scholarly journals Management of Patients Presenting with Acute Subdural Hematoma due to Ruptured Intracranial Aneurysm

2012 ◽  
Vol 2012 ◽  
pp. 1-19 ◽  
Author(s):  
Serge Marbacher ◽  
Ottavio Tomasi ◽  
Javier Fandino
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Subdural Hematoma ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mass Effect ◽  
Aneurysm Rupture ◽  
Treatment Modalities ◽  
Acute Subdural Hematoma ◽  
Rare Presentation ◽  
Ruptured Intracranial Aneurysm ◽  
Threatening Condition

Acute subdural hematoma is a rare presentation of ruptured aneurysms. The rarity of the disease makes it difficult to establish reliable clinical guidelines. Many patients present comatose and differential diagnosis is complicated due to aneurysm rupture results in or mimics traumatic brain injury. Fast decision-making is required to treat this life-threatening condition. Determining initial diagnostic studies, as well as making treatment decisions, can be complicated by rapid deterioration of the patient, and the mixture of symptoms due to the subarachnoid hemorrhage or mass effect of the hematoma. This paper reviews initial clinical and radiological findings, diagnostic approaches, treatment modalities, and outcome of patients presenting with aneurysmal subarachnoid hemorrhage complicated by acute subdural hematoma. Clinical strategies used by several authors over the past 20 years are discussed and summarized in a proposed treatment flowchart.

scholarly journals Bilateral subdural hygromas after endovascular coiling for ruptured aneurysmal subarachnoid hemorrhage: an unusual and rare complication

2021 ◽  
Vol 2021 (8) ◽  
Author(s):  
Walid O Ahmed ◽  
Shady N Mashhour ◽  
Marwa E Abdelfattah
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Rare Complication ◽  
Mass Effect ◽  
Contralateral Side ◽  
Endovascular Coiling ◽  
Neurological Assessment ◽  
Ruptured Intracranial Aneurysm ◽  
Significant Mass Effect

ABSTRACT Subarachnoid hemorrhage (SAH) with subdural hygroma (SH) was rarely reported after endovascular coiling. A 60-year-old male presented with impaired consciousness and convulsions due to SAH from a ruptured aneurysm. It was managed by endovascular coiling 20 h after the onset of symptoms. Serial brain imaging for 2 weeks revealed progressive bilateral SHs, more on contralateral side of leaking aneurysm. Management of SH was discussed in a multidisciplinary setting to be conservative as there was neither significant mass effect nor hydrocephalus. The patient recovered neurologically except for mild dysarthria. The SH persisted for 2 months and then cleared gradually. We concluded that SH may arise and become symptomatic as an unusual sequela of post-coiling of a ruptured intracranial aneurysm, in which the SH can complicate the clinical course of SAH. However, the symptomatic SH may resolve spontaneously and completely without any intervention, but needs meticulous neurological assessment and follow-up.

Acute subdural hematoma associated with aneurysmal subarachnoid hemorrhage

1997 ◽  
Vol 99 ◽  
pp. S45
Author(s):  
Motohiko Shimazu ◽  
Hiroyuki Jimbo ◽  
Noriyoshi Kawamura ◽  
Hiroshi Ozawa ◽  
Hitoshi Izumiyama ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Subdural Hematoma ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Acute Subdural Hematoma

Abstract WP353: Assessing the Accuracy of ICD-10 Codes for Ruptured Intracranial Aneurysm Location

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christopher Roark ◽  
Sheila Kubes ◽  
David Mayer ◽  
Laura K Wiley
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Aneurysm Rupture ◽  
Administrative Database ◽  
Risk Modeling ◽  
Billing Data ◽  
Ruptured Intracranial Aneurysm ◽  
Advanced Analysis

