Bleeding patterns in ruptured posterior fossa aneurysms: a CT study

Computed tomography of the brains in 20 patients with acute rupture of posterior fossa aneurysms was reviewed and analyzed retrospectively. Findings were compared with those from 44 cases described in the literature and with the findings in ruptured supratentorial aneurysms. Extravasated blood was observed in 19 of 20 patients (95%); intraventricular hemorrhage (IVH) in 17 of 20 (85%); and subarachnoid hemorrhage (SAH) in 13 of 20 (65%). These values were significantly higher than those previously reported and suggest that, during the acute phase of rupture, extravasated blood may be detected with the same frequency in either infratentorial or supratentorial ruptured aneurysms. Subarachnoid hemorrhage was accompanied by IVH, prominent in the fourth ventricle and without intraparenchymal hematoma, in 11 patients (55%). This pattern is highly suggestive of ruptured posterior fossa aneurysms. Intraventricular hemorrhage without SAH was noted in five patients (25%) and specifically represented ruptured posterior inferior cerebellar artery aneurysms. Subarachnoid hemorrhage without IVH was noted in only two patients (10%).