Aneurysmal isolated intracerebral hemorrhage and/or intraventricular hemorrhage without subarachnoid hemorrhage: a rare and perplexing scenario in neurosurgical practice

Abstract

Ruptured aneurysms with a presentation of intracerebral hemorrhage (ICH) and/or intraventricular hemorrhage (IVH) without subarachnoid hemorrhage (SAH) are rarely reported. Issues on the clinical characteristics, mechanism, diagnosis, treatment and prognosis of this rare entity are obscure to us. We present two cases of ruptured aneurysms with a presentation of isolated ICH. A systematic review of the literature was also conducted. There were 21 cases plus our cases. Good recovery was achieved in 10 patients (47.6 %). Pertaining to location, 38 % of presenting aneurysms were on the right side, 52 % were on the left side, and 10 % were midline. Anterior circulation aneurysms were identified in 81 % of patients (7 PComA, 8 MCA, 1 ICA, 1 AComA) and posterior in 19 % of patients (3 PCA, 1 BA). Sizes of the aneurysms ranged from 3 mm to 40 mm (16.21 ± 8.45). Ruptured aneurysms at the main trunks of the Willis cycle with a presentation of isolated ICH and/or IVH without SAH is extremely rare. The cause of this rare entity is multifactorial. The diagnosis and management of this entity pose a great challenge to us. The prognosis was discouraging based on the now available data.