Intracerebral hematoma from aneurysm rupture

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Patients who present with an intraparenchymal hematoma associated with a ruptured aneurysm usually require urgent clot evacuation and aneurysm obliteration. The impact of the presence of hematoma on outcome has been poorly characterized. The authors report on 460 patients who had dense subarachnoid hemorrhage (SAH) (Fisher Grades 3 and 4) with and without associated hematoma.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Of the 959 consecutive patients who presented with SAH, 460 patients with Fisher Grade 3 and 4 SAH were analyzed and divided into two groups: those with (Group 1) and those without (Group 2) hematoma. The presenting Hunt and Hess grade and 6-month outcomes of the two groups were compared.</jats:p> <jats:p>Of the 460 patients, 116 (25%) had intraparenchymal hematomas and admission Hunt and Hess grades were worse in Group 1 compared with Group 2. Outcome scores were worse for Group 1 compared with Group 2; however, when comparing Group 1 and Group 2 within the same initial Hunt and Hess score, there was no statistical difference in outcome.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Intraparenchymal hematoma in association with SAH does not differ significantly from those patients without associated hematomas. We therefore recommend aggressive clot evacuation and aneurysm obliteration.</jats:p></jats:sec>

Subarachnoid Hemorrhage in Perivascular Spaces Mimicking Brainstem Hematoma

“…Intraparenchymal hematomas can occur, being more common with middle cerebral artery 2 and rare with posterior fossa aneurysms 3 , where intraventricular bleeding without parenchymal haemorrhage is the usual pattern 4 . The presence of intraparenchymal brainstem hematomas is not common and has not been described in a patient with a good clinical grade.…”

Ultra-early microsurgical treatment within 24 h of SAH improves prognosis of poor-grade aneurysm combined with intracerebral hematoma

“…Certain authors prefer to use endovascular coiling, since it is considered to present several advantages, including less trauma and shorter preoperative preparation or operative time when compared to general surgery (17). However, this procedure is generally ineffective or even aggravating for removing the intracranial hematoma and resolving the vasospasm (24,25). Prat and Galeano (26) reported 12 cases of mild cerebral artery aneurysm with intracerebral hematoma who demonstrated good outcomes following early surgery.…”

Treatment of ruptured anterior communicating artery aneurysm accompanying intracerebral hematomas: endovascular coiling followed by hematoma evacuation with burr hole trephination and catheterization

“…The presence of an ICH from a ruptured aneurysm is known to be a negative prognostic factor and is associated with high mortality rates [3,8]. The most common location of aneurysm accompanying ICH is the middle cerebral artery (MCA) [1,2]. It has been generally accepted that the standard treatment of ruptured aneurysms with ICH should be surgical clipping with simultaneous ICH evacuation, although the mortality rates have been shown to be high with a reported range of 21 to 85% [8][9][10][11].…”