Acute subdural hematoma from ruptured cerebral aneurysm

Autor: Javier Fandino, Anton Lukes, Serge Marbacher
Rok vydání: 2009
Předmět:
Adult
Male
Emergency Medical Services
medicine.medical_specialty
Subarachnoid hemorrhage
medicine.medical_treatment
610 Medicine & health
Comorbidity
Severity of Illness Index
Neurosurgical Procedures
Prosthesis Implantation
Aneurysm
Hematoma
Predictive Value of Tests
Modified Rankin Scale
Outcome Assessment
Health Care
medicine
Hematoma
Subdural
Acute
Humans
Glasgow Coma Scale
cardiovascular diseases
Aged
Retrospective Studies
Intracerebral hemorrhage
business.industry
Incidence
Glasgow Outcome Scale
Angiography
Digital Subtraction
Intracranial Aneurysm
Clipping (medicine)
Middle Aged
Prognosis
Surgical Instruments
medicine.disease
Embolization
Therapeutic
Surgery
Treatment Outcome
cardiovascular system
Female
Neurology (clinical)
Radiology
Tomography
X-Ray Computed
business
Vascular Surgical Procedures
Zdroj: Marbacher, Serge; Fandino, Javier; Lukes, Anton (2010). Acute subdural hematoma from ruptured cerebral aneurysm. Acta neurochirurgica, 152(3), pp. 501-7. Wien: Springer Vienna 10.1007/s00701-009-0521-0
ISSN: 0942-0940
0001-6268
Popis: Purpose: The combination of ruptured aneurysms with acute subdural hematomas (aSDHs) is a rare presentation. Patients with aSDH associated with aneurysmal bleeding represent a subgroup within the spectrum of aneurysmatic hemorrhage. We summarize the clinical characteristics, diagnostic evaluation, and management of a series of cases presenting with aSDH associated with aneurysmal subarachnoid hemorrhage (SAH). Methods: Medical records and surgical reports of 743 consecutive patients admitted to our institution with SAH from January 1995 to December 2007 were screened to detect cases of associated aSDH. Admission evaluations included the Glasgow Coma Scale (GCS) and the subarachnoid grade of the World Federation of Neurosurgical Societies (WFNS). Radiological assessment included computer tomography (CT) scan, CT angiography (CTA), and digital subtraction angiography (DSA). The presence and volume of SAH, intracerebral hemorrhage (ICH), and aSDH were documented. Outcome was measured in terms of Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) at 4-8 months. Results: A total of seven cases (0.9%) presenting with aSDH (mean width: 11.2mm ± 4.8mm, range: 5-20mm) attributable to SAH were documented. Three of these patients were admitted with a suspicion of trauma. Five patients presented with WFNS grade 5, one patient with WFNS grade 3, and one patient with WFNS grade 1. All patients underwent evacuation of the aSDH. In four patients, surgical obliteration of the aneurysm was achieved in the same procedure. Two patients underwent delayed occlusion of the aneurysm: one by coiling and one by clipping. Three of the seven patients recovered completely from their neurological deficits (GOS 5, mRS 0-1), three recovered with mild disability (GOS 4, mRS 2-3), and one died within 8 h after the decompressive procedure. Conclusions: The incidence of aSDH associated with SAH is low. Most of the patients with aSDH due to a ruptured aneurysm present in exceptionally poor neurological condition. Nevertheless, rapid surgical treatment of the hematoma and aneurysm obliteration can lead to a favorable outcome. Routine CTA should be performed in all patients presenting with an aSDH associated with SAH and no clear history of trauma
Databáze: OpenAIRE
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