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22 February 2002

Clinical signs pointing to the source of hemorrhage in multiple intracranial aneurysms.

Zbigniew Pawlik, Edward Zderkiewicz, Marian Czochra, Arkadiusz Tabora

Med Sci Monit 2002; 8(2): CR83-86 :: ID: 420936

Abstract

BACKGROUND: In multiple aneurysms of cerebral vessels it is essential tocorrectly identify the aneurysm that has caused the hemorrhage, since it must be operated first. On thebasis of our own material, we have evaluated the usefulness of various clinical signs and examinationsin diagnosing which of several aneurysms was the cause of an intracranial hemorrhage. MATERIAL/METHODS:The material consisted of 163 patients with a total of 391 aneurysms. Diagnosis was based on panangiographyand neurological examinations in all cases and CT in the majority. RESULTS: All the diagnostic examinationsin question (neurological, angiography, CT and intraoperative evaluation) enabled a correct diagnosisin 72.6% of cases. In CT scanning, diagnostic value diminishes with time. Intracerebral hematoma is themost persistent sign. The highest rupture index involved aneurysms localized on the anterior communicatingartery, while those on the internal carotid artery ranked second. Four patients in whom intraoperativeevaluation showed that the order in which the aneurysms were treated surgically was erroneous died asthe result of rebleeding that occurred prior to planned follow-up surgery. CONCLUSIONS: It is vitallyimportant for outcome to determine which of several aneurysms has ruptured, since errors in the sequencingof surgical repair significantly increase mortality due to rebleeding preceding the next stage of surgery.When diagnosing the source of a hemorrhage one should take into account neurological findings, angiography,EEG, CT, MRI, and the location of the aneurysms.

Keywords: Adolescent, Cerebral Hemorrhage, Child, intracranial aneurysm

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750