RESUMO
To study the presentation and the results of the different radiological tools; computed tomography [CT] brain scan, magnetic resonance imaging [MRI], magnetic resonance angiography [MRA] and cerebral angiography [CA] in patients with subarachnoid hemorrhage [SAH] resulting from ruptured cerebral aneurysms. Consecutive patients with CT proved diagnosis of SAH were subjected to thorough history taking, general, neurological examination and laboratory investigation. After exclusion and deaths, 13 patients underwent MRA and CA beside CT and MRI. CA detected 11 aneurysms in 11 patients, arterio-venous malformation in one patient and in one patient there was no apparent cause. Among our 11 patients with aneurysmal SAH, females and age group of 31-50 years predominated. Smoking was present in 45.5%, hypertension in 27.3% and history of recurrent headache in 63.6%. With the onset of SAH, headache with neck stiffness was the most common presentation [63.6%]. Disturbed consciousness was found in 45.5%, seizures in 18.2% and focal signs in 9.1%. 36.4% of the patients had grade II and 27.3% had grade III in Hunt and Hess scale. Radiological assessment revealed that 7 patients had pure SAH, 3 patients had intracerebral hemorrhage [ICH] and one patient had intraventricular hemorrhage [IVH] in association with SAH. 63.6% of the aneurysms in our patients were small and no giant aneurysms were found. The most common site of aneurysms was middle cerebral artery [MCA] accounted for 36.4%. Anterior cerebral artery [ACA] and anterior communicating artery [ACoA] accounted for 18.2% each. Internal carotid artery [ICA] and posterior communicating artery [PCoA] accounted for 27.3%. In comparison to the CA, as the golden standard method, MRA detected 10 aneurysms out of 11, and missed one small aneurysm, with a sensitivity of 90.9% in detection of aneurysms. Ruptured intracranial aneurysms accounted for about 85% of causes of SAH. History of recurrent headache, smoking, hypertension and female gender may be predictors of aneurysmal rupture in the 4[th] and 5[th] decades. 36.4% of SAH may be associated with ICH or IVH. Headache is the most common presentation of rupture aneurysm while less than half of the patients presented with altered consciousness. About tow thirds of aneurysms are small sized. Intracranial aneurysms located in the anterior cerebral circulation mostly in MCA. MRA is a rapid, non invasive technique and can be used to detect intracranial aneurysms with high sensitivity of 90.9%, with excellent correlation with the gold standard, invasive, CA