Intraventricular hemorrhage from ruptured aneurysm

1983 ◽  
Vol 58 (4) ◽  
pp. 482-487 ◽  
Author(s):  
Gerard Mohr ◽  
Gary Ferguson ◽  
Moe Khan ◽  
David Malloy ◽  
Reginald Watts ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ct Scan ◽  
Intraventricular Hemorrhage ◽  
Prognostic Significance ◽  
Aneurysm Rupture ◽  
Intracerebral Hematoma ◽  
Early Management ◽  
Content Type ◽  
Medical Centers ◽  
Number Of Patients

✓ Intraventricular hemorrhage (IVH) from aneurysm rupture is generally considered to be of grave prognostic significance. Ninety-one cases have been studied retrospectively from seven medical centers. The overall mortality rate was 64%. The dramatically poor condition of these patients leads to their rapid admission to the hospital. Eighty-seven percent were admitted on Day 0 or 1, and more than half were classified neurologically as Grade 4 or 5. A multiple regression analysis explained 56% of the variance in survival, using the variables of ventriculocranial ratio (VCR), day of admission, diastolic blood pressure, location of aneurysm, associated intracerebral hematoma, age, grade on admission, sex, and systolic blood pressure. No patient with a VCR of more than 0.25, as calculated from the initial computerized tomography (CT) scan, survived. No patient whose smallest VCR was 0.23 or more survived. This ratio can be simply measured with a millimeter ruler from the CT scan. Patients with IVH usually had enlarged ventricles, even initially. The overall results suggest that early management of intracranial hypertension should be more generally considered, although even when this was done the prognosis was still guarded. The timing of surgery was not an important determinant of outcome, although a significant number of patients died awaiting surgery.

Intracranial arterial aneurysms in children and adolescents

1983 ◽  
Vol 58 (6) ◽  
pp. 832-837 ◽  
Author(s):  
John R. Østergaard ◽  
Bo Voldby
Keyword(s):  
Mortality Rate ◽  
Prognostic Significance ◽  
Aneurysm Rupture ◽  
Intracerebral Hematoma ◽  
Neurosurgical Department ◽  
Content Type ◽  
Subarachnoid Bleeding ◽  
The University ◽  
Arterial Aneurysms ◽  
Overall Mortality

✓ Throughout the period 1943 to 1980, 1368 patients with verified intracranial saccular aneurysms were treated in the University of Aarhus neurosurgical department. Forty-three (3.1%) patients (25 boys and 18 girls) were 19 years old or younger, and 33 (77%) had an onset of symptoms typical of subarachnoid bleeding. Using the classification system of Hunt and Hess as a basis for clinical assessment on admission, 58% of the patients could be placed in Grade I or II. Cerebral vasospasm was demonstrated in 53% of the patients undergoing angiography between the 4th and 16th day after hemorrhage. There was no increased morbidity or mortality in the group of patients with vasospasm, and no cerebral infarction was demonstrated at necropsy. Therefore, it is possible that vasospasm is of minor prognostic significance in children. In 15 patients (37%), aneurysm rupture was accompanied by intracerebral hematoma. The mortality rate in this group of 15 patients was 50%, whereas in the group without hematoma it was 26%. The overall mortality rate was 33%. The surviving 29 patients were followed for 3 months to 14 years. Twenty-three patients made a good recovery (80% of survivors and 54% of the total series), five were moderately disabled, and one was severely disabled.

Early management of aneurysmal subarachnoid hemorrhage

1981 ◽  
Vol 54 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Harold P. Adams ◽  
Neal F. Kassell ◽  
James C. Torner ◽  
Donald W. Nibbelink ◽  
Adolph L. Sahs
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Medical Management ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Early Management ◽  
Neurological Sequelae ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Effective Reduction ◽  
Fine Print

✓ The overall results are presented of early medical management and delayed operation among 249 patients studied during the period 1974 to 1977, treated within 3 days of subarachnoid hemorrhage (SAH) and evaluated 90 days after aneurysm rupture. The results included 36.2% mortality, 17.9% survival with serious neurological sequelae, and 46% with a favorable outcome. Of the patients admitted in good neurological condition, 28.7% had died and only 55.7% had a favorable recovery at 90 days after SAH. These figures represent the results despite effective reduction in early rebleeding by antifibrinolytic therapy and successful surgery in those patients reaching operation. Further therapeutic advances are needed for patients hospitalized within a few days after SAH.

