Hematoma as a Consequence of Ruptured Intracranial Aneurysms

ABSTRACT

The importance of hematoma associated with ruptured aneurysm has been discribed frequently. Hematomas may be intracisternal, intracerbral or subdural and intracerebral hematomas frequently rupture into the adjacent ventricle. The authors have analysed in clinically 33 cases of intracranial hematomas which developed as a consequence of 100 cases of ruptured intracranial aneurysms. Of 100 cases of ruptured intracranial aneurysms, the incidence of hematoma was 33%(33 cases). The most common site of aneurysm associated with hematoma was middle cerebral artery(50%) and anterior cerebral-anterior communicating artery in turn. Intracerebral hematomas are most common(20%), followed by intracerebral and intraventricular hematomas(5%). The incidence of subdural hematomas and intraventricular hematomas is 3% in each. There was no significant difference according to sex. The incidence of hematoma was considerably increased in 30-40 age group. The operative result in 33 cases who have hematomas was favorable(excellent good result) in 36.5%, and was unfavorable(fair - poor result) in 27.4%. The operative mortality was 36.4% and 7.5% in non-hematoma group. Cases of internal carotid artery aneurysms with hematoma carried the highest mortality and the next is cerebral-anterior communicating artery aneurysms. There showed poor result in cases of preoperative grade IV & V, either hematoma or non-hematoma group. We also analysed the correlations between the frequency of hematoma and the vasospasm, hydrocephalus. Of 33 cases of ruptured aneurysm with hematoma, vasospasm was detected in 8 cases, hydrocephalus was in 6 cases and vasospasm, combined with hydrocephalus was 8 cases. It revealed a tendency of increased mortality in cases of hematoma with vasospasms.