Intracerebral haematoma complicating ruptured cerebral berry aneurysm

Abstract

This paper is an account of the morbid anatomical findings at necropsy in a study of intracerebral haematomata in 103 consecutively examined cases of ruptured cerebral berry aneurysm. In the majority of these cases the site of the ruptured aneurysm had been demonstrated by carotid angiography during life but in a few the aneurysm was only shown at necropsy. It is by studying these lesions at necropsy that information will be gained concerning some of the lesions probably present in patients surviving with a neurological deficit but it must be remembered that the severity and frequency of the lesions in cases coming to necropsy will not necessarily be the same as in these surviving though the nature of the lesions will probably be very similar.As pointed out by Robertson (1949) and again 10 years later by Tomlinson (1959), the factual information to be found in the literature on the intracerebral sequelae of ruptured cerebral aneurysm is very sparse. Many of the conclusions drawn have resulted from impressions gained from a small number of cases rather than from factual observations on a larger series. This paper is primarily concerned with intracerebral haematomata, but figures relating to cerebral infarction and subarachnoid haematomata in the same series will be given for comparison, and also because it is important to avoid giving the impression that intracerebral haematomata are the only complication of the rupture of cerebral berry aneurysms. INCIDENCEOne hundred and three cases of ruptured cerebral aneurysm were examined at necropsy. Sixty-two of them had intracerebral haematomata and 62 had cerebral infarction. This implies definite, large regions of cortical infarction, involving at least onethird of the region of supply of one of the cerebral arteries or ganglionic necrosis at least 5 mm. in diameter. Of those 62 cases with intracerebral haematomata, 32 also showed cerebral infarction. AGE AND SEX DISTRIBUTION Table I shows the age distribution of the 103 cases in decades. These have been separated into subgroups and it can be seen that nearly all the cases over 60 years of age were in women.The age distribution for cases with infarction and cases with intracerebral haematomata is similar to that of the total series, except that infarction is somewhat more common in the older age groups than are haematomata and a large number of these older cases with infarction are in women. The respective incidence of haematomata and infarction in men and women is summarized in Table I, and

Surgical indications in patients with an intracerebral hemorrhage due to a ruptured middle cerebral artery aneurysm

“…[2][3][4][5]7,9,10,12,13,18,20] In our experience with these patients, however, individual surgical results were variable, and outcomes were not as good as expected. Although in our patient series, patients recovered fully despite fatal neurological findings at their initial presentation, similar to postoperative patients with an acute epidural hematoma.…”

“…[2][3][4][5]7,9,12,13,18,20]. However, few large surgical series of patients with an ICH due to a ruptured MCA aneurysm have been reported.…”

Poor-Grade Ruptured Middle Cerebral Artery Aneurysm With Intracerebral Hematoma: Bleeding Characteristics and Management

“…1,3,5,6,17,19,29,34) Patients do not always achieve outcomes consistent with their initial neurological status, and 50-60% of patients affected by rupture of an intracranial aneurysm can become functional survivors. 3,[9][10][11][12]14,18,20,22,25,26) However, insufficient surgical intervention may result in loss of potentially salvageable function or life.…”

“…In general, patients with poor-grade SAH present with either massive intraparenchymal hematoma or dense subarachnoid clot. 5,6,19) Hematoma associated with ruptured MCA aneurysms has been classified into two patterns, temporal intraparenchymal hematoma and intra-sylvian hematoma. 15,16,19,22,34) In contrast, this study classified hematoma into three categories: temporal hematoma; sylvian hematoma; and frontal hematoma, representing hematoma extending to the base of the frontal lobe.…”

“…The aneurysm ruptured into the external capsule, the frontal lobe, and then into the frontal horn. 5) The third ventricle is widely dilated if the hematoma ruptured into the ventricular system.…”