Role of intracranial pressure monitoring in severely head-injured patients without signs of intracranial hypertension on initial computerized tomography

1994 ◽  
Vol 80 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Michael G. O'Sullivan ◽  
Patrick F. Statham ◽  
Patricia A. Jones ◽  
J. Douglas Miller ◽  
N. Mark Dearden ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ct Scan ◽  
Intracranial Hypertension ◽  
Mass Lesion ◽  
Midline Shift ◽  
Pressure Monitoring ◽  
Content Type ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

✓ Previous studies have suggested that only a small proportion (< 15%) of comatose head-injured patients whose initial computerized tomography (CT) scan was normal or did not show a mass lesion, midline shift, or abnormal basal cisterns develop intracranial hypertension. The aim of the present study was to re-examine this finding against a background of more intensive monitoring and data acquisition. Eight severely head-injured patients with a Glasgow Coma Scale score of 8 or less, whose admission CT scan did not show a mass lesion, midline shift, or effaced basal cisterns, underwent minute-to-minute recordings of arterial blood pressure, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) derived from blood pressure minus ICP. Intracranial hypertension (ICP ≥ 20 mm Hg lasting longer than 5 minutes) was recorded in seven of the eight patients; in five cases the rise was pronounced in terms of both magnitude (ICP ≥ 30 mm Hg) and duration. Reduced CPP (≤ 60 mm Hg lasting longer than 5 minutes) was recorded in five patients. Severely head-injured (comatose) patients whose initial CT scan is normal or does not show a mass lesion, midline shift, or abnormal cisterns nevertheless remain at substantial risk of developing significant secondary cerebral insults due to elevated ICP and reduced CPP. The authors recommend continuous ICP and blood pressure monitoring with derivation of CPP in all comatose head-injured patients.

Timing of surgery for intracerebral hematomas due to aneurysm rupture

1983 ◽  
Vol 58 (4) ◽  
pp. 476-481 ◽  
Author(s):  
Brian Wheelock ◽  
Bryce Weir ◽  
Reginald Watts ◽  
Gerard Mohr ◽  
Moe Khan ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Aneurysm Rupture ◽  
Acute Stage ◽  
Timing Of Surgery ◽  
Prognostic Indicators ◽  
Brain Herniation ◽  
Content Type ◽  
Medical Centers ◽  
High Degree ◽  
Lower Morbidity

✓ Intracerebral hematomas (ICH) from aneurysm rupture are not rare and can now be diagnosed easily and accurately by computerized tomography. The authors have collected 132 such cases from 11 medical centers. Of these patients, 38% died prior to discharge from the hospital. Seventy-eight percent of cases were admitted to the neurosurgical services on Day 0 or 1 after rupture of the aneurysm; of these patients, 15% died without surgery, 28% had surgery and died postoperatively, and 57% were operated on and survived. Mortality rates were increased in patients who were hypertensive, had poor neurological grades, showed evidence of brain herniation, or had larger clots. If the patient lived beyond the first few days and did not have brain herniation, the timing of surgery was not of great consequence, although there was a tendency toward lower morbidity in earlier surgery. This was true despite the fact that earlier operations were carried out on an initially sicker group of patients. Ischemic deterioration attributed to vasospasm occurred in 26% of cases; even when deaths at the acute stage were excluded, it was no more common in patients with early than in those with late surgery. Morbidity and mortality rates were prohibitively high in operations consisting solely of evacuation of ICH without clipping of the aneurysm. Parietal hematomas were particularly dangerous, while those in the temporal lobe were associated with the best outcome. Since it is impossible to predict survival with a high degree of reliability, even when the prognostic indicators are known, the authors recommend that patients with a significant ICH have it removed as soon as possible and that their ruptured aneurysm be clipped at the same time.

Combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolization

2001 ◽  
Vol 95 (1) ◽  
pp. 24-35 ◽  
Author(s):  
Brian L. Hoh ◽  
Christopher M. Putman ◽  
Ronald F. Budzik ◽  
Bob S. Carter ◽  
Christopher S. Ogilvy
Keyword(s):  
Intracranial Aneurysms ◽  
Massachusetts General Hospital ◽  
Treatment Strategies ◽  
Aneurysm Rupture ◽  
Morbidity Rate ◽  
Content Type ◽  
Flow Alteration ◽  
Fisher Grade ◽  
Number Of Patients ◽  
Fine Print

Object. Certain intracranial aneurysms, because of their fusiform or complex wide-necked structure, giant size, or involvement with critical perforating or branch vessels, are unamenable to direct surgical clipping or endovascular coil treatment. Management of such lesions requires alternative or novel treatment strategies. Proximal and distal occlusion (trapping) is the most effective strategy. In lesions that cannot be trapped, alteration in blood flow to the “inflow zone,” the site most vulnerable to aneurysm growth and rupture, is used. Methods. From 1991 to 1999 the combined neurosurgical—neuroendovascular team at the Massachusetts General Hospital (MGH) managed 48 intracranial aneurysms that could not be clipped or occluded. Intracavernous internal carotid artery aneurysms were excluded from this analysis. By applying a previously described aneurysm rupture risk classification system (MGH Grades 0–5) based on the age of the patient, aneurysm size, Hunt and Hess grade, Fisher grade, and whether the aneurysm was a giant lesion located in the posterior circulation, the authors found that a significant number of patients were at moderate risk (MGH Grade 2; 31.3% of patients) and at high risk (MGH Grades 3 or 4; 22.9%) for treatment-related morbidity. The lesions were treated using a variety of strategies—surgical, endovascular, or a combination of modalities. Aneurysms that could not be trapped or occluded were treated using a paradigm of flow alteration, with flow redirected from either native collateral networks or from a surgically performed vascular bypass. Overall clinical outcomes were determined using the Glasgow Outcome Scale (GOS). A GOS score of 5 or 4 was achieved in 77.1%, a GOS score of 3 or 2 in 8.3%, and death (GOS 1) occurred in 14.6% of the patients. Procedure-related complications occurred in 27.1% of cases; the major morbidity rate was 6.3% and the mortality rate was 10.4%. Three patients experienced aneurysmal hemorrhage posttreatment; in two patients this event proved to be fatal. Aneurysms with MGH Grades 0, 1, 2, 3, and 4 were associated with favorable outcomes (GOS scores of 5 or 4) in 100%, 92.8%, 71.4%, 50%, and 0% of instances, respectively. Conclusions. Despite a high incidence of transient complications, intracranial aneurysms that cannot be clipped or occluded require alternative surgical and endovascular treatment strategies. In those aneurysms that cannot safely be trapped or occluded, one approach is the treatment strategy of flow alteration.

Delayed aneurysm rupture following treatment with the WEB embolization device

2021 ◽  
Vol 14 (4) ◽  
pp. 1-2
Author(s):  
Bradley A Gross ◽  
Michael J Lang
Keyword(s):  
Intracranial Pressure ◽  
Ct Scan ◽  
Intraventricular Hemorrhage ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Post Treatment ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Microsurgical Clipping ◽  
The Web

Delayed rupture of an aneurysm following WEB embolization has not yet been reported. We present a case of a multiply ruptured anterior communicating artery aneurysm treated via WEB embolization. A post-treatment CT scan confirmed no evidence of rebleeding during treatment. Four hours after treatment, the patient developed an acute, significant increase in intracranial pressure with bloody ventriculostomy output, with CT scan demonstrating new parenchymal and intraventricular hemorrhage. The aneurysm was subsequently treated via microsurgical clipping that did not identify an “uncovered” bleb or rupture source.

