Origin of Sylvian Hematoma in Patients with Subarachnoid Hemorrhage: Findings of Extravasation on Multiphase Contrast-Enhanced Computed Tomography

Suzuki, Kazufumi; Ueno, Eiko; Kasuya, Hidetoshi

doi:10.1016/j.wneu.2013.02.014

Cited by 13 publications

(11 citation statements)

References 15 publications

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“…This case shares some similarities with the few cases previously published 5 6. Our patient was of Chinese ethnicity and the previous cases have been published by Japanese authors, hinting at a possible genetic contribution.…”

Section: Discussionsupporting

confidence: 87%

“…When an aneurysm adherent to the pia mater bleeds, the blood may spread below the pia and the expanding hematoma may rupture the thin arteries that run in the pial space 8. We believe that this is what we visualized during angiography and has been previously demonstrated with dynamic CTA 5 6. This bleeding may have been accentuated by the use of intraprocedural heparin and nimodipine flushes attached to guide catheters.…”

Section: Discussionsupporting

confidence: 77%

“…Our patient was of Chinese ethnicity and the previous cases have been published by Japanese authors, hinting at a possible genetic contribution. A past history of diabetes has also been reported 6. Three of the previously reported cases had either MCA aneurysms or PComm aneurysms,6 and location of the ruptured aneurysm close to the Sylvian fissure may result in blood tracking into the subpial space and triggering a cascade of events leading to hematoma formation.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that judicious reduced doses of anticoagulants should be used when coiling acutely ruptured aneurysms when concomitant Sylvian hematomas are present 6. Our standard practice for acute coiling cases is to administer 5000 units of heparin at the start of the procedure and maintain activated clotting time at 2–3 times the base level.…”

Section: Discussionmentioning

confidence: 99%

“…Previously Sylvian hematoma in subarachnoid hemorrhage (SAH) has been attributed to aneurysm rupture 4. Recent case reports using 4D CT angiography (4D CTA)5 6 suggest an additional mechanism for the development of Sylvian hematomas in patients with acute post-aneurysmal SAH that is separate from aneurysmal rebleeding. We present a case of unilateral Sylvian hematoma secondary to multifocal bleeding points detected on conventional angiography during coiling of an acutely ruptured posterior communicating (PComm) artery aneurysm.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Republished: Remote multifocal bleeding points producing a Sylvian subpial hematoma during endovascular coiling of an acutely ruptured cerebral aneurysm

Hilditch

Sonwalkar

Wuppalapati

2016

J NeuroIntervent Surg

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Subpial hematoma is a rare type of intracranial hemorrhage with a poor prognosis. A new mechanism to explain subpial Sylvian hematoma formation in acute post-aneurysmal subarachnoid hemorrhage (SAH) was observed during coiling of a posterior communicating artery aneurysm. Multiple small bleeding points from pial branches of the left middle cerebral artery, which were remote from the ruptured aneurysm, were observed on conventional angiography. This bleeding led to the formation of a large expanding subpial Sylvian hematoma. Similar observations have been recently demonstrated on 4D CT angiography (4D CTA). We present a case that adds evidence to the literature in support of a new mechanism of subpial hematoma formation in the setting of acute SAH. This may advocate the early use of 4D CTA and conveys a poor prognosis, which might influence treatment decisions.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 77%