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[CT scan in ruptured intracranial aneurysm--comparative studies of initial bleeding and rebleeding]
Insights
Initial bleeding from ruptured aneurysms shows diffuse high density on CT scans. Rebleeding cases exhibit varied CT patterns, with increased risk of intracerebral hemorrhage.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Ruptured intracranial aneurysms are a leading cause of subarachnoid hemorrhage.
- Distinguishing initial bleeding from rebleeding is crucial for patient management.
- Computed Tomography (CT) is a primary diagnostic tool for intracranial hemorrhage.
Purpose of the Study:
- To investigate the differences in CT findings between initial bleeding and rebleeding in patients with ruptured intracranial aneurysms.
- To correlate CT findings with the timing of bleeding events and the presence of secondary hemorrhages.
Main Methods:
- A retrospective study of 120 patients with ruptured cerebral aneurysms.
- CT examinations performed within two weeks of bleeding.
- Classification of subarachnoid hemorrhage on CT into Diffuse high, Localized high, and Iso or Low types based on basal cistern findings.
Main Results:
- Initial bleeding within 24 hours showed Diffuse high density in 96% of cases.
- Rebleeding cases presented varied CT patterns: 50% Diffuse high, 25% Localized high, 25% Iso or Low.
- Incidence of intracerebral and/or ventricular hemorrhage was significantly higher in rebleeding (59%) compared to initial bleeding (18%).
Conclusions:
- CT findings differ significantly between initial and rebleeding aneurysmal subarachnoid hemorrhage.
- The timing of CT scan after bleeding influences the observed patterns.
- Rebleeding is associated with a higher risk of secondary intracerebral and ventricular hemorrhage.
Abstract:
The differences between initial bleeding and rebleeding due to ruptured intracranial aneurysm was investigated by CT. The study included 120 cases of ruptured cerebral aneurysm; 71 cases had only one bleeding and 49 cases had rebleeding. All the cases underwent CT examinations within 2 weeks following bleeding. Subarachnoid hemorrhages were classified into three groups according to the CT findings: Diffuse high type--high density areas in the entire basal cistern; Localized high type--high density area in a restricted part of the basal cistern; and Iso or Low type--no high density areas in the basal cistern. CT scans done within 24 hours following initial bleeding showed Diffuse high type in 96% of the cases and Localized high type in 4%. On the other hand, in rebleeding cases, Diffuse high type was 50%, Localized high type 25% and Iso or Low type 25%. In rebleeding cases within three days following initial bleeding, Diffuse high type was 90% and Iso or Low type 10%. However, between day 4 and day 14, Diffuse high type was 14%, Localized high type 42% and Iso or Low type 42%. After day 15, Diffuse high type was 36%, Localized type 36% and Iso or Low type 28%. Intracerebral hematoma and/or ventricular hemorrhage secondary to ruptured aneurysms were also investigated. Following initial bleeding, 18% of cases showed intracerebral and/or ventricular hemorrhage, however, the incidence increased up to 59% in rebleeding cases.(ABSTRACT TRUNCATED AT 250 WORDS)