Outcomes of surgical treatment for ruptured pericallosal artery aneurysms

2018 ◽  
Vol 20 (2) ◽  
pp. 17-26
Author(s):  
V. V. Krylov ◽  
V. G. Dashyan ◽  
I. V. Grigoryev ◽  
V. A. Lukyanchikov ◽  
I. V. Senko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Surgical Outcome ◽  
Intraventricular Hemorrhage ◽  
Aneurysm Rupture ◽  
Early Surgery ◽  
Intracerebral Hematoma ◽  
Study Objective ◽  
Factors Affecting ◽  
Pericallosal Artery

The study objectiveis to assess short-term outcomes of surgical treatment in patients with ruptured pericallosal artery aneurysms (PCAA) and to identify factors affecting treatment outcomes.Materials and methods.Patients with ruptured PCAA (n = 61) were admitted to the Department of Emergency Neurosurgery at the N. V. Sklifosovsky Research Institute for Emergency Medicine for examination and surgical treatment between 01.01.1992 and 31.12.2015.Results.At the moment of discharge, 33 (54.1 %) patients demonstrated good recovery (Glasgow Outcome Scale (GOS) of 5), 9 (14.7 %) patients had moderate disability (GOS 4), 6 (9.9 %) patients had severe disability (GOS 3), and 13 (21.3 %) patients died (GOS of 1). An outcome was rated as favorable if the GOS was 4 or 5 and unfavorable if the GOS was 1–3. The following risk factors were found to be significant for unfavorable surgical outcome: Hunt and Hess grade 4 and 5, presence of intracerebral hematoma and its volume over 20 cm3, recurrent aneurysm rupture, pronounced angiospasm and intraventricular hemorrhage, early surgery (within 1–3 days). The patient»s age and the volume of intraventricular hemorrhage had no impact on the surgical outcome.Conclusion.The choice of an optimal surgery time should be based on the assessment of hemorrhage severity upon admission. Early surgery is recommended for all patients with Hunt and Hess grade I–II, whereas in patients with Hunt and Hess grade V, the intervention should be postponed until the condition is stabilized, unless the severity is associated with a dislocation syndrome due to intracerebral hematoma or occlusive hydrocephalus. In patients with Hunt and Hess grade III–IV, the decision on surgery time should be made for each individual patient according to existing risk factors.

Early death from rupture of an intracranial aneurysm

1982 ◽  
Vol 57 (6) ◽  
pp. 765-768 ◽  
Author(s):  
Albert Hijdra ◽  
Jan van Gijn
Keyword(s):  
Intracranial Aneurysm ◽  
Intraventricular Hemorrhage ◽  
Circulatory Arrest ◽  
Early Death ◽  
Intracerebral Hematoma ◽  
Brain Shift ◽  
Secondary Brain Damage ◽  
Content Type ◽  
Ventricular Hemorrhage ◽  
Fine Print

✓ The authors studied the clinical features and computerized tomography scans of 31 patients who died within 24 hours after the rupture of an intracranial aneurysm. Nine patients showed evidence of an intracerebral hematoma and brain shift, eight of a massive intraventricular hemorrhage, eight of both a hematoma and ventricular hemorrhage, and six of only subarachnoid hemorrhage (SAH). These anatomical types of hemorrhage could not be distinguished clinically. Four of the six patients with only SAH suffered initial apnea and circulatory arrest. In these cases, secondary brain damage may have been caused by anoxia, and therefore might have been reversible.

