Abstract: Objective　To investigate the clinical features, misdiagnosis causes, and preventive measures of ruptured intracranial aneurysm with simple acute subdural hematoma as the main sign. Methods　Two cases of ruptured intracranial aneurysm presenting as simple acute subdural hematoma admitted to The Third People's Hospital of Hubei Province, Jianghan University from November 2021 to January 2022 were retrospectively analyzed. Results　Both patients showed acute subdural hematoma on imaging. One case was distal posterior inferior cerebellar artery aneurysm; missed diagnosis was not found in time during angiography; finally the aneurysm was diagnosed only after the second rupture. The other case was posterior communicating aneurysm, and was misdiagnosed as internal carotid cavernous sinus fistula at admission. Both patients received surgical treatment; 1 patient had good prognosis, and the other patient remained in coma after surgery. Conclusions　Ruptured intracranial aneurysm with simple acute subdural hematoma is extremely rare and has the characteristics of mild symptoms, severe disease, and rapid progression, and is prone to misdiagnosis and missed diagnosis and delayed treatment. Neurosurgeons can improve their understanding of the disease so that they can treat the causes, reduce the risk of rebleeding, and improve the prognosis.

Key words: Acute subdural hematoma, Intracranial aneurysm, Misdiagnosis, Missed diagnosis

摘要： 目的　探讨以单纯急性硬膜下血肿为表现的颅内动脉瘤破裂的临床特点、误诊原因及防范措施。方法　对2021年11月至2022年1月江汉大学附属湖北省第三人民医院收治的2例以单纯急性硬膜下血肿为表现的颅内动脉瘤破裂患者进行回顾性分析。结果　2例首次出血影像都仅表现为天幕薄层急性硬膜下血肿。1例为小脑后下动脉（PICA）远端动脉瘤，造影时漏诊未及时发现，于第2次出血才确诊为动脉瘤破裂出血。另1例为颈内动脉后交通段动脉瘤，入院时误判为海绵窦型硬脑膜动静脉瘘。2例患者均行手术治疗，1例患者预后良好，1例患者术后持续昏迷。结论　以单纯急性硬膜下血肿为表现的颅内动脉瘤破裂极为罕见，有症状轻、病情重、进展快等临床特点，易误诊漏诊，延误治疗。神经外科医师提高对该病的认识，可及时针对病因治疗，减少再出血风险，改善预后。

关键词: 急性硬膜下血肿, 颅内动脉瘤, 误诊, 漏诊