No abstract available.
Prognosis* ; Subarachnoid Hemorrhage, Traumatic*

No abstract available.
Subarachnoid Hemorrhage, Traumatic*

OBJECTIVE: Post-traumatic hydrocephalus is a complication of head injury and can present with several different clinical symptoms. However, the developing factors of post-traumatic hydrocephalus and treatment are still not well known. The authors design the study to focus on incidence, causing diseases and treatment of post-traumatic hydrocephalus. METHODS: The 789patients of traumatic head injury followed by admission treatment over 7days from Jan. 1997 to Dec. 2001, were divided shunt group and shunt free group. We analyzed age, sex, causing diseases, developing time of hydrocephalus and effects of shunt operation in post-traumatic hydrocephalus. RESULTS: The incidence of post-traumatic hydrocephalus for requiring shunt was 9.2% (64cases). Chronic hydrocephalus which developed after 14days of injury was higher incidence (51cases). We found following variables were significiantly related to shunt-dependent hydrocephalus: low GCS score at admission, initial CT finding of traumatic subarachnoid hemorrhage and intracerebral hemorrhage (including intraventricular hemorrhage). The effect of shunt operation was not related with the spinal pressure, but had statistically significant correlation with the response of lumbar drainage. CONCLUSION: We conclude that development of hydrocephalus after head trauma is related to low GCS score, intracerebral hemorrhage (including intraventricular hemorrhage) and subarachnoid hemorrhage. The effect of preoperative lumbar drainage has a significiant role in predicting the result of shunt operation in patient with post-traumatic hydrocephalus.
Cerebral Hemorrhage ; Craniocerebral Trauma ; Drainage ; Humans ; Hydrocephalus* ; Incidence ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic

Traumatic subarachnoid hemorrhage (tSAH) can be almost immediately fatal. However, sudden death due to tSAH caused by delayed aneurysmal rupture is very rare sequela of mild head trauma. We experienced a death case of a 47-year-old woman who had subarachnoid hemorrhage and intraventricular hemorrhage 3 days after head trauma. Delayed death after any kinds of trauma is important to forensic and legal aspects. Herein we report a case of fatal subarachnoid hemorrhage caused by delayed rupture of traumatic aneurysm.
Aneurysm ; Craniocerebral Trauma ; Death, Sudden ; Female ; Head ; Hemorrhage ; Humans ; Jurisprudence ; Middle Aged ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic

OBJECTIVE: The purpose of this study is to identify any differential point in computerized tomographic(CT) findings between aneurysmal subarachnoid hemorrhage(ASAH) and traumatic subarachnoid hemorrhage(TSAH), which sometimes make us not confident in differentiation. METHODS: CT of 142 ASAH and 82 TSAH patients over the last 2 years were retrospectively reviewed. We evaluated the thickness of SAH, the laterality of sylvian cisternal hemorrhage, the location, the number of involved cisterns, and the associated other lesions between two types of SAH. RESULTS: Suprasellar cisterns and sylvian cisterns were most prominently and frequently involved cisterns in ASAH but cortical sulci and sylvian cisterns were most frequently involved in TSAH. Intraventricular and intracerebral hemorrhage were frequently seen in ASAH. Thickness of SAH over 1 mm, bilateral sylvian SAH, multiple cisternal SAH were in favor of ASAH. The number of involved cisterns were more frequently seen in ASAH than in TSAH. In ASAH, bilateral sylvian hemorrhages were more frequently seen than in TSAH. Skull fracture, subdural hematoma, subgaleal hematoma, and hemorrhagic contusion were frequently associated with TSAH. CONCLUSION: As a result of our study, the authors conclude that when IVH, hydrocephalus, thick SAH>1 mm bilateral sylvian SAH, and multiple cisternal SAH are seen in CT, immediate angiography should be performed to rule out cerebral aneurysms whether associated with other traumatic lesions or not.
Aneurysm* ; Angiography ; Cerebral Hemorrhage ; Contusions ; Diagnosis, Differential ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Retrospective Studies ; Skull Fractures ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic*

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.
Aneurysm, Ruptured ; Angiography ; Brain Injuries* ; Contusions ; Diagnosis, Differential ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Retrospective Studies ; Rupture* ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic

PURPOSE: Rupture of pre-existing cerebral aneurysms has been reported as a cause of traumatic subarachnoid hemorrhage (TSAH). SAH due to rupture of pre-existing cerebral aneurysm is an important differential diagnosis in TSAH. Our study was aimed to assess whether a rupture in a pre-existing cerebral aneurysm could be predicted on the basis of the quantity and distribution pattern of hemorrhage on the initial computed tomography (CT). METHODS: 197 patients with TSAH were retrospectively studied between the years 2003 and 2008. We examined the age and sex of patients, mechanisms of injury, consciousness level at admission, and CT parameters including the distribution and quantity of SAH, localized blood clot, intraventricular hemorrhage, or hemorrhagic contusion and extra-axial hematoma. We compared the patients with nonaneurysmal TSAH to the patients with aneurysmal TSAH. RESULTS: 22(11.2%) patients with TSAH harbored pre-existing cerebral saccular aneurysms. The aneurysms were found in the patients with diffuse or anteriorly located blood in the basal cisterns(40.6%), unilateral sylvian fissure (16.7%), and anterior interhemispheric fissure(18.2%). But the aneurysm was not found in all patients with perimesencephalic hemorrhage, bilateral sylvian fissures, and convexities. TSAH with localized clot in the anterior interhemispheric or sylvian fissure (OR=5.924, p=0.005), or SAH completely filling any cistern or fissure (OR=3.148, p=0.034) was significantly associated with rupture of pre-existing cerebral aneurysm in logistic regression analysis. CONCLUSION: SAH in the basal cisterns extended into bilateral sylvian fissures and anterior interhemispheric fissure, and SAH in the unilteral sylvian fissure on initial CT could be predicted rupture of pre-existing cerebral aneurysm.
Aneurysm ; Consciousness ; Contusions ; Craniocerebral Trauma ; Diagnosis, Differential ; Head ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Logistic Models ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic ; Tomography, X-Ray Computed

Traumatic subarachnoid hemorrhage (T-SAH) is said to be typically occurred in a young, healthy, but intoxicated man who receives a minor blow, immediately collapses, and dies within minutes. Sixteen forensic cases of T-SAH were analysed in the point of time of collapse, blood alcohol level, injured site, vascular rupture sites, and sentenced servitude. Majority of the cases (12 cases) were autopsied in the department of Kyungpook National University. Two cases of National Institute of Scientific Investigation, South District Office and 1 case of Jeju National University were added. Autopsy was not done in one case. There were 14 male and 2 female victims. The peak age were their forties (7 cases) and under twenties (7 cases). The time of incident was most often at night. The survival time from the time of trauma until death indicates that 62.5% (10 victims) died immediately from the assault, 12.5% (2 victims) died within 30 minutes. Blood alcohol was detected in 11 cases (68.8%), and mean blood alcohol level was 0.16% (0.08-0.22%). The damage was generated to the facial region, especially around the jaw and below the ears (7 cases), and temporal areas (4 cases). Bleeding foci were detected in 7 cases; basilar artery (2 cases), left vertebral artery (2 cases), and right vertebral artery (3 cases). Meticulous autopsy techniques for identifying the vascular rupture sites are required. The author conclude that tremendous emphasis must be placed on the fact that fatal T-SAH can occur due to minor facial trauma and social campaign for alerting people to the danger of T-SAH is needed.
Autopsy ; Basilar Artery ; Death, Sudden ; Ear ; Female ; Gyeongsangbuk-do ; Hemorrhage ; Humans ; Jaw ; Male ; Rupture ; Subarachnoid Hemorrhage, Traumatic* ; Vertebral Artery

We present a case of angiographically confirmed transection of the cisternal segment of the anterior choroidal artery (AChA) associated with a severe head trauma in a 15-year old boy. The initial brain computed tomography scan revealed a diffuse subarachnoid hemorrhage (SAH) and pneumocephalus with multiple skull fractures. Subsequent cerebral angiography clearly demonstrated a complete transection of the AChA at its origin with a massive extravasation of contrast medium as a jet trajectory creating a plume. We speculate that severe blunt traumatic force stretched and tore the left AChA between the internal carotid artery and the optic tract. In a simulation of the patient's brain using a fresh-frozen male cadaver, the AChA is shown to be vulnerable to stretching injury as the ipsilateral optic tract is retracted. We conclude that the arterial injury like an AChA rupture should be considered in the differential diagnosis of severe traumatic SAH.
Angiography ; Arteries* ; Brain ; Cadaver ; Carotid Artery, Internal ; Cerebral Angiography ; Choroid* ; Craniocerebral Trauma ; Diagnosis, Differential ; Humans ; Male ; Pneumocephalus ; Rupture ; Skull Fractures ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic* ; Visual Pathways

Isolated traumatic pseudoaneurysms of the basilar artery are extremely rare but often fatal resulting in a mortality rate as high as 50%. A 51-year-old man presented with craniofacial injury after blunt trauma. A brain computed tomography (CT) scan showed thick basal subarachnoid hemorrhage associated with multiple craniofacial fractures, while CT angiography revealed contrast extravasation at the distal basilar artery with pseudoaneurysm formation. After this primary survey, the condition of the patient suddenly deteriorated. Conventional angiography confirmed the contrast extravasation resulted from pseudoaneurysm formation, which was successfully treated with endovascular coil embolization. Decompressive craniectomy and coma therapy with propofol were also performed. However, the patient died on the 7th hospital day because of the poor initial clinical condition. The current case is the first report of acute pseudoaneurysm rupture arising from the basilar artery within the first day after trauma. Our findings suggest the possibility that pseudoaneurysm rupture should be considered if brain CT shows thick traumatic subarachnoid hemorrhage on the basal cistern with a basal skull fracture.
Aneurysm, False* ; Angiography ; Basilar Artery* ; Brain ; Brain Injuries ; Coma ; Decompressive Craniectomy ; Embolization, Therapeutic ; Humans ; Middle Aged ; Mortality ; Propofol ; Rupture ; Skull Fractures ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic*