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(Stroke. 2002;33:876.)
© 2002 American Heart Association, Inc.

Letters to the Editor

The Unusually Shaped Bifrontal Hematoma

Süleyman Kutluhan, MD

Department of Neurology

Orhan Oyar, MD

Department of Radiology

Sadik Ozmen, MD Alev Noyaner, MD

Department of Anesthesiology

Kezban Guler, MD

Department of Neurology

Ahmet Yesildag, MD

Department of Radiology, Suleyman Demirel University School of Medicine, Isparta, Turkey

To the Editor:

We present a rare case of bifrontal hematoma resulting in death caused by a spontaneously ruptured aneurysm of the anterior communicating artery (ACoA). The hematoma was in the shape of a thick crescent, and the aneurysm was revealed on computerized tomography (CT) and CT angiography.

A 60-year-old man suffering from hypertension and diabetes mellitus was admitted to the emergency service after having lost consciousness following vomiting and urinary incontinence. Examination revealed a systolic blood pressure of 220 mm Hg and a diastolic blood pressure of 120 mm Hg. He had a tachypneic and irregular respiration. His score on the Glasgow Coma Scale was 5 (E₁M₃V₁). Both of his pupils were middilated, and direct and indirect light reflexes were decreased; deep tendon reflexes were decreased in all extremities, and he had a bilateral positive Babinski sign. He was admitted directly to the intensive care unit (ICU) from the emergency department. In the ICU, cardiopulmonary arrest developed. He was intubated, and a ventilator maintained his respiration. His radiological evaluation including CT revealed a thick, crescent-shaped bifrontal hematoma measuring 90 cm³ (Figure). He was grade 5 according to the World Federation of Neurological Surgeons grading scale. Conventional angiographic examination could not be performed because there was no indication of surgical approach and the patient’s clinical condition was not appropriate for transporting him to the angiography unit. On the second day of admission, the patient underwent a control CT and CT angiography. It demonstrated a 0.5-cm-diameter berry-shaped hyperdensity on . . . [Full Text of this Article]