An acute subdural hematoma caused by rupture of a middle cerebral artery aneurysm

: Acute subdural hematoma caused by cerebral aneurysm rupture is rare. We describe a clinical case of an acute subdural hematoma developed due to rupture of an aneurysm at the M1 segment bifurcation of the middle cerebral artery (MCA). The acute subdural hematoma associated with intracranial hypertension and transtentorial herniation resulted in a comatose condition. The patient underwent decompressive craniectomy, hematoma removal, and clipping of the aneurysm. A significant improvement was observed in the postoperative period. The patient was discharged with mild hemiparesis and moderate paresis of the oculomotor nerve. This case demonstrates the need for an urgent surgical intervention in the form of decompressive craniectomy and aneurysm clipping as life-saving surgery, even in patients with transtentorial herniation syndrome in a serious condition.