Rebleeding of ruptured cerebral aneurysms during three-dimensional computed tomographic angiography: report of two cases and literature review.
Although three-dimensional computed tomographic angiography (3D-CTA) is less complicated and time-consuming than conventional cerebral angiography (CCA) and represents a reliable alternative for evaluating cerebral aneurysms, some patients experience aneurysmal rerupture during 3D-CTA. Two women, 79 and 71 years old, who presented with severe subarachnoid hemorrhage (SAH) underwent 3D-CTA within 3 h after SAH onset. Their images clearly indicated extravasation from their aneurysms. Neither patient recovered from deep coma, and both died within 2 days. We reviewed the literature with special reference to the condition of SAH patients at admission and the interval between SAH onset and 3D-CTA, and discuss serious complications of 3D-CTA study. Although aneurysmal rerupture may reflect the natural course, rerupture during 3D-CTA, especially in SAH patients who are in poor clinical condition during the acute stage, should be recognized as a potentially fatal complication. Their blood pressure must be strictly controlled and factors such as their clinical condition and the interval from the ictus must be considered.
Hashiguchi
Akihito
A
Division of Neurosurgery, Shinbeppu Hospital, Beppu-City, Oita 874-0833, Japan. akihitohash@shinbeppu-hosp.jp
Mimata
Chikara
C
Ichimura
Homare
H
Morioka
Motohiro
M
Kuratsu
Jun-ichi
J
D000368:Aged; D017542:Aneurysm, Ruptured / Q000209:etiology*; D002533:Cerebral Angiography / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000009:adverse effects*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*