title: Hyperacute cerebral aneurysm rerupture during CT angiography.
abstract: OBJECTIVE
  The object of this study was to identify the clinical features and outcomes of a subgroup of patients with aneurysmal subarachnoid hemorrhage (SAH) who had active contrast extravasation from a ruptured aneurysm during initial cerebral CT angiography (CTA).
  
  
  METHODS
  The authors performed a retrospective study of spontaneous SAH cases involving patients treated at their institute. They identified 9 cases in which active contrast extravasation was evident on the initial CT angiogram. Another 12 similar cases were also identified in a literature review and data was gathered from these cases to evaluate the outcomes.
  
  
  RESULTS
  Analysis of all 21 cases revealed that the overall outcomes in cases characterized by active aneurysmal bleeding during CTA were poor. Seventy-six percent of patients had unfavorable results. Patients who showed poor neurological status at presentation died no matter what kind of treatment they received. In contrast, patients who presented with good neurological status initially had a chance of favorable outcome. Among the patients with good initial neurological status, most demonstrated rapid deterioration of their condition during the CTA examination; only those who received immediate and effective decompressive surgery and aneurysm obliteration had good results.
  
  
  CONCLUSIONS
  Active aneurysmal rebleeding during CTA is an uncommon but devastating event. Though the mortality of this distinct group of patients remains high, a clinical subgroup may benefit from immediate surgery. Patients with good initial neurological status who show rapid neurological deterioration may still have a favorable outcome if they undergo timely and successful decompressive surgery and proper aneurysm obliteration. Patients who present with poor neurological status do badly, and there is no effective treatment for such patients.
authors.affiliation: Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
authors.forename: Fon-Yih
authors.initials: FY
authors.lastname: Tsuang
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Su
authors.forename: Jo-Yu
authors.initials: JY
authors.lastname: Chen
authors.forename: Jing-Er
authors.initials: JE
authors.lastname: Lee
authors.forename: Dar-Ming
authors.initials: DM
authors.lastname: Lai
authors.forename: Yong-Kwang
authors.initials: YK
authors.lastname: Tu
authors.forename: Kuo-Chuan
authors.initials: KC
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D002533:Cerebral Angiography; D003287:Contrast Media / Q000008:administration & dosage; D003399:Craniotomy; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging*; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide