Clinical features of the acute period of primary aneurysmal hemorrhage due to rupture of arterial aneurysms of the posterior circulation
Objective — to determine the clinical features of the hemorrhagic course of the primary aneurysmal hemorrhage in the acute period of the disease due to rupture of the arterial aneurysms of the posterior circulation.
Materials and methods. Arterial aneurysms of the posterior circulation with a hemorrhagic type of flow were observed in 338 patients. According to the results of the study, patients who had single aneurysmatic hemorrhages prevailed. There were 295 such patients (87.3 %) in the structure of the group of patients with hemorrhagic course of the disease. In other patients, the relapse course of the disease was observed. Single aneurysmal hemorrhages occurred in 295 cases. This group is represented by patients with acute and cold periods of aneurysmal hemorrhage. In the acute period of the disease 208 patients were treated with a single transferred aneurysmal hemorrhage due to rupture of arterial aneurysms of the posterior circulation. This study presents the characteristics of the main clinical manifestations of an acute period of aneurysmal hemorrhage due to rupture of posterior circulation arterial aneurysms.
Results. The analysis of the main clinical manifestations (headache, level of impaired consciousness, meningeal, cerebral symptoms, dysfunction of the cranial nerves, motor disorders, cerebellar symptoms, severity of the patient's condition) and X-ray anatomical (prevalence of subarachnoidal, ventricular hemorrhage, liquorodynamic violations, cererebral angiospasm and secondary ischemic brain damage characteristic of the acute period of a single primary aneurysmal hemorrhage due to the rupture of arterial aneurysms posterior circulanion.
Conclusions. Localization of aneurysms in the area of the main artery bifurcation, main artery — superior cerebellar artery, vertebral artery complex — posterior lower cerebellar artery, which in total is 78.7 % of cases of hemorrhagic disease, should be considered as the main causes of aneurysmal hemorrhage due to rupture of the posterior semicircle. In the presented group of patients, patients with saccular aneurysms convincingly prevail — 199 (95.7 %) cases. The main symptoms of arterial aneurysm rupture of the vertebro-basilar basin, the evaluation of which requires careful research and increased attention, are headache, level of impaired consciousness, meningeal, cerebral symptoms, dysfunction of the cranial nerves, motor impairment, and cerebellar symptoms. The determining components of treatment planning tactics and predicting the outcome of treatment are the severity of the patient’s condition, the prevalence of aneurysmal hemorrhage, the presence and spread of ventricular hemorrhage, the presence of liquorodynamic disorders, cerebral angiospasm, and secondary ischemic brain damage.
Bassi P, Bandera R, Loiero M, Tognoni G, Mangoni A. Warning signs in subarachnoid hemorrhage: a cooperative study. Acta Neurol Scand. 1991;84:277-81.
de Falco FA. Sentinel headache. Neurol Sci. 2004;25 (suppl 3):S215-7. doi: 10.1007/s10072-004-0289-1.
Polmear A. Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review. Cephalalgia. 2003;23:935-41.
Ohman J. Hypertens as a risk factor for epilepsy after aneurismal subarachnoid hemorrhage and surgery. Neurosurgery. 1990;27: 578-81.
Sundaram MB, Chow F. Seizures associated with spontaneous subarachnoid hemorrhage. Can J Neurol Sci. 1986;13:229-31. [PubMed].
Komotar RJ, Hahn DK, Kim GH, et al. The impact of microsurgical fenestration of the lamina terminalis on shunt-dependent hydrocephalus and vasospasm after an-eurysmal subarachnoid hemorrhage. Neurosurgery. 2008;62:123-32 ; discussion 32-4 [PubMed].
Little AS, Zabramski JM, Peterson M, et al. Ventriculoperitoneal shunting after aneurysmal subarachnoid hemorrhage: analysis of the indications, complications, and outcome with a focus on patients with borderline ventriculomegaly. Neurosurgery. 2008;62:618-27. [PubMed].
de Oliveira JG, Beck J, Setzer M, et al. Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling: a single-institution series and meta-analysis. Neurosurgery. 2007;61:924-33; discussion 33-4 [PubMed].
Mura J, Rojas-Zalazar D, Ruíz A, Vintimilla LC, Marengo JJ. Improved outcome in high-grade aneurysmal subarachnoid hemorrhage by enhancement of endogenous clearance of cisternal blood clots: a prospective study that demonstrates the role of lamina terminalis fenestration combined with modern microsurgical cisternal blood evacuation. Minim Invasive Neurosurg. 2007;50:355-62.
Kwon JH, Sung SK, Song YJ, et al. Predisposing factors related to shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc. 2008;43: 177-81. doi: 10.3340/jkns.2008.43.4.177. Hellingman CA, van den Bergh WM, Beijer IS, van Dijk GW, Algra A, van Gijn J, Rinkel GJ. Risk of rebleeding after treatment of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38:96-9. doi: 10.1161/01.
Rincon F, Gordon E, Starke RM, et al. Predictors of long-term shuntdependent hydrocephalus after aneurysmal subarachnoid hemorrhage: clinical article. J Neurosurg. 2010;113:774-80. doi: 10.3171/2010.2.JNS09376.
Chan M, Alaraj A, Calderon M, et al. Prediction of ventriculoperitoneal shunt dependency in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2009;110:44-9. [PubMed].
O’Kelly CJ, Kulkarni AV, Austin PC, Urbach D, Wallace MC. Shuntdependent hydrocephalus after aneurysmal subarachnoid hemorrhage: incidence, predictors, and revision rates: clinical article. J Neurosurg. 2009;111:1029-35. [PubMed].
Komotar RJ, Hahn DK, Kim GH, et al. Efficacy of lamina terminalis fenestration in reducing shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage: a systematic review: clinical article. J Neurosurg. 2009;111:147-54.
Jartti P, Karttunen A, Isokangas JM, et al. Chronic hydrocephalus after neurosurgical and endovascular treatment of ruptured intracranial aneurysms. Acta Radiol. 2008;49: 680-6. doi: 10.1080/02841850802050754.
Kowalski RG, Claassen J, Kreiter KT, et al. Initial misdiagnosis and outcome after subarachnoid hemorrhage. JAMA. 2004;291:866-9. doi:10.1001/ · jama.291.7.866.
This work is licensed under a Creative Commons Attribution 4.0 International License.