Computerized tomography and angiography in subarachnoid haemorrhage

Area of Science:

• Neurosurgery
• Neuroradiology
• Vascular Neurology

Background:

• Multiple aneurysms present a complex clinical challenge.
• Subarachnoid hemorrhage (SAH) necessitates prompt diagnosis and management.
• The risk of bleeding from incidental aneurysms requires careful consideration.

Purpose of the Study:

• To evaluate the outcomes of patients with multiple aneurysms.
• To assess the utility of Computed Axial Tomography (CAT) in localizing the source of SAH.
• To determine the optimal management strategy for incidental aneurysms in the context of SAH.

Main Methods:

• Retrospective analysis of 100 patients with multiple aneurysms.
• Evaluation of 75 patients with SAH, assessing CAT scan accuracy for hemorrhage localization.
• Follow-up data collection averaging over seven years.

Main Results:

• 66% of patients with multiple aneurysms survived the initial danger period.
• CAT scans localized hemorrhage in 56 out of 75 SAH patients (75%), identifying aneurysms or arteriovenous malformations.
• CAT localization accuracy decreased significantly after the first week post-hemorrhage (86% within 7 days vs. 34% later).
• Only one subsequent death from an incidental aneurysm occurred during follow-up.

Conclusions:

• Conservative management or surgery for the ruptured aneurysm is effective for most patients.
• Treatment focused on the source of SAH is a reasonable approach, given the low risk of incidental aneurysm rupture.
• Extensive angiography beyond the site of hemorrhage is not routinely necessary unless dictated by surgical planning.