CT and angiographic evaluation in ruptured intracranial aneurysm: clinical correlation

ABSTRACT

CT has become one of the most important diagnostic method in the evaluation of ruptured intracranial aneurysm with direct detection of subarachnoid, intracerebral and intraventricular hemorrhage, and identification of complications such as recurrent bleeding, hydrocephalus and infarction secondary to arterial spasm. Angiography gives precise information on the location, size of aneurysm and presence of arterial spasm. Authors attempted toperedict the location of ruptured intracranial aneurysm confiremd by CT and angiography at Keimyung University Hospital for last 2 years. The results were as follows; 1 The age and sex distribution; the most prevalent agegroup was 5th to 6th decades (70%), and female patient was slightly more than male patient(57.5%: 42.5%). 2. The locaiton of aneruysms were; posterior communicating artery group 17 cases (42.2%), middle cerebral artery group 10 cases (25.0%), anterior communicating artery group 7 cases (17.5%), basilar artery bifucation 1 case (2.5%),posterior inferior cerebellar artery 1 case(2.5%), and multiple aneurysms 4 case (10%) in order to frequency. 3.Characteristic distributions of intracranial hemorrhage in CT were as follows; 1) In 6 cases (85.7%) of anterior communicating artery aneurysm, interhemispheric fissure hemorrhage was noted. 2) The ipsilateral sylvian fisuurehemorrhage was noted in all cases of middle cerebral artery aneurysm(10 cases) and 12 cases (70.6%) of posterior communicating artery aneurysm. 3) Localized hematoma in frontal lobe near interhemispheric fissure (2 cases:28.6%), septum pellucidum (1 case: 14.3%) and corpus callosum (1 case: 14.3%) were characteristic in anterior communicating artery aneurysm. 4) Comma-shape sylvian fissure hematoma (5 cases: 50%) and temporal lobe hematomanear sylvian fissure (5 cases: 50%) may indicate middle cerebral artery anerysm, 5) Intraventricular hemorrhage (6cases: 15%) has no particular predilection of aneurysmal location. 4. In 9 patients (22.5%) of clinicallysuggesting subarachnoid hemorrhage, no extravasated blood was noted in preenhancement CT alone. 5. Six cases (15%)showed aneurysm itself on preenhancement CT as a round or ovoid hyperdense area or isodense area with mass effectsuch as cisternal obliteration. 6. Hydrocephalus was noted in 9 cases (22.5%). 7. There was no direct correlation between the size of the intracranial aneurysm and extent of the hemorrhage in CT, and between the size of the intracranial aneurysm and clinical grade. 8. There was direct correlation between the extent of blood in CT andclinical grade.