumatic carotid-ophthalmic aneurysm associated with bilateral acute subdural hematoma

C. Dogăroiu, C. O. Căpățînă,

Abstract: Nontraumatic intracranial aneurysms have a 2-5% incidence in the population and most are asymptomatic. However, even though the risk of rupture is low, it has a high mortality and morbidity. We report an extremely rare case of concurrently rupture of bilateral nontraumatic carotid-ophthalmic aneurysm complicated with acute bilateral subdural hematoma in a postpartum woman. The imagistic examinations showed two saccular bilateral aneurysm located at the carotid-ophthalmic junction, bilateral basal frontotemporal subdural hematoma, a right frontotemporal intraparenchimatous hematoma and massive cerebral edema. Additionally, the autopsy revealed the location of rupture of both aneurysms, and the presence of recent bilateral thrombi in the lumen of the cervical segment of the internal carotid arteries (as a result of the mechanical occlusion of these arteries due to the massive cerebral edema). In the absence of any medical and antenatal check-ups records of the patient, we concluded that in the pathogenesis of the development and rupture of these aneurysms could contributed the following factors: hemodynamic, blood, and arterial wall changes during pregnancy and puerperium, infection, presence of intraluminal aneurysm thrombus. We have suggested the possible pathogenic mechanism for the bilateral subdural hematoma based on the hypothesis of the aneurysm sentinel bleeding, sustained by the patient’s symptomatology.
Keywords: bilateral ruptured carotid-ophthalmic aneurysm, bilateral acute nontraumatic subdural hematoma, puerperium, sentinel hemorrhage.