title: Intracerebral Hematoma Due to Aneurysm Rupture: Are There Risk Factors Beyond Aneurysm Location?
abstract: Along with subarachnoid hemorrhage (SAH), a ruptured aneurysm may also cause an intracerebral hematoma (ICH), which negatively impacts the functional outcome of SAH.
  
  
  
  To identify independent risk factors of aneurysmal ICH.
  
  
  
  Six hundred thirty-two consecutive patients with aneurysmal SAH treated at our institution from January 2005 to December 2012 were eligible for this study. Demographic parameters and preexisting comorbidities of patients, as well as various clinical and radiographic characteristics of SAH were correlated with the incidence and volume of aneurysmal ICH.
  
  
  
  One hundred fifty-five patients (25%) had ICH on initial computed tomography with a mean volume of 26.7 mL (±26.8 mL). Occurrence and volume of ICH were associated with the location (distal anterior or middle cerebral artery >proximal anterior cerebral or internal carotid artery >posterior circulation, P < .001/P < .001) and size (>12 mm, P = .026/P < .001) of the ruptured aneurysm. Vascular risk factors independently increased the risk of ICH as well (arterial hypertension: odds ratio [OR] = 1.62, P = .032; diabetes mellitus: OR = 3.06, P = .009), while the use of aspirin (P = .037) correlated with the volume of ICH. The predictors of ICH were included into a risk score (0-9 points) that strongly predicted the occurrence of ICH (P = .01). Poor functional outcome after SAH was independently associated with the occurrence of ICH (P = .003, OR = 2.77) and its volume (P = .001, OR = 1.07 per-mL-increase).
  
  
  
  Aneurysmal ICH is strongly associated with poorer functional outcome and seems to be predictable even before the bleeding event. The proposed risk factors for aneurysmal ICH require further validation and may be considered for treatment decisions regarding unruptured intracranial aneurysms.
  
  
  
  ACA, anterior cerebral arteryDHC, decompressive hemicraniectomyEVD, external ventricular drainageICA, internal carotid arteryICH, intracerebral hematomaMCA, middle cerebral arterymRS, modified Rankin scalePC, posterior circulationSAH, subarachnoid hemorrhageSIRS, systemic inflammatory response syndromeTCD, transcranial Doppler sonography.
authors.affiliation: *Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany; ‡Department of Neurosurgery, University Hospital Essen, Essen, Germany; §Department of Neurology, University Medical Center Freiburg, Freiburg, Germany; ‖Institute for Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany; ¶Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Jabbarli
authors.forename: Matthias
authors.initials: M
authors.lastname: Reinhard
authors.forename: Roland
authors.initials: R
authors.lastname: Roelz
authors.forename: Mukesch
authors.initials: M
authors.lastname: Shah
authors.forename: Wolf-Dirk
authors.initials: WD
authors.lastname: Niesen
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaier
authors.forename: Christian
authors.initials: C
authors.lastname: Taschner
authors.forename: Astrid
authors.initials: A
authors.lastname: Weyerbrock
authors.forename: Vera
authors.initials: V
authors.lastname: Van Velthoven
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000150:complications*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D055815:Young Adult