Identifying People at Risk for Suicide: Implementation of Screening for the Zero Suicide Initiative in Large Health Systems.

Subdural hematoma (SDH), defined as blood accumulation within the potential space between the dura and arachnoid, is most often traumatic in origin.[] Other causes include acceleration–deceleration injury, intracranial hypotension, vascular malformations, and iatrogenic complications.[] While venous bleeding from bridging veins predominates, arterial bleeding, particularly from dural or cortical vessels, can also occur. Arterial-source SDH is diagnostically challenging as it often mimics venous bleeding, and pseudoaneurysms may not be visible on initial scans, especially studies without contrast. Rarely, this arises from traumatic intracranial pseudoaneurysms (TIPAs).[,] TIPAs account for fewer than 1% of all intracranial aneurysms and are histologically false aneurysms formed by arterial wall disruption contained by surrounding tissue.[] They carry mortality rates approaching 50%.[] Previous reports describe TIPAs from distal middle cerebral artery (MCA)[] and posterior cerebral artery (PCA)[,] branches presenting as acute or delayed SDH. Murakami . first reported a ruptured traumatic pseudoaneurysm mimicking spontaneous SDH in 2003,[] while later, Miyazaki . described a false aneurysm associated with vasospasm, leading to a SDH.[] Management options include microsurgery (clipping, trapping, bypass, or resection)[,] and endovascular strategies such as coil or liquid embolic occlusion.[,]