Simple intracranial hematoma caused by ruptured intracranial aneurysms: Clinical analysis and literature review / 中国脑血管病杂志

ABSTRACT

Objective To explore the clinical features of patients with ruptured intracranial aneurysm combined with simple intracranial hematoma. Methods A total of 410 continuous patients with ruptured intracranial aneurysms in the Neurosurgery of the Second Affiliated Hospital of University of South China from October 2012 to December 2018 was enrolled retrospectively. Eight cases of those combined with simple intracranial hematoma but without subarachnoid hemorrhage. The clinical data of these patients were collected, including cerebrovascular risk factors, Glasgow Coma Scale score, Hunt-Hess classification, Fisher classification, imaging signs, the characteristics of intracranial aneurysm, the type of surgical treatment, and the outcomes of follow-up. After 3 months of treatment, the prognosis was evaluated by modified Rankin scale (mRS) score. Results (1) The proportion of ruptured intracranial aneurysms with simple intracranial hematoma accounted for 2.0% (8/410). Five patients ignored the diagnosis of intracranial aneurysm at initial diagnosis one case was diagnosed with acute traumatic subdural hematoma at the first time, and then diagnosed as posterior communicating artery aneurysm by CT angiography (CTA); one case was diagnosed with spontaneous basal ganglia hemorrhage at the first time, and then diagnosed as middle cerebral aneurysm by CTA; one case was diagnosed with spontaneous basal ganglia cerebral hemorrhage in the other hospital at the first time, and then diagnosed as middle cerebral artery bifurcation aneurysm during the craniotomy hematoma removal, and further diagnosed as anterior communicating artery aneurysm 2 weeks after surgery by DSA; one case was diagnosed with spontaneous frontal lobe hemorrhage due to headache in the other hospital at the first time, and then diagnosed as anterior cerebral aneurysm by CTA; one case was diagnosed with spontaneous basal ganglia hemorrhage at the first time, and then diagnosed as posterior cerebral aneurysm by CTA. (2) Imaging features hematoma in the basal ganglia is immediately adjacent to the lateral fissure or temporal lobe, and some patients had a round-like slightly high-density shadow on the edge of the hematoma; simple lateral intraventricular hemorrhage showed that the temporal lobe hematoma invaded into the lateral ventricle temporal angle, and the subdural hematoma was without skull fracture. In addition, CTA demonstrated that the expansion direction of the aneurysm toward the brain lobe was easy to form cerebral intraparenchymal hematoma, and the direction toward the dura mater was easy to form spontaneous subdural hematoma. (3)2 cases had good prognosis (mRS score 0-2), 6 cases had poor prognosis (mRS score 3-6). Conclusions For patients who are initially diagnosed with spontaneous intracranial hematoma without subarachnoid hemorrhage, head CTA or DSA should be performed as soon as possible, especially the hematoma in the basal ganglia area near to the lateral fissure, the hematoma existing a slightly rounded high-density shadow on edge, and subdural hematoma without skull fracture. The study should pay more attention to these imaging signs to identify intracranial aneurysms.