A ruptured pediatric intracranial aneurysm mimicking an epidural hematoma: a case report and review of the literature

Abstract BackgroundPediatric intracranial aneurysms are rare. SAH due to a ruptured intracranial aneurysm is potentially catastrophic; therefore, early identification and treatment are essential. Subarachnoid hemorrhage (SAH) is characterized on brain CT by the presence of blood in the subarachnoid cisterns and sulci.Case presentationAn eight-year-old female presented to the emergency room (ER) unconscious after a generalized tonic-clonic seizure. There was no history of fever or head trauma, or a personal or family history of epilepsy. At the ER, she was unresponsive, with dilated and unreactive pupils, absent brainstem reflexes, and a Glasgow Coma Scale (GCS) of three. Therefore, she was subsequently intubated. An emergency brain CT scan revealed a hyperdense, lens-shaped right parietal collection with surrounding brain edema and midline shift. The diagnosis of non-traumatic EDH was made. The patient underwent decompressive craniotomy and evacuation. Intraoperatively, the surgeons discovered that the hematoma was due to localized subarachnoid hemorrhage (SAH) secondary to a ruptured distal middle cerebral artery aneurysm. Histopathologic examination of the resected tissue excluded an infectious bacterial or mycotic etiology. After a stable in-hospital course, the patient was discharged. A year later, she remains seizure-free.ConclusionsA well-circumscribed aneurysmal SAH could rarely present as a lens-shaped hematoma, leading to the radiological diagnosis of an epidural hematoma. Good outcome remains likely in pediatric patients with aneurysmal SAH.