[Carotid aneurysm with intracerebral hematoma]

The rare intracerebral bleeding type among the aneurysms of the internal carotid artery occurs only in case of certain anatomical relations between the thin-walled part of the aneurysm and the cerebrum. Based on our observations, we differentiate between three types which are mainly determined by the intensity of the extravasation: 1. The acute form with decompensated intracerebral haematoma (possibly with ventricular haemorrhage). 2. The subacute form with intracerebral haematoma, the space-occupying growth of which, however, is still compensated for by central mechanisms. 3. The chronic form with small intermittent extravasations resulting in an enlargement of the aneurysm by thrombotic deposition. In intracerebral haematomas originating from cerebrovascular aneurysms, the haematoma will usually result in an aneurysm. The carotid aneurysm is an exception, since the aneurysm will be first, followed by the haematoma. A highly differentiated therapeutic approach must consider the different courses taken by the intracerebral haematomas, as shown in this article. It will have to be decided from case to case which approach is best, e.g. acute intervention or intensive medical attention to severe disease patterns before appropriate operation, or purely symptomatic conservative treatment.