Elsevier

Surgical Neurology

Volume 25, Issue 1, January 1986, Pages 6-17
Surgical Neurology

Intracranial hematomas following aneurysmal rupture: Experience with 309 cases

https://doi.org/10.1016/0090-3019(86)90107-2Get rights and content

Abstract

Three hundred and nine consecutive cases of intracranial hematomas due to aneurysmal rupture—representing 34% of the total number of patients with aneurysms observed in a 12-year period—were evaluated; of these, 211 were submitted to computed tomography scan. Hematomas were present on admission in 71% of patients and occurred at rebleeding in 29%. Ruptured middle cerebral artery aneurysms caused an intracranial hematoma more frequently than aneurysms in other locations. Ventricular hematomas were frequently observed—especially at rebleeding—in cases with anterior communicating artery aneurysms. Basal ganglia hematomas were detected in eight cases with internal carotid bifurcation aneurysms and in three with middle cerebral artery aneurysms. Subdural hematomas were observed in 32 cases, mainly due to ruptured middle-cerebral-artery and internal-carotid-artery aneurysms. As for clinical evolution, a rapid deterioration was observed in 39% of cases and a chronic course in 46%; a subacute deterioration was far less frequent. Delayed deterioration from vasospasm was observed in 8% of cases, and appeared to be related to the amount of subarachnoid bleeding associated with the hematoma. One hundred and forty-two patients were submitted to surgical treatment (evacuation of hematoma together with exclusion of aneurysm); deep coma, poor medical condition, stabilized neurological disability, or combinations of these factors accounted for the high number of patients not operated upon. Regardless of treatment, 24% of patients showed good results and 58% died. Presence of a large hematoma, ventricular hemorrhage, and shift of the ventricles represented significant risk factors, associated with a poor prognosis. A comparison between two groups of patients admitted within 3 days of hemorrhage-47 operated on early, and 149 with delayed treatment—showed that better results were achieved by early operations, especially for cases in Hunt's grades IV and V.

References (38)

  • RD Hayward et al.

    Intracerebral haemorrhage: accuracy of computerized transverse axial scanning in predicting the underlying aetiology

    Lancet

    (1976)
  • AF Reynolds et al.

    Bleeding patterns from ruptured intracranial aneurysms: an autopsy series of 205 patients

    Surg Neurol

    (1981)
  • H Abe et al.

    Ruptured aneurysms with intracerebral hematoma

    No Shinkei Geka

    (1977)
  • E Barton et al.

    Subdural hematoma in association with intracranial aneurysm

    Neuroradiology

    (1982)
  • E Bohm et al.

    Experiences of surgical treatment of 400 consecutive ruptured cerebral arterial aneurysms

    Acta Neurochir

    (1978)
  • WC Boop et al.

    Ruptured intracranial aneurysm complicated by subdural hematoma

    J Neurosurg

    (1961)
  • J Bromowicz et al.

    Intracerebral and subdural hematoma due to hemorrhage from intracranial aneurysm

    Neurol Neurochir Pol

    (1973)
  • MR Crompton

    Intracerebral hematoma complicating ruptured cerebral berry aneurysm

    J Neurol Neurosurg Psychiatry

    (1962)
  • R Da Pian et al.

    A preliminary report on early surgery for bleeding intracranial aneurysms

    J Neurosurg Sci

    (1983)
  • KR Davis et al.

    Computed tomographic evaluation of hemorrhage secondary to intracranial aneurysm

    Am J Roentgenol

    (1976)
  • CG Drake

    Subdural hematoma from arterial rupture

    J Neurosurg

    (1961)
  • CG Drake

    The treatment of aneurysms of the posterior circulation

    Clin Neurosurg

    (1979)
  • JM Fein et al.

    Interhemispheric subdural hematoma secondary to hemorrhage from a callosomarginal artery aneurysm

    Neuroradiology

    (1970)
  • E Freytag

    Fatal rupture of intracranial aneurysms, survey of 250 medicolegal cases

    Arch Pathol

    (1966)
  • J Golden et al.

    Subdural hematoma following subarachnoid hemorrhage

    Arch Neurol Psychiatry

    (1953)
  • P Gruss

    Therapeutic procedures in aneurysms with intracerebral hematoma

  • SF Handel et al.

    Subdural hematomas due to ruptured cerebral aneurysms: angiographic diagnosis and potential pitfall for CT

    AJR

    (1978)
  • A Hijdra et al.

    Early death from rupture of an intracranial aneurysm

    J Neurosurg

    (1982)
  • TM Keller et al.

    Persistent isodense intraventricular hematoma caused by intraventricular saccular aneurysm

    Surg Neurol

    (1980)
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