Causes of acute deterioration in patients with a ruptured intracranial aneurysm

A prospective study with serial CT scanning

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  • 1 Departments of Neurology, University Hospital, Rotterdam, and Academisch Medisch Centrum, Amsterdam, The Netherlands
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✓ The authors studied the acute neurological deterioration in 150 patients with aneurysmal hemorrhage. These patients were closely observed for a 4-week period or until death or operation. Forty-six patients suffered a total of 62 episodes of deterioration that developed within 5 minutes after aneurysm rupture; 59 of these episodes consisted of severe impairment of consciousness. Computerized tomography (CT) was performed within a few hours of the event. Serial scans were obtained at least weekly after admission. Rebleeding was diagnosed as the cause of 42 episodes (68%), including six patients who died rapidly without a repeat CT scan. The final diagnosis of the cause in other acute episodes was epilepsy (in six), acute onset of ischemia (in three), and ventricular fibrillation (in one). Ten unexplained events occurred in nine patients. Rebleeding could be excluded with confidence in nine of these events, because the residual clots had disappeared or markedly decreased on CT. It is concluded that a purely clinical diagnosis of rebleeding will be incorrect in about every third patient, even if these patients are under close observation.

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Contributor Notes

Address reprint requests to: Marinus Vermeulen, M.D., University Hospital Rotterdam (Dijkzigt), Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
  • 1.

    Crompton MR: Intracerebral haematoma complicating ruptured cerebral berry aneurysm. J Neurol Neurosurg Psychiatry 25:378386, 1962 Crompton MR: Intracerebral haematoma complicating ruptured cerebral berry aneurysm. J Neurol Neurosurg Psychiatry 25:378–386, 1962

    • Search Google Scholar
    • Export Citation
  • 2.

    Duffy GP: Lumbar puncture in spontaneous subarachnoid haemorrhage. Br Med J 285:11631164, 1982 Duffy GP: Lumbar puncture in spontaneous subarachnoid haemorrhage. Br Med J 285:1163–1164, 1982

    • Search Google Scholar
    • Export Citation
  • 3.

    Earnest MP, , Heaton RK, & Wilkinson WE, et al. : Cortical atrophy, ventricular enlargement and intellectual impairment in the aged. Neurology 29:11381143, 1979 Earnest MP, Heaton RK, Wilkinson WE, et al: Cortical atrophy, ventricular enlargement and intellectual impairment in the aged. Neurology 29:1138–1143, 1979

    • Search Google Scholar
    • Export Citation
  • 4.

    Geller SA: Autopsy. Sci Am 248:110121, 1983 Geller SA: Autopsy. Sci Am 248:110–121, 1983

  • 5.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 6.

    Locksley HB: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, Part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the Cooperative Study. J Neurosurg 25:321368, 1966 Locksley HB: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, Part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the Cooperative Study. J Neurosurg 25:321–368, 1966

    • Search Google Scholar
    • Export Citation
  • 7.

    Maurice-Williams RS: Ruptured intracranial aneurysms: has the incidence of early rebleeding been over-estimated? J Neurol Neurosurg Psychiatry 45:774779, 1982 Maurice-Williams RS: Ruptured intracranial aneurysms: has the incidence of early rebleeding been over-estimated? J Neurol Neurosurg Psychiatry 45:774–779, 1982

    • Search Google Scholar
    • Export Citation
  • 8.

    Meese W, , Kluge W, & Grumme T, et al. : CT evaluation of the CSF spaces of healthy persons. Neuroradiology 19:131136, 1980 Meese W, Kluge W, Grumme T, et al: CT evaluation of the CSF spaces of healthy persons. Neuroradiology 19:131–136, 1980

    • Search Google Scholar
    • Export Citation
  • 9.

    Schwartz D, & Lellouch J: Explanatory and pragmatic attitudes in therapeutical trials. J Chron Dis 20:637648, 1967 Schwartz D, Lellouch J: Explanatory and pragmatic attitudes in therapeutical trials. J Chron Dis 20:637–648, 1967

    • Search Google Scholar
    • Export Citation
  • 10.

    Teasdale G, & Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:8184, 1974 Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84, 1974

    • Search Google Scholar
    • Export Citation
  • 11.

    van Crevel H: Pitfalls in the diagnosis of rebleeding from intracranial aneurysm. Clin Neurol Neurosurg 82:19, 1980 van Crevel H: Pitfalls in the diagnosis of rebleeding from intracranial aneurysm. Clin Neurol Neurosurg 82:1–9, 1980

    • Search Google Scholar
    • Export Citation
  • 12.

    van Gijn J, & van Dongen KJ: Computed tomography in the diagnosis of subarachnoid haemorrhage and ruptured aneurysm. Clin Neurol Neurosurg 82:1124, 1980 van Gijn J, van Dongen KJ: Computed tomography in the diagnosis of subarachnoid haemorrhage and ruptured aneurysm. Clin Neurol Neurosurg 82:11–24, 1980

    • Search Google Scholar
    • Export Citation
  • 13.

    van Gijn J, & van Dongen KJ: Computerized tomography in subarachnoid hemorrhage: difference between patients with and without an aneurysm on angiography. Neurology 30:538539, 1980 van Gijn J, van Dongen KJ: Computerized tomography in subarachnoid hemorrhage: difference between patients with and without an aneurysm on angiography. Neurology 30:538–539, 1980

    • Search Google Scholar
    • Export Citation
  • 14.

    van Gijn J, & van Dongen KJ: The time course of aneurysmal haemorrhage on computed tomograms. Neuroradiology 23:153156, 1982 van Gijn J, van Dongen KJ: The time course of aneurysmal haemorrhage on computed tomograms. Neuroradiology 23:153–156, 1982

    • Search Google Scholar
    • Export Citation
  • 15.

    Vermeulen M, & Muizelaar JP: Do antifibrinolytic agents prevent rebleeding after rupture of a cerebral aneurysm? A review. Clin Neurol Neurosurg 82:2530, 1980 Vermeulen M, Muizelaar JP: Do antifibrinolytic agents prevent rebleeding after rupture of a cerebral aneurysm? A review. Clin Neurol Neurosurg 82:25–30, 1980

    • Search Google Scholar
    • Export Citation
  • 16.

    Vermeulen M, , van Gijn J, & Blijenberg BG: Spectrophotometric analysis of CSF after subarachnoid hemorrhage: limitations in the diagnosis of rebleeding. Neurology 33:112114, 1983 Vermeulen M, van Gijn J, Blijenberg BG: Spectrophotometric analysis of CSF after subarachnoid hemorrhage: limitations in the diagnosis of rebleeding. Neurology 33:112–114, 1983

    • Search Google Scholar
    • Export Citation
  • 17.

    Walton JN: Subarachnoid Haemorrhage. Edinburgh: E & S Livingstone, 1956, 350 pp Walton JN: Subarachnoid Haemorrhage. Edinburgh: E & S Livingstone, 1956, 350 pp

    • Search Google Scholar
    • Export Citation

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