Smaller cerebral aneurysms producing more extensive subarachnoid hemorrhage following rupture: a radiological investigation and discussion of theoretical determinants

View More View Less
  • 1 Department of Neurosurgery, New York University School of Medicine, New York, New York
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. The goal of this study was to determine the relationship between aneurysm size and the volume of subarachnoid hemorrhage (SAH).

Methods. One hundred consecutive patients who presented with acute SAH, which was diagnosed on the basis of a computerized tomography (CT) scan within 24 hours postictus and, subsequently, confirmed to be aneurysmal in origin by catheter angiography, were included in this study. The data were collected prospectively in 32 patients and retrospectively in 68. The volume of SAH on the admission CT scan was scored in a semiquantitative manner from 0 to 30, according to a previously published method.

The mean aneurysm size was 8.3 mm (range 1–25 mm). The mean SAH volume score was 15 (range 0–30). Regression analysis revealed that a smaller aneurysm size correlated with a more extensive SAH (r2 = 0.23, p < 0.0001). Other variables including patient sex and age, intraparenchymal or intraventricular hemorrhage, multiple aneurysms, history of hypertension, and aneurysm location were not statistically associated with a larger volume of SAH.

Conclusions. Smaller cerebral aneurysm size is associated with a larger volume of SAH. The pathophysiological basis for this correlation remains speculative.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Jafar J. Jafar, M.D., Department of Neurosurgery, New York University Medical Center, 530 First Avenue, Suite 8R, New York, New York 10016. email: jafar.jafar@med.nyu.edu.
  • 1.

    Adams HP Jr, , Kassell NF, & Torner JC, et al: Predicting cerebral ischemia after aneurysmal subarachnoid hemorrhage: influences of clinical condition, CT results, and antifibrinolytic therapy. A report of the Cooperative Aneurysm Study. Neurology 37:15861591, 1987 Adams HP Jr, Kassell NF, Torner JC, et al: Predicting cerebral ischemia after aneurysmal subarachnoid hemorrhage: influences of clinical condition, CT results, and antifibrinolytic therapy. A report of the Cooperative Aneurysm Study. Neurology 37:1586–1591, 1987

    • Search Google Scholar
    • Export Citation
  • 2.

    Brouwers PJ, , Dippel DW, & Vermeulen M, et al: Amount of blood on computed tomography as an independent predictor after aneurysm rupture. Stroke 24:809814, 1993 Brouwers PJ, Dippel DW, Vermeulen M, et al: Amount of blood on computed tomography as an independent predictor after aneurysm rupture. Stroke 24:809–814, 1993

    • Search Google Scholar
    • Export Citation
  • 3.

    del Zoppo GJ, , Yu JQ, & Copeland BR, et al: Tissue factor localization in non-human primate cerebral tissue. Thromb Haemost 68:642647, 1992 del Zoppo GJ, Yu JQ, Copeland BR, et al: Tissue factor localization in non-human primate cerebral tissue. Thromb Haemost 68:642–647, 1992

    • Search Google Scholar
    • Export Citation
  • 4.

    Eddleston M, , de la Torre JC, & Oldstone MB, et al: Astrocytes are the primary source of tissue factor in the murine central nervous system. A role for astrocytes in cerebral hemostasis. J Clin Invest 92:349358, 1993 Eddleston M, de la Torre JC, Oldstone MB, et al: Astrocytes are the primary source of tissue factor in the murine central nervous system. A role for astrocytes in cerebral hemostasis. J Clin Invest 92:349–358, 1993

    • Search Google Scholar
    • Export Citation
  • 5.

    Fisher CM, , Roberson GH, & Ojemann RG: Cerebral vasospasm with ruptured saccular aneurysm—the clinical manifestations. Neurosurgery 1:245248, 1977 Fisher CM, Roberson GH, Ojemann RG: Cerebral vasospasm with ruptured saccular aneurysm—the clinical manifestations. Neurosurgery 1:245–248, 1977

    • Search Google Scholar
    • Export Citation
  • 6.

    Fleck RA, , Rao LV, & Rapaport SI, et al: Localization of human tissue factor antigen by immunostaining with monospecific, polyclonal anti-human tissue factor antibody. Thromb Res 59:421437, 1990 Fleck RA, Rao LV, Rapaport SI, et al: Localization of human tissue factor antigen by immunostaining with monospecific, polyclonal anti-human tissue factor antibody. Thromb Res 59:421–437, 1990

    • Search Google Scholar
    • Export Citation
  • 7.

    Forget TR Jr, , Benitez R, & Veznedaroglu E, et al: A review of size and location of ruptured intracranial aneurysms. Neurosurgery 49:13221326, 2001 Forget TR Jr, Benitez R, Veznedaroglu E, et al: A review of size and location of ruptured intracranial aneurysms. Neurosurgery 49:1322–1326, 2001

    • Search Google Scholar
    • Export Citation
  • 8.