Population-based analysis of arteriovenous malformation treatment

2001 ◽  
Vol 95 (4) ◽  
pp. 633-637 ◽  
Author(s):  
Jan Hillman
Keyword(s):  
De Novo ◽  
Population Based ◽  
Treatment Modalities ◽  
Intracerebral Hematoma ◽  
Consecutive Series ◽  
Initial Manifestation ◽  
Content Type ◽  
Number Of Patients ◽  
Grade 3 ◽  
Fine Print

Object. The author sought to describe overall management data on cerebral arteriovenous malformations (AVMs) and to focus the actuarial need for different treatment modalities on a population-based scale. Such data would seem important in the planning of regional or national multimodality strategies for the treatment of AVMs. This analysis of a nonselected, consecutive series of patients representing every diagnosed case of cerebral AVM in a population of 1,000,000 over one decade may serve to shed some light on these treatment aspects. Methods. During the 11-year period from 1989 to 1999, data from every patient harboring a cerebral AVM that was presented clinically or discovered incidentally in a strictly defined population of 986,000 people were collected prospectively. No patient was lost to follow up. There were 12.4 de novo diagnosed AVMs per 1,000,000 population per year (135 AVMs). Large high-grade AVMs (Spetzler—Martin classification) were rare, and Grade 1 to 3 lesions represented 85% of the caseload. Hemorrhage was the initial manifestation of AVM in 69.6% of the cases. Intracerebral hematoma was the most common hemorrhagic manifestation occurring in 78 patients. There were 4.4 cases per 1,000,000 population per year of hematomas needing expedient surgical evacuation. In the remaining patients who did not require hematoma surgery, small, critically located Grade 3 and Grade 4 lesions amounted to 1.6 cases per 1,000,000 population per year. There were 5.8 cases per 1,000,000 population per year of Grade 1 to 2 and larger noncritically located Grade 3 malformations. There were 0.5 cases per 1,000,000 population per year of Grade 5 AVMs. The overall outcome in 135 patients was classified as good according to the Glasgow Outcome Scale (Score 5) in 61% of the cases, and the overall mortality rate was 9%. Conclusions. In centers with population-based referral, AVM of the brain is predominantly a disease related to intracranial bleeding, and parenchymal clots have a profound impact on overall management outcome. The rupture of an AVM is as devastating as that of an aneurysm. Aneurysm ruptures are more lethal, whereas AVM rupture tends to result in more neurological disability due to the high occurrence of lobar intracerebral hematoma. In an attempt to quantify the need for different modalities of AVM treatment based on a population of 1,000,000 people, figures for surgeries performed range from six to 10 operations per year and embolization as well as gamma knife surgery procedures range from two to seven per year, depending on the strategy at hand. When using nonsurgical approaches to Grade 1 to 3 lesions, the number of patients requiring treatment with more than one method for obliteration increases drastically as does the potential risk for procedure-related complications.

Early detection of delayed traumatic intracranial hematomas using near-infrared spectroscopy

1995 ◽  
Vol 83 (3) ◽  
pp. 438-444 ◽  
Author(s):  
Shankar P. Gopinath ◽  
Claudia S. Robertson ◽  
Charles F. Contant ◽  
Raj K. Narayan ◽  
Robert G. Grossman ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Ct Scan ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Mass Effect ◽  
Intracerebral Hematoma ◽  
Secondary Brain Injury ◽  
Content Type ◽  
Postoperative Hematoma ◽  
Intracranial Hematomas

✓ Delayed intracranial hematomas are an important treatable cause of secondary brain injury in patients with head trauma. Early identification and treatment of these lesions, which appear or enlarge after the initial computerized tomography (CT) scan, may improve neurological outcome. Serial examinations using near-infrared spectroscopy (NIRS) to detect the development of delayed hematomas were performed in 167 patients. The difference in absorbance of light (ΔOD) at 760 nm between the normal and the hematoma side was measured serially during the first 3 days after injury. Twenty-seven (16%) of the patients developed a type of late hematoma: intracerebral hematoma in eight, extracerebral hematoma in six, and postoperative hematoma in 13 patients. Eighteen of the delayed hematomas caused significant mass effect and required surgical evacuation. The hematomas appeared between 2 and 72 hours after admission. In 24 of the 27 patients, a significant increase (> 0.3) in the ΔOD occurred prior to an increase in intracranial pressure, a change in the neurological examination, or a change on CT scan. A favorable outcome occurred in 67% of the patients with delayed hematomas, which suggests that early diagnosis using NIRS may allow early treatment and reduce secondary injury caused by delayed hematomas.

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