Subdural Hæematoma Complicating Intracranial Aneurysm and Angioma

Clarke, Edwin; Walton, John N.

doi:10.1093/brain/76.3.378

Cited by 78 publications

(30 citation statements)

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“…22,23 However, the degree of SAH itself was not statistically enhanced by rebleeding, which can be explained by the reports indicating that adhesion of an aneurysm with surrounding structures such as brain or arachnoid, which was caused by the initial bleeding, causes the blood to expand into the brain parenchyma or subdural space when rebleeding occurs. 24,25 These results show that the prehospitalization period is a vulnerable period for rebleeding and that prehospitalization rebleeding seriously affects the patient's prognosis, leading us to recognize that to improve the overall outcome of SAH patients, the prevention of prehospitalization rebleeding is essential. In the present report, hemostatic parameters and arterial blood pressures were examined as possible factors contributing to rebleeding.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

Ohkuma

Tsurutani

Suzuki

2001

Stroke

301

182

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Background and Purpose-Rebleeding is a major cause of death and disability in aneurysmal subarachnoid hemorrhage (SAH); however, there has been no report focusing on rebleeding before hospitalization in neurosurgical or neurological institutions. The aim of this study was to clarify the incidence of prehospitalization rebleeding, its impact on the clinical course and prognosis in patients with aneurysmal SAH, and the possible factors inducing it. Methods-In 273 patients who were admitted to our institution within 24 hours after the initial SAH bleeding and whose clinical course before admission could be fully evaluated, the patients' clinical conditions and CT findings on admission, operability, prognosis, and possible factors inducing rebleeding were comparatively evaluated between the patients with and without an episode of prehospitalization rebleeding. Results-Of the 273 patients, 37 (13.6%) patients suffered from 39 episodes of rebleeding in the ambulance or at the referring hospital before admission to our hospital. The peak time of rebleeding was within 2 hours (77%), in which the incidence was statistically significant compared with that occurring 2 to 8 hours after the initial SAH bleeding (PϽ0.01).The group experiencing rebleeding showed more severe Hunt and Hess grades on admission, higher rates of intracerebral hematoma, of intraventricular hematoma, and of subdural hematoma on CT scan on admission, less operability, and poorer prognoses with statistically significant differences compared with the group that did not experience rebleeding. Systolic arterial pressure Ͼ160 mm Hg was a possible risk factor of rebleeding (odds ratio 3.1, 95% CI 1.5 to 6.8). Conclusions-Rebleeding during transfer and at the referring hospital is not rare. To improve overall outcome of aneurysmal SAH, the results obtained in this study should be made available to general practitioners and the doctors devoted to emergency medicine.

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Section: Discussionmentioning

confidence: 99%

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

Ohkuma

Tsurutani

Suzuki

2001

Stroke

301

182

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“…In most reports [4,10,12,14], the patient's clinical features on admission are bad, often with bilateral dilated unreactive pupils like two of our cases. Often the urgency of craniotomy and haematoma evacuation allows no angiographic diagnosis.…”

Section: Discussionmentioning

confidence: 53%

Acute subdural haematoma from ruptured intracranial aneurysms

et al. 1995

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Acute subdural haematoma (SDH) secondary to a ruptured intracranial aneurysm is a rare event. Out of a total of 292 patients with a verified aneurysm (period 1986-1992) in five cases SDH was the diagnosis on CT-evaluation. One patient was in such a bad condition that no treatment was indicated. The remaining four patients were operated on: craniotomy and haematoma evacuation in two cases, craniotomy for haematoma evacuation and aneurysm clipping in the other two cases. Two patients died and two achieved a good outcome.