The adoption of ICD10 in October 2015 offers important opportunities for administrative database and EHR-based aneurysm research as it includes more than twenty distinct codes for subarachnoid hemorrhage (SAH), for the first time labeling the specific location for common sites of aneurysm rupture. Aneurysm location is a significant risk factor for rupture, but was not specified in any previous ICD classification. This has limited the value of “big-data” research for aneurysm risk modeling. Currently, it is not clear how frequently - or accurately - the codes are being used in practice. This study reviewed three years of records (10/2015-9/2018) from the UCHealth system in Colorado to assess the accuracy and utility of these codes for stroke research. Over this time, ICD10 codes for SAH (I60.x) were used a total of 5,090 times in 1,842 patients. After removing non-aneurysmal SAH (I60.8), the majority (92.7%) of the codes had no location specified (I60.7, I60.9). Of the codes with a location (I60.00-I60.6), upon review of the clinical record 9 (2.5%) did not have any evidence of subarachnoid hemorrhage, 3 (0.8%) did not have an aneurysm, and 5 (1.4%) had a pseudoaneurysm. Of the 338 verified instances of aneurysmal subarachnoid hemorrhage, 82 (24%) had multiple aneurysms and were excluded from further analysis. Within those records that had only a single aneurysm 197/256 (77%) had the location coded correctly. Of the 23% that were incorrectly coded, 1 was coded as the correct artery on the wrong side, all remaining (n=58) were the wrong artery. Although ICD10 codes offers the possibility of more advanced analysis due to the inclusion of aneurysm location, based on these data, we found that codes specifying location are frequently incorrect. Future studies are needed to validate these findings in other settings. However, researchers should be cautious about their ability to detect aneurysm location from administrative billing data using ICD10 location mapping.

Risk Factors for Acute Subdural Hematoma From Intracranial Aneurysm Rupture

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 264-269 ◽  
Author(s):  
J. Matthijs Biesbroek ◽  
Gabriel J.E. Rinkel ◽  
Ale Algra ◽  
Jan Willem Berkelbach van der Sprenkel
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysm ◽  
Subdural Hematoma ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Rare Complication ◽  
Aneurysm Rupture ◽  
Posterior Communicating Artery ◽  
Acute Subdural Hematoma ◽  
Vertebral Aneurysm ◽  
Risk Ratios

Abstract BACKGROUND: An acute subdural hematoma (aSDH) is a rare complication of aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor clinical condition on admission and poor outcome. Risk factors for the development of an aSDH from aneurysmal rupture are unknown and may help our understanding of how an aSDH develops. OBJECTIVE: To identify risk factors for the development of an aSDH from intracranial aneurysm rupture. METHODS: Patients were selected from our prospectively collected single-center SAH database. From all 1757 patients fulfilling prespecified inclusion criteria, 63 had an aSDH. We assessed sex, age, smoking, hypertension, history of SAH, sentinel headache, location of the ruptured aneurysm, and intracerebral hemorrhage (ICH) as risk factors for an aSDH. Univariable and multivariable risk ratios with corresponding 95% confidence intervals (CIs) were calculated for characteristics with Poisson regression. RESULTS: Multivariable risk ratios were 1.021 (95% CI: 1.001-1.042) for each year increase in age, 2.3 (95% CI: 1.3-3.8) for posterior communicating artery aneurysms, 3.0 (95% CI: 1.5-6.0) for sentinel headache, and 5.2 (95% CI: 3.1-8.9) for ICH. None of the 95 patients (0%; 95% CI: 0%-3.8%) with a ruptured vertebrobasilar aneurysm had an aSDH, which was statistically significantly lower than at other sites (P = .02 for basilar aneurysm; P = .04 for vertebral aneurysm). None of the other studied characteristics had a statistically significant association with an aSDH. CONCLUSION: Increasing age, sentinel headache, ICH, and aneurysms at the posterior communicating artery are independent risk factors for an aSDH. Patients with a basilar or vertebral aneurysm have a low risk of an aSDH.

Superior Hypophyseal Artery Ruptured Aneurysm in a 5-Month-Old Child Presenting as an Acute Subdural Hematoma: A Case Report

2020 ◽  
pp. 1-6
Author(s):  
Piotr Komuński ◽  
Emilia Nowosławska ◽  
Krzysztof Zakrzewski ◽  
Bartosz Polis ◽  
Wojciech Świątnicki
Keyword(s):  
Case Report ◽  
Subdural Hematoma ◽  
Mass Effect ◽  
Ruptured Aneurysm ◽  
Treatment Modalities ◽  
Acute Subdural Hematoma ◽  
Clot Removal ◽  
Right Cerebral Hemisphere ◽  
The Right ◽  
Significant Mass Effect

