J Cerebrovasc Endovasc Neurosurg.  2012 Sep;14(3):181-185. 10.7461/jcen.2012.14.3.181.

The Clinical Characteristics and Treatment Outcomes of Patients with Ruptured Middle Cerebral Artery Aneurysms Associated with Intracerebral Hematoma

Affiliations
  • 1Department of Neurosurgery, Ajou University Hospital, School of Medicine, Ajou University, Suwon, Korea. nsyclim@gmail.com

Abstract


OBJECTIVE
The objective of this study is to evaluate the clinical presentation and outcomes of patients with an intracerebral hematoma (ICH) associated with a ruptured middle cerebral artery (MCA) aneurysm, and the correlation factors associated with the aneurysm and characteristics of the hematoma.
METHODS
A retrospective evaluation of clinical and radiologic characteristics and outcomes was conducted for 24 patients (11 men and 13 women; mean age, 53 years) with ruptured MCA aneurysms associated with ICH between September 2008 and December 2011.
RESULTS
Thirteen (54%) of the 24 patients had a favorable outcome, four (17%) suffered from severe disability, and seven (29%) died. Based on Hunt and Hess grade, one patient was classified as Grade II, three as Grade III, 12 as Grade IV, and eight as Grade V. Patients with an unfavorable outcome had significantly larger aneurysms (p = 0.047) and ICH volumes (p = 0.002), compared with patients in the group with a favorable outcome. The most frequent rupture point of aneurysms was the lateral aspect of the aneurysm (54.2%). When the rupture point is toward the lateral direction, the distribution of ICH tended to be located at the temporal lobe and intrasylvian.
CONCLUSION
Results of the present study suggest an association of the initial clinical state, the size of the aneurysm, and ICH volume with outcome. Although no difference was observed between the location of the rupture point and patient outcomes, an accurate assessment of ICH patterns and the rupture point in angiography may help to ensure surgical exposure and a safe aneurysm clipping.

Keyword

Aneurysm; Middle cerebral artery; Intracerebral hematoma

MeSH Terms

Aneurysm
Angiography
Dietary Sucrose
Hematoma
Humans
Intracranial Aneurysm
Male
Middle Cerebral Artery
Retrospective Studies
Rupture
Temporal Lobe
Dietary Sucrose

Figure

  • Fig. 1 Admission brain computed tomography (CT) scan shows right frontal intracerebral hemorrhage (ICH) with a mass effect by ipsilateral ventricle compression (A). Right three-dimensional digital subtraction angiogram (3D-DSA) shows the rupture point of the middle cerebral artery (MCA) bifurcation aneurysm projecting superiorly (B).

  • Fig. 2 Brain CT scan shows a right temporal and intrasylvian ICH with a mass effect (A). The emergency right 3D-DSA shows a MCA bifurcation aneurysm with a laterally projecting rupture point (B). Postoperative CT scan shows evacuation of the ICH and clip using a catheter (C, D).


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