Intracerebral Hematoma From Aneurysm Rupture
Intracerebral Hematoma From Aneurysm Rupture
Object: Patients who present with an intraparenchymal hematoma associated with a ruptured aneurysm usually require urgent clot evacuation and aneurysm obliteration. The impact of the presence of hematoma on outcome has been poorly characterized. The authors report on 460 patients who had dense subarachnoid hemorrhage (SAH) (Fisher Grades 3 and 4) with and without associated hematoma.
Methods: Of the 959 consecutive patients who presented with SAH, 460 patients with Fisher Grade 3 and 4 SAH were analyzed and divided into two groups: those with (Group 1) and those without (Group 2) hematoma. The presenting Hunt and Hess grade and 6-month outcomes of the two groups were compared.
Of the 460 patients, 116 (25%) had intraparenchymal hematomas and admission Hunt and Hess grades were worse in Group 1 compared with Group 2. Outcome scores were worse for Group 1 compared with Group 2; however, when comparing Group 1 and Group 2 within the same initial Hunt and Hess score, there was no statistical difference in outcome.
Conclusions: Intraparenchymal hematoma in association with SAH does not differ significantly from those patients without associated hematomas. We therefore recommend aggressive clot evacuation and aneurysm obliteration.
Although rupture of cerebral aneurysms usually results in SAH, some degree of intraparenchymal bleeding is often seen. A cooperative study reported by Locksley showed that 90% of patients with SAH who died within 72 hours also had intracerebral clots. Only 4 to 17% patients with aneurysmal SAH, however, have clinically significant hematomas.
It is well known that the presence of an ICH after aneurysm rupture negatively influences the patient's clinical course and outcome. The overall mortality rate ranges from 36 to 58%.
Controversy persists regarding the optimal management of ICHs caused by aneurysm rupture. In this paper, we review the literature and present our experience at the Massachusetts General Hospital with intraparenchymal and sylvian hematomas caused by ruptured aneurysms.
Object: Patients who present with an intraparenchymal hematoma associated with a ruptured aneurysm usually require urgent clot evacuation and aneurysm obliteration. The impact of the presence of hematoma on outcome has been poorly characterized. The authors report on 460 patients who had dense subarachnoid hemorrhage (SAH) (Fisher Grades 3 and 4) with and without associated hematoma.
Methods: Of the 959 consecutive patients who presented with SAH, 460 patients with Fisher Grade 3 and 4 SAH were analyzed and divided into two groups: those with (Group 1) and those without (Group 2) hematoma. The presenting Hunt and Hess grade and 6-month outcomes of the two groups were compared.
Of the 460 patients, 116 (25%) had intraparenchymal hematomas and admission Hunt and Hess grades were worse in Group 1 compared with Group 2. Outcome scores were worse for Group 1 compared with Group 2; however, when comparing Group 1 and Group 2 within the same initial Hunt and Hess score, there was no statistical difference in outcome.
Conclusions: Intraparenchymal hematoma in association with SAH does not differ significantly from those patients without associated hematomas. We therefore recommend aggressive clot evacuation and aneurysm obliteration.
Although rupture of cerebral aneurysms usually results in SAH, some degree of intraparenchymal bleeding is often seen. A cooperative study reported by Locksley showed that 90% of patients with SAH who died within 72 hours also had intracerebral clots. Only 4 to 17% patients with aneurysmal SAH, however, have clinically significant hematomas.
It is well known that the presence of an ICH after aneurysm rupture negatively influences the patient's clinical course and outcome. The overall mortality rate ranges from 36 to 58%.
Controversy persists regarding the optimal management of ICHs caused by aneurysm rupture. In this paper, we review the literature and present our experience at the Massachusetts General Hospital with intraparenchymal and sylvian hematomas caused by ruptured aneurysms.