    Gabrielsen TO, & Greitz T: Normal size of the internal carotid, middle cerebral and anterior cerebral arteries. Acta Radiol Diagn 10:110, 1970 Gabrielsen TO, Greitz T: Normal size of the internal carotid, middle cerebral and anterior cerebral arteries. Acta Radiol Diagn 10:1–10, 1970

    • Search Google Scholar
    • Export Citation
  • 9.

    Hijdra A, , Brouwers PJ, & Vermeulen M, et al: Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke 21:11561161, 1990 Hijdra A, Brouwers PJ, Vermeulen M, et al: Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke 21:1156–1161, 1990

    • Search Google Scholar
    • Export Citation
  • 10.

    The International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:17251733, 1998 The International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733, 1998

    • Search Google Scholar
    • Export Citation
  • 11.

    Kamath S: Observations on the length and diameter of vessels forming the circle of Willis. J Anat 133:419423, 1981 Kamath S: Observations on the length and diameter of vessels forming the circle of Willis. J Anat 133:419–423, 1981

    • Search Google Scholar
    • Export Citation
  • 12.

    Kassell NF, & Torner JC: Size of intracranial aneurysms. Neurosurgery 12:291297, 1983 Kassell NF, Torner JC: Size of intracranial aneurysms. Neurosurgery 12:291–297, 1983

    • Search Google Scholar
    • Export Citation
  • 13.

    Kataoka K, , Taneda M, & Asai T, et al: Difference in nature of ruptured and unruptured cerebral aneurysms. Lancet 355:203, 2000 (Letter) Kataoka K, Taneda M, Asai T, et al: Difference in nature of ruptured and unruptured cerebral aneurysms. Lancet 355:203, 2000 (Letter)

    • Search Google Scholar
    • Export Citation
  • 14.

    Kyriacou SK, & Humphrey JD: Influence of size, shape and properties on the mechanics of axisymmetric saccular aneurysms. J Biomech 29:10151022, 1996 Kyriacou SK, Humphrey JD: Influence of size, shape and properties on the mechanics of axisymmetric saccular aneurysms. J Biomech 29:1015–1022, 1996

    • Search Google Scholar
    • Export Citation
  • 15.

    Roos EJ, , Rinkel GJ, & Velthuis BK, et al: The relation between aneurysm size and outcome in patients with subarachnoid hemorrhage. Neurology 54:23342336, 2000 Roos EJ, Rinkel GJ, Velthuis BK, et al: The relation between aneurysm size and outcome in patients with subarachnoid hemorrhage. Neurology 54:2334–2336, 2000

    • Search Google Scholar
    • Export Citation
  • 16.

    Smoker WR, , Price MJ, & Keyes WD, et al: High-resolution computed tomography of the basilar artery: I. Normal size and position. AJNR 7:5560, 1986 Smoker WR, Price MJ, Keyes WD, et al: High-resolution computed tomography of the basilar artery: I. Normal size and position. AJNR 7:55–60, 1986

    • Search Google Scholar
    • Export Citation
  • 17.

    Suzuki M, , Kudo A, & Otawara Y, et al: Extrinsic pathway of blood coagulation and thrombin in the cerebrospinal fluid after sub-arachnoid hemorrhage. Neurosurgery 44:487494, 1999 Suzuki M, Kudo A, Otawara Y, et al: Extrinsic pathway of blood coagulation and thrombin in the cerebrospinal fluid after sub-arachnoid hemorrhage. Neurosurgery 44:487–494, 1999

    • Search Google Scholar
    • Export Citation
  • 18.

    Wardlaw JM, , Cannon J, & Statham PF, et al: Does the size of intracranial aneurysms change with intracranial pressure? Observations based on color “power” transcranial Doppler ultrasound. J Neurosurg 88:846850, 1998 Wardlaw JM, Cannon J, Statham PF, et al: Does the size of intracranial aneurysms change with intracranial pressure? Observations based on color “power” transcranial Doppler ultrasound. J Neurosurg 88:846–850, 1998

    • Search Google Scholar
    • Export Citation
  • 19.

    Wiebers DO, , Whisnant JP, & Sundt TM Jr, et al: The significance of unruptured intracranial saccular aneurysms. J Neurosurg 66:2329, 1987 Wiebers DO, Whisnant JP, Sundt TM Jr, et al: The significance of unruptured intracranial saccular aneurysms. J Neurosurg 66:23–29, 1987

    • Search Google Scholar
    • Export Citation
  • 20.

    Yasui N, , Magarisawa S, & Suzuki A, et al: Subarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: a retrospective analysis of 25 cases. Neurosurgery 39:10961101, 1996 Yasui N, Magarisawa S, Suzuki A, et al: Subarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: a retrospective analysis of 25 cases. Neurosurgery 39:1096–1101, 1996

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 309 96 9
Full Text Views 110 1 0
PDF Downloads 88 1 0
EPUB Downloads 0 0 0