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

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Diagram showing the division of the basal subarachnoid space into 10 cisternal compartments for the quantification of SAH. Each compartment was scored from 0 (no hemorrhage) to 3 (maximal hemorrhage). The total score (0–30) was the sum of all compartments. Center and Right: Representative axial CT scans obtained in a single patient, revealing acute SAH. The SAH volume score for each cisternal compartment are as follows: Compartment 1, 2; Compartment 2, 3; Compartment 3, 3; Compartment 4, 1; Compartment 5, 1; Compartment 6, 2; Compartment 7, 2; Compartment 8, 1; Compartment 9, 1; Compartment 10, 1; giving a total score of 17 (of a possible 30).

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    Scatterplots, best-fit lines, and results of regression analysis displaying the relationship between aneurysm size and volume of SAH for all 100 aneurysms (r2 = 0.23, p < 0.0001 [upper]), and for 27 PCoA aneurysms (r2 = 0.36, p = 0.0009 [lower]).

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    Graph showing SAH volume scores grouped according to increasing aneurysm size. The means (dots) and their standard errors (bars) are displayed.

References

1.

Adams HP JrKassell NFTorner JCet 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 37:158615911987Adams 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

2.

Brouwers PJDippel DWVermeulen Met al: Amount of blood on computed tomography as an independent predictor after aneurysm rupture. Stroke 24:8098141993Brouwers 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

3.

del Zoppo GJYu JQCopeland BRet al: Tissue factor localization in non-human primate cerebral tissue. Thromb Haemost 68:6426471992del Zoppo GJ Yu JQ Copeland BR et al: Tissue factor localization in non-human primate cerebral tissue. Thromb Haemost 68:642–647 1992

4.

Eddleston Mde la Torre JCOldstone MBet 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 92:3493581993Eddleston 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

5.

Fisher CMRoberson GHOjemann RG: Cerebral vasospasm with ruptured saccular aneurysm—the clinical manifestations. Neurosurgery 1:2452481977Fisher CM Roberson GH Ojemann RG: Cerebral vasospasm with ruptured saccular aneurysm—the clinical manifestations. Neurosurgery 1:245–248 1977

6.

Fleck RARao LVRapaport SIet al: Localization of human tissue factor antigen by immunostaining with monospecific, polyclonal anti-human tissue factor antibody. Thromb Res 59:4214371990Fleck 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

7.

Forget TR JrBenitez RVeznedaroglu Eet al: A review of size and location of ruptured intracranial aneurysms. Neurosurgery 49:132213262001Forget TR Jr Benitez R Veznedaroglu E et al: A review of size and location of ruptured intracranial aneurysms. Neurosurgery 49:1322–1326 2001

8.

Gabrielsen TOGreitz T: Normal size of the internal carotid, middle cerebral and anterior cerebral arteries. Acta Radiol Diagn 10:1101970Gabrielsen TO Greitz T: Normal size of the internal carotid middle cerebral and anterior cerebral arteries. Acta Radiol Diagn 10:1–10 1970

9.

Hijdra ABrouwers PJVermeulen Met al: Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke 21:115611611990Hijdra A Brouwers PJ Vermeulen M et al: Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke 21:1156–1161 1990

10.

The International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:172517331998The 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

11.

Kamath S: Observations on the length and diameter of vessels forming the circle of Willis. J Anat 133:4194231981Kamath S: Observations on the length and diameter of vessels forming the circle of Willis. J Anat 133:419–423 1981

12.

Kassell NFTorner JC: Size of intracranial aneurysms. Neurosurgery 12:2912971983Kassell NF Torner JC: Size of intracranial aneurysms. Neurosurgery 12:291–297 1983

13.

Kataoka KTaneda MAsai Tet al: Difference in nature of ruptured and unruptured cerebral aneurysms. Lancet 355:2032000 (Letter)Kataoka K Taneda M Asai T et al: Difference in nature of ruptured and unruptured cerebral aneurysms. Lancet 355:203 2000 (Letter)

14.

Kyriacou SKHumphrey JD: Influence of size, shape and properties on the mechanics of axisymmetric saccular aneurysms. J Biomech 29:101510221996Kyriacou SK Humphrey JD: Influence of size shape and properties on the mechanics of axisymmetric saccular aneurysms. J Biomech 29:1015–1022 1996

15.

Roos EJRinkel GJVelthuis BKet al: The relation between aneurysm size and outcome in patients with subarachnoid hemorrhage. Neurology 54:233423362000Roos EJ Rinkel GJ Velthuis BK et al: The relation between aneurysm size and outcome in patients with subarachnoid hemorrhage. Neurology 54:2334–2336 2000

16.

Smoker WRPrice MJKeyes WDet al: High-resolution computed tomography of the basilar artery: I. Normal size and position. AJNR 7:55601986Smoker 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

17.

Suzuki MKudo AOtawara Yet al: Extrinsic pathway of blood coagulation and thrombin in the cerebrospinal fluid after sub-arachnoid hemorrhage. Neurosurgery 44:4874941999Suzuki 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

18.

Wardlaw JMCannon JStatham PFet al: Does the size of intracranial aneurysms change with intracranial pressure? Observations based on color “power” transcranial Doppler ultrasound. J Neurosurg 88:8468501998Wardlaw 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

19.

Wiebers DOWhisnant JPSundt TM Jret al: The significance of unruptured intracranial saccular aneurysms. J Neurosurg 66:23291987Wiebers DO Whisnant JP Sundt TM Jr et al: The significance of unruptured intracranial saccular aneurysms. J Neurosurg 66:23–29 1987

20.

Yasui NMagarisawa SSuzuki Aet al: Subarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: a retrospective analysis of 25 cases. Neurosurgery 39:109611011996Yasui 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

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