<b><i>Introduction:</i></b> We present a very rare case of ruptured superior hypophyseal artery (SHA) aneurysm that presented as an acute subdural hematoma (SDH) discussing its initial presentation, diagnosis, and treatment modalities. To our knowledge it is one of very few if any cases of a ruptured aneurysm in infants regarding that specific vascular location. <b><i>Case Report:</i></b> A 5-month-old boy was referred to our department due to acute SDH over the right cerebral hemisphere without significant mass effect nor hydrocephalus. Further evaluation revealed a right internal carotid artery (ICA) aneurysm arising from the SHA segment. Microsurgical clip ligation using a fenestrated, angled clip was performed with simultaneous subdural clot removal and proximal control of the ICA dissected in the neck. Our patient made an excellent recovery without any complicating features. <b><i>Conclusion:</i></b> Surgical management seems to be a better option in this subgroup of patients given the long life expectancy and durability of microsurgical clip ligation. We believe that our brief case report would add some insight into the management of this rare subgroup of patients, leading to better decision-making and outcome.

Clinical, laboratory, and radiographic predictors of the occurrence of seizures following aneurysmal subarachnoid hemorrhage

2013 ◽  
Vol 119 (2) ◽  
pp. 347-352 ◽  
Author(s):  
George M. Ibrahim ◽  
Aria Fallah ◽  
R. Loch Macdonald
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Roc Curve ◽  
Subdural Hematoma ◽  
Clinical Laboratory ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Univariate Analysis ◽  
Aneurysm Rupture ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Clot Burden

Object At present, the administration of prophylactic antiepileptic medication following aneurysmal subarachnoid hemorrhage (SAH) is controversial, and the practice is heterogeneous. Here, the authors sought to inform clinical decision making by identifying factors associated with the occurrence of seizures following aneurysm rupture. Methods Exploratory analysis was performed on 413 patients enrolled in CONSCIOUS-1 (Clazosentan to Overcome Neurological Ischemia and Infarction Occurring after Subarachnoid Hemorrhage), a prospective randomized trial of clazosentan for the prevention of angiographic vasospasm. The association among clinical, laboratory, and radiographic covariates and the occurrence of seizures following SAH were determined. Covariates with a significance level of p < 0.20 on univariate analysis were entered into a multivariate logistic regression model. Receiver operating characteristic (ROC) curve analysis was used to define optimal predictive thresholds. Results Of the 413 patients enrolled in the study, 57 (13.8%) had at least 1 seizure following SAH. On univariate analysis, a World Federation of Neurosurgical Societies grade of IV–V, a greater subarachnoid clot burden, and the presence of midline shift and subdural hematomas were associated with seizure activity. On multivariate analysis, only a subarachnoid clot burden (OR 2.76, 95% CI 1.39–5.49) and subdural hematoma (OR 5.67, 95% CI 1.56–20.57) were associated with seizures following SAH. Using ROC curve analysis, the optimal predictive cutoff for subarachnoid clot burden was determined to be 21 (of a possible 30) on the Hijdra scale (area under the curve 0.63). Conclusions A greater subarachnoid clot burden and subdural hematoma are associated with the occurrence of seizures after aneurysm rupture. These findings may help to identify patients at greatest risk for seizures and guide informed decisions regarding the prescription of prophylactic anticonvulsive therapy. Clinical trial registration no.: NCT00111085 (ClinicalTrials.gov).

scholarly journals Identification of upregulated NF-κB inhibitor alpha and IRAK3 targeting lncRNA following intracranial aneurysm rupture-induced subarachnoid hemorrhage

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Leng ◽  
Dan Fan ◽  
Zhong Ren ◽  
Qiaoying Li
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Signaling Pathway ◽  
Aneurysm Rupture ◽  
Cytokine Receptor ◽  
Gene Set Enrichment Analysis ◽  
Receptor Interaction ◽  
Regulatory Pathways ◽  
Ruptured Intracranial Aneurysm ◽  
Neurotrophin Signaling

