Endovascular treatment of distal anterior cerebral artery aneurysm presenting with acute subdural hematoma

•Endovascular treatment of distal anterior cerebral artery aneurysm.•Endovascular treatment of aneurysm in the presence of acute subdural hematoma.•Late treatment of borderline sized acute subdural hematoma in its chronic phase. Distal anterior cerebral artery /DACA/ aneurysms are located distally from the anterior communicating artery /AComA/ and account for less than 10% of all intracranial aneurysms, according to large cohort studies. Most commonly they present with subarachnoid hemorrhage /SAH/ and frontal intracerebral hemorrhage /ICH/, located preferentially close to the interhemispheric fissure. Only 2–5% of the intracranial aneurysms present with acute subdural hematomas /ASDH/. A few cases have been published where the sole presenting symptom of ruptured DACA aneurysm was ASDH. In all of those cases the therapeutic management consisted of ASDH evacuation and aneurysm clipping. However, we would like to present a clinical case of a patient with ruptured DACA aneurysm with ASDH that underwent endovascular coiling in the acute setting and operative treatment of the SDH later on with excellent clinical outcome.