Prediction of Rupture of Pre-existing Cerebral Aneurysm by CT Findings in Patients with Traumatic Brain Injury.
- Author:
Yong Oh KIM
1
;
Gab Teog KIM
;
Han Ju CHOI
Author Information
1. Department of Emergency Medicine, College of Medicine, Dankook University, Chunan, Korea. gtkim@dankook.ac.kr
- Publication Type:Original Article
- Keywords:
Subarachnoid hemorrhage;
Traumatic;
Computed tomography;
Intracranial aneurysm
- MeSH:
Aneurysm, Ruptured;
Angiography;
Brain Injuries*;
Contusions;
Diagnosis, Differential;
Hematoma;
Hematoma, Subdural;
Hemorrhage;
Humans;
Intracranial Aneurysm*;
Retrospective Studies;
Rupture*;
Subarachnoid Hemorrhage;
Subarachnoid Hemorrhage, Traumatic
- From:Journal of the Korean Society of Emergency Medicine
2014;25(5):602-610
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Rupture of pre-existing cerebral aneurysms has occasionally been reported as a cause of traumatic subarachnoid hemorrhage (TSAH) and intraparenchymal hemorrhage (IPH). SAH due to rupture of pre-existing cerebral aneurysm is an important differential diagnosis in TSAH. The aim of our study was to determine whether a rupture in a pre-existing cerebral aneurysm could be predicted based on the pattern of hemorrhage on the initial computed tomography (CT) scan in patients with traumatic brain injury (TBI). METHODS: A total of 336 patients who had undergone computed tomography angiography (CTA) for detection of rupture of pre-existing cerebral aneurysm in TBI between the years 2004 and 2013 were retrospectively studied. In order to investigate CT findings of ruptured cerebral aneurysm, patients who had a lesion of SAH, IPH, or IVH were compared with the control group (who had intracranial lesions of contusion, epidural hematoma, subdural hematoma, or hemorrhagic contusion). RESULTS: Fifty eight (17.3%) patients with TSAH harbored cerebral aneurysms, and 45 (13.4%) patients had ruptured cerebral aneurysms. The ruptured aneurysms showed significant association with CT findings of a diffuse hemorrhage in the basal cisterns (29.2%, p=0.003, OR=23.130), unilateral sylvian fissure (13.8%, p=0.039, OR=8.842), anterior interhemispheric fissure (20.0%, p=0.028, OR=14.000), and associated IPH (22.6%, p=0.011, OR=16.333). However, the ruptured aneurysms did not show association with CT findings of hemorrhage on convexities, perimesencephalic cisterns, bilateral sylvian fissure, and IVH (p>0.1). CONCLUSION: Patterns of distribution of SAH and associated IPH on initial CT can be predicted of rupture pre-existing cerebral aneurysm in patients with TBI.