Abstract Background This study was performed to identify genes and lncRNAs involved in the pathogenesis of subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysm (RIA). Methods Microarray GSE36791 was downloaded from Gene Expression Omnibus (GEO) database followed by the identification of significantly different expressed RNAs (DERs, including lncRNA and mRNA) between patients with SAH and healthy individuals. Then, the functional analyses of DEmRNAs were conducted and weighted gene co-expression network analysis (WGCNA) was also performed to extract the modules associated with SAH. Following, the lncRNA-mRNA co-expression network was constructed and the gene set enrichment analysis (GSEA) was performed to screen key RNA biomarkers involved in the pathogenesis of SAH from RIA. We also verified the results in a bigger dataset GSE7337. Results Totally, 561 DERs, including 25 DElncRNAs and 536 DEmRNAs, were identified. Functional analysis revealed that the DEmRNAs were mainly associated with immune response-associated GO-BP terms and KEGG pathways. Moreover, there were 6 modules significantly positive-correlated with SAH. The lncRNA-mRNA co-expression network contained 2 lncRNAs (LINC00265 and LINC00937) and 169 mRNAs. The GSEA analysis showed that these two lncRNAs were associated with three pathways (cytokine-cytokine receptor interaction, neurotrophin signaling pathway, and apoptosis). Additionally, IRAK3 and NFKBIA involved in the neurotrophin signaling pathway and apoptosis while IL1R2, IL18RAP and IL18R1 was associated with cytokine-cytokine receptor interaction pathway. The expression levels of these genes have the same trend in GSE36791 and GSE7337. Conclusion LINC00265 and LINC00937 may be implicated with the pathogenesis of SAH from RIA. They were involved in three important regulatory pathways. 5 mRNAs played important roles in the three pathways.

Volumetric quantification of aneurysmal subarachnoid hemorrhage independently predicts hydrocephalus and seizures

2021 ◽  
pp. 1-9
Author(s):  
Badih J. Daou ◽  
Siri Sahib S. Khalsa ◽  
Sharath Kumar Anand ◽  
Craig A. Williamson ◽  
Noah S. Cutler ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Characteristic Curve ◽  
Volumetric Analysis ◽  
Aneurysm Rupture ◽  
Mean Difference ◽  
Analysis Tool ◽  
Volume Data ◽  
Hemorrhage Volume ◽  
The Mean

OBJECTIVEHydrocephalus and seizures greatly impact outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH); however, reliable tools to predict these outcomes are lacking. The authors used a volumetric quantitative analysis tool to evaluate the association of total aSAH volume with the outcomes of shunt-dependent hydrocephalus and seizures.METHODSTotal hemorrhage volume following aneurysm rupture was retrospectively analyzed on presentation CT imaging using a custom semiautomated computer program developed in MATLAB that employs intensity-based k-means clustering to automatically separate blood voxels from other tissues. Volume data were added to a prospectively maintained aSAH database. The association of hemorrhage volume with shunted hydrocephalus and seizures was evaluated through logistic regression analysis and the diagnostic accuracy through analysis of the area under the receiver operating characteristic curve (AUC).RESULTSThe study population comprised 288 consecutive patients with aSAH. The mean total hemorrhage volume was 74.9 ml. Thirty-eight patients (13.2%) developed seizures. The mean hemorrhage volume in patients who developed seizures was significantly higher than that in patients with no seizures (mean difference 17.3 ml, p = 0.01). In multivariate analysis, larger hemorrhage volume on initial CT scan and hemorrhage volume > 50 ml (OR 2.81, p = 0.047, 95% CI 1.03–7.80) were predictive of seizures. Forty-eight patients (17%) developed shunt-dependent hydrocephalus. The mean hemorrhage volume in patients who developed shunt-dependent hydrocephalus was significantly higher than that in patients who did not (mean difference 17.2 ml, p = 0.006). Larger hemorrhage volume and hemorrhage volume > 50 ml (OR 2.45, p = 0.03, 95% CI 1.08–5.54) were predictive of shunt-dependent hydrocephalus. Hemorrhage volume had adequate discrimination for the development of seizures (AUC 0.635) and shunted hydrocephalus (AUC 0.629).CONCLUSIONSHemorrhage volume is an independent predictor of seizures and shunt-dependent hydrocephalus in patients with aSAH. Further evaluation of aSAH quantitative volumetric analysis may complement existing scales used in clinical practice and assist in patient prognostication and management.

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