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“…Secondary to the poor clinical status of these types of patients, some authors have questioned the need to perform angiography immediately; these authors recommend angiography if the clinical condition of patients is stable and does not require immediate surgical intervention 21) . Some authors have suggested that emergency craniotomy and evacuation of the hematoma should precede angiography to allow for rapid cerebral decompression; later, if the patient is stable, angiography should be performed for definitive aneurysm clipping 3,12,20,24) . In more recent reports, 3D-CT angiography has been recommended for detecting the presence of an aneurysm as it has the advantages of rapid results, good quality, noninvasiveness compared to DSA, and is easier to perform on patients in poor neurological condition 1,4,23) .…”

Section: Resultsmentioning

confidence: 99%

“…In our experience the incidence was 4.2% during the six years of the review period. Several mechanisms to explain the occurrence of aSDH after aneurysmal rupture have been proposed : 1) successive small bleeding from the ruptured aneurysm allowing aneurysmal adhesion to the arachnoid membrane with the final rupture occurring into the subdural space; 2) the arachnoid membrane being directly torn by high systolic pressures from the bleeding aneurysm; 3) the arachnoid membrane being ruptured by rapid accumulation of blood under pressure from the leaking aneurysm; 4) erosion of the cavernous sinus wall by acute enlargement of the intracavernous aneurysm following thrombosis causes a hematoma of the subdural space; and 5) a ruptured distal ACA aneurysm adheres directly to either the dura or falx in the adjacent subdural space causing a subdural hematoma 2,3,6,9,12,16,22) . In our cases, twelve cases showed large volume of ICH were adjacent with subdural hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…Two patients (Cases 15, 17) had a history of cerebral infarction. On admission, the mean GCS score was 7.0 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15], the WFNS grade was grade V Societies (WFNS) grade; 3) location of the ruptured aneurysm; 4) existence of the intracerebral hematoma (ICH), intraventricular hematoma (IVH), midline shifting (≥5 mm) 13,25) , and thickness of subdural hematoma, Fisher grade of the SAH; 5) the methods of treatment received; and 6) outcome evaluated by the Glasgow Outcome Scale. To assess statistical significance, frequencies were evaluated with the chi-square test (SPSS for windows version 13.0 : SPSS INC., Chicago, IL).…”

Section: Introductionmentioning

confidence: 99%

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Clinical Features of Acute Subdural Hematomas Caused by Ruptured Intracranial Aneurysms

Kwon

Park

et al. 2011

J Korean Neurosurg Soc

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6lected single-center experiences are extremely rare. The objective of this report was to review and discuss the clinical aspects of our single-center experience with 23 cases of SAH associated with an aSDH originating from a ruptured intracranial aneurysm. MATERIALS AND METHODSAll patients with ruptured intracranial aneurysms who were admitted to our department between January 2005 and December 2010 were identified. The medical records and films of the patients were retrospectively reviewed. We selected cases of aSDH secondary to a ruptured intracranial aneurysm. The criteria for selection were; 1) no history of head trauma, 2) radiologist-confirmed definitive subdural hematoma on initial computed tomography (CT) imaging, 3) CT angiography or digital subtraction angiography (DSA) demonstrating an intracranial aneurysm, and 4) a visible subdural hematoma with evidence of a ruptured aneurysm by operative report. The following information was collected and assessed : 1) patient demographic data; 2) clinical status on admission according to the Glasgow Coma Scale (GCS) and the World Federation of Neurosurgical INTRODUCTIONSubarachnoid hemorrhage (SAH) caused by a ruptured intracranial aneurysm is a devastating disease with high mortality and morbidity 7) . SAH associated with acute subdural hematoma (aSDH) originating from ruptured intracranial aneurysms is rare and carries a poor prognosis 8,15,20,24) . The majority of posttraumatic aSDH result from vascular injury in the brain cortex. Because of rapid clinical deterioration, early decompression is mandatory, but the prognosis remains poor in many cases. Previous investigators have reported small case series of spontaneous aSDH caused by an aneurysmal rupture 2,12,20,24) . The majority of these series reported poor clinical grades and suggested the use of various detecting modalities and treatment plans 5,8,11,15,18) . However, these cases were not numerous and consistently col-J Korean Neurosurg Soc 50 : 6-10, 2011 10.3340/jkns.2011.50.1.6 Copyright © 2011 The Korean Neurosurgical Society

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Subdural Hæematoma Complicating Intracranial Aneurysm and Angioma

Cited by 78 publications

References 0 publications

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

Acute subdural haematoma from ruptured intracranial aneurysms

Clinical Features of Acute Subdural Hematomas Caused by Ruptured Intracranial Aneurysms

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