[Review of cases of ruptured cerebral aneurysm with a history of examination at our institution prior to the diagnosis of subarachnoid hemorrhage--in order to improve treatment outcome in patients with intracranial aneurysms].
There were 78 patients who had been examined at our institution prior to the diagnosis of subarachnoid hemorrhage (SAH) among the 1114 patients with ruptured aneurysm stet between April 1974 and March 1992. Among these 78 cases these were 35 patients who might have been treated at an earlier stage, i.e., 26 patients in which the diagnosis was made belatedly and 9 patients in which an unruptured aneurysm was missed. All 26 patients with belatedly diagnosed SAH had headache without neck stiffness or neurological deficits and thus were Hunt and Kosnic grade 1-2 while 25 cases were categorized so called "minor leak". The causes in 6 of the 7 patients with poor outcome was rerupture or vasospasm due to delay in the diagnosis of SAH. Because the diagnosis of mild SAH is not always easy, it is important to take a careful medical history. MRI or lumbar puncture should be performed when SAH is suspected from the history, even if CT shows no evidence of SAH. The cause of failure to diagnose unruptured aneurysms, in addition to misreading was blood vessel overlapping as a result of non-selective angiography, poor contrast, etc. Angiography should be performed selectively and the inclusion of oblique, magnified, stereoscopic, and other imaging techniques is advisable, if an unruptured aneurysm is suspected, and angiographic follow-up is necessary when an ruptured aneurysm is uncertain.
Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita, Japan.
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S
Magarisawa
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Suzuki
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N
Yasui
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D016896:Treatment Outcome