Delayed haemorrhage in the splenium of the corpus callosum after aneurysm rupture

摘要

Background and object. Delayed haemorrhage in the splenium of the corpus callosum after aneurysm rupture is a rare finding. It can be defined as a haemorrhage not present at the initial diagnosis of subarachnoid bleeding, in the context of an aneurysm not located in the corpus callosum vascularization. Only three such cases have been reported, all with focal and circumscribed haematomas. We describe a case of diffuse haemorrhage along the splenium fibres. Patient. A 75-year-old woman was attended for an acute cognitive deterioration. Imaging studies revealed an aneurysm in the anterior communicating artery, and subacute haematomas in both frontal lobes. An uneventful surgical clipping of the aneurysm was performed. Postoperative CT-scans showed a haemorrhage along the splenium fibres, and hydrocephalus. A ventriculoperitoneal shunt was placed, and subsequent CT scans demonstrated progressive, spontaneous improvement of the splenium haemorrhage. Conclusions. Delayed haemorrhage in the splenium of the corpus callosum has a sporadic incidence. Physiopathology is unknown, and proposed explanations include compression of the splenium against the falx due to hydrocephalus, and haemorrhagic transformation of an ischaemic infarct due to vasospasm. Treatment is therefore based on adequate treatment of hydrocephalus and discontinuation of vasodilator drugs. The three previous cases of focal haematomas are discussed, and the first case of diffuse haemorrhage is described.