The prognostic significance of intracerebral haematoma as shown on CT scanning after aneurysmal subarachnoid haemorrhage

Abstract

In a prospective study of 1076 consecutive patients with aneurysmal subarachnoid haemorrhage (SAH), CT was carried out in 815 patients. CT visible intracerebral haematoma (ICH) was found in 42.6% of the 815 patients. There were no differences in age, pre-existing hypertension or sex between patients with or without ICH. Patients with ICH were in poorer clinical condition on admission, and had a poorer mental outcome and a higher mortality at the 2-year follow-up examination compared with patients without ICH. Of the 491 operated patients, there were in every group according to the clinical condition on admission fewer patients with a normal mental outcome and more fatal cases if an ICH was present after aneurysm rupture. This indicates that the acute brain dysfunction from SAH complicated by ICH is more likely to be followed by permanent cerebral damage compared to the corresponding acute cerebral dysfunction from SAH without ICH.

Surgical Outcome following Decompressive Craniectomy for Poor-Grade Aneurysmal Subarachnoid Hemorrhage in Patients with Associated Massive Intracerebral or Sylvian Hematomas

“…The clinical outcome of SAH patients with ICH is usually worse than that of SAH patients without ICH [12, 20]. Heuer et al [21] showed that the ICP increases in over half of all patients with SAH, particularly among those with a poor grade who also have ICH.…”

Emergency microsurgery for aneurysmal subarachnoid hemorrhage coexisted with brain hernia

“…For this reason, it remains a difficulty in neurosurgery. Aneurysmal SAH coexisted with brain hernia is often accompanied by intracerebral hematoma; when such a condition occurs, patient's condition will turn more serious and higher disability and fatality rates will occur, compared with aneurysmal SAH without intracerebral hematoma (5). Therefore, early diagnosis and accordingly-decided rational treatment greatly influence the prognosis of this condition.…”

Cerebral Aneurysms

“…Not surprisingly, the average outcome is worse than in patients with purely subarachnoid blood (26). When a large haematoma is the most likely cause of the poor condition on admission, the immediate evacuation of the haematoma should be seriously considered (with simultaneous clipping of the aneurysm if it can be identified), often with the aneurysm having been demonstrated only by MR angiography or CT angiography.…”