The relationship of blunt head trauma, subarachnoid hemorrhage, and rupture of pre-existing intracranial saccular aneurysms

Subarachnoid haemorrhage in Sweden 1987-2002: regional incidence and case fatality rates

“…When trauma is excluded, 10–15% of all SAH cases are of non-aneurysmal origin and generally have a better prognosis 23. Traumatic SAH is expected to have had trauma as primary diagnosis, in almost all cases, although in rare instances it may be difficult to disentangle aneurysm and trauma as the cause of the SAH 24 25. Second, SAH may be diagnosed more accurately and frequently in more recent years, as diagnostic tools have become more advanced.…”

Delayed Rebleeding of Cerebral Aneurysm Misdiagnosed as Traumatic Subarachnoid Hemorrhage

“…Although 2.8-28% of patients with aneurysmal SAH experience head trauma prior to the hemorrhage,5) the relationship between head trauma and a pre-existing intracranial aneurysm is rarely discussed in the literature. The relationship of trauma to rupture of a cerebral aneurysm is controversial and a causal relationship can be difficult to ascertain 3). Some authors concluded that head injury itself is rarely the primary cause of the fatal rupture of a saccular aneurysm.…”

“…Some authors concluded that head injury itself is rarely the primary cause of the fatal rupture of a saccular aneurysm. However, a thin aneurysmal sac could be ruptured by being thrust against a bony structure such as the anterior or posterior clinoid process 3). Another report postulated that no relationship, or at best a very weak one, exists between closed head injury and the rupture of saccular aneurysms 7).…”

“…Another report postulated that no relationship, or at best a very weak one, exists between closed head injury and the rupture of saccular aneurysms 7). Cummings et al3) reported 5 (8%) of 60 patients with traumatic SAH harbored pre-existing intracranial saccular aneurysms. Of the 5 cases of aneurysm, the 3 patients who had SAH in the basal cisterns were highly suspicious for aneurysmal bleed, and the bleed may have precipitated the trauma.…”

Cerebral Saccular Aneurysm Rupture After Head Injury

“…Occasionally, a conventional saccular aneurysm is found. 1 The clinical history, physical examination, and computed tomography (CT) scan in such a patient may suggest that an aneurysmal SAH was the primary event, with the trauma resulting from SAH-associated incapacity. But this scenario is not usually apparent and, if a saccular cerebral aneurysm is found on angiogram after a patient has been injured, it is often difficult to know if the aneurysm is incidental, caused the SAH and trauma, or bled as a result.…”