Intrasylvian hematoma caused by ruptured middle cerebral artery aneurysms predicts recovery from poor-grade subarachnoid hemorrhage

Abstract

P atients who present with a poor neurological grade after aneurysmal subarachnoid hemorrhage (SAH) often have poor outcomes. Intrasylvian hematoma (ISH) is a subtype of intracranial hematoma caused by aneurysmal rupture and has distinct features. 2,18,19 Poor-grade SAH with ISH has been considered to be less associated with severe initial injury and regarded as a potential responder to intensive treatment. 2,19,20 The purpose of this study is to clarify whether the presence of ISH predicts good functional recovery from poor-grade aneurysmal SAH. MethodsThe study is reported based on criteria from the STROBE (Strengthening the Reporting of Observational abbreviatioNs ICH = intracerebral hematoma; ISH = intrasylvian hematoma; mRS = modified Rankin Scale; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies. obJect Intrasylvian hematoma (ISH) is a subtype of intracranial hematoma caused by aneurysmal rupture and often presents with a poor initial neurological grade; it is not well studied. The aim of this study was to elucidate outcomes of aneurysmal subarachnoid hemorrhage (SAH) with ISH. Methods Data for 97 patients with poor-grade SAH (World Federation of Neurosurgical Societies Grade IV or V) were retrospectively analyzed from a single-center, prospective, observational cohort database. Ultra-early surgical clipping, removal of hematoma, external decompression for brain swelling, and prevention of vasospasm by cisternal irrigation with milrinone were combined as an aggressive treatment. Characteristics and clinical courses of SAH with ISH were identified. The authors also evaluated any correlations between poor admission-grade SAH and ISH with good functional outcome. results Patients with poor admission-grade SAH and with ISH were more likely to have initial cerebral edema (p < 0.001, Mann-Whitney U-test), which significantly resolved over time (p < 0.001, Mann-Whitney U-test). These patients had a better chance of functional survival (modified Rankin Scale scores of 1-3; OR 5.75; 95% CI 1.36-24.3; p = 0.017) at 6 months after hospital discharge, after adjustment for potential confounders such as younger age and better initial neurological grade by multivariable analysis. coNclusioNs ISH predicted good functional recovery from poor-grade aneurysmal SAH.

Excellent Outcome after Early Surgery for Ruptured Middle Cerebral Artery Aneurysm Complicated with Intracerebral and Intraventricular Hemorrhage: A Case Report

“…Aneurysmal intracerebral hematoma (ICH) is strongly associated with poorer functional outcome and seems to be predictable even before the bleeding event [1][2][3]. Aneurysms from distal anterior cerebral and middle cerebral artery are most likely to produce ICH and intraventricular hemorrhage (IVH) [4][5][6]. Intracerebral hematomas complicate 34% of aneurysm cases [7,8].…”

Ruptured middle cerebral artery aneurysms with a concomitant intraparenchymal hematoma: the role of hematoma volume

“…We evaluated the overall clinical outcome after 3 to 6 months using the modified Rankin scale (mRS) [ 14 ]. Favorable outcome was defined as a mRS score of 0–3 in concordance with recent publications on the treatment of MCA aneurysms with associated hematomas [ 1 , 15 ].…”

Outcome of Early Versus Late Operated Patients Due to Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm

“…^esto postoi dilema za vremeto vo koe se prezema natamoшen hirurшki tretman [1]. Toj mo`e da bide vo rana faza (prvite 72 чasa po krvaveweto) ili odlo`en (dve nedeli po krvaveweto) [2][3][4][5]. Mnogu faktori vlijaat na odlukata, nekoi od niv se nevroloшkiot status pri priemot na pacientot, vozrasta, eventualnoto postoewe na kompresiven hematom.…”

“…Vsuшnost, kaj subarahnoidalnata hemoragija od rupturirana intrakranijalna anevrizma najva`en e izborot na modalitet koj e najefikasen i najsiguren za pacientot. Na ova vlijaat pove}e faktori kako: sostojbata i vozrasta na pacientot, goleminata i lokacijata na anevrizmata, prisustvo na интрацеребрален хематом, интравентри-куларна хеморагија ili hidrocefalus [2][3][4][5] Samo so precizna analiza na site ovie faktori za postignuvawe optimlen tretman za pacientot. Sekako deka iskustvoto na hirurgot vo koja bilo tehnika na tretman ima uloga vo izbor na istata.…”

“…Faktori koi najmnogu vlijaat na izborot na tajmingot kaj pacientot se gradusot i vozrasta. Iako kaj pacientite so loш gradus mozoчniot edem mo`e da pretstavuva znaчajna preчka vo komotnata hirurgija i tie se zemaat predvid za ran tretman so endovaskularna metoda [2][3][4][5][6][7][8]. Kaj pacиеntite so intra cerebralna hemoragija primarna cel e evakuacija na hematomot so supsekventen kliping na anevrizmata [3,4].…”