title: Simultaneous or Early Sequential Rupture of Multiple Intracranial Aneurysms: A Rare and Insufficiently Understood Entity.
abstract: BACKGROUND
  Simultaneous or early sequential rupture of multiple intracranial aneurysms (MIAs) is encountered rarely, with no more than 10 cases having been reported. As a result of its rarity, there are a lot of questions concerning this entity need to be answered.
  
  
  METHODS
  A 67-year-old woman was admitted to the First Hospital of Jilin University (Eastern Division) from a local hospital after a sudden onset of severe headache, nausea, and vomiting. Head computed tomography (CT) at the local hospital revealed diffuse subarachnoid hemorrhage (SAH) that was concentrated predominately in the suprasellar cistern and interhemispheric fissure. During her transfer to our hospital, she experienced another episode of sudden headache. CT on admission to our hospital revealed that the SAH was increased with 2 isolated hematomas both in the interhemispheric fissure and the left paramedian frontal lobe. Further CT angiography and intraoperative findings were in favor of early sequential rupture of 2 intracranial aneurysms. To further elucidate the characteristics, mechanism, management, and prognosis of this specific entity, we conducted a comprehensive review of the literature.
  
  
  CONCLUSIONS
  The mechanism of simultaneous or early sequential rupture of MIAs is still obscure. Transient elevation of blood pressure might play a role in the process, and preventing the sudden elevation of blood pressure might be beneficial for patients with aneurysmal SAH and MIAs. The management of simultaneously or early sequentially ruptured aneurysms is more complex for its difficulty in responsible aneurysm determination, urgency in treatment, toughness in intraoperative manipulation and poorness in prognosis.
authors.affiliation: The First Hospital of Jilin University, Changchun, People's Republic of China.
authors.forename: Kun
authors.initials: K
authors.lastname: Hou
authors.affiliation: The First Hospital of Jilin University, Changchun, People's Republic of China.
authors.forename: Jinchuan
authors.initials: J
authors.lastname: Zhao
authors.affiliation: The First Hospital of Jilin University, Changchun, People's Republic of China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: The First Hospital of Jilin University, Changchun, People's Republic of China.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Zhu
authors.affiliation: The First Hospital of Jilin University, Changchun, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: The First Hospital of Jilin University, Changchun, People's Republic of China. Electronic address: gretchen666@yeah.net.
authors.forename: Guichen
authors.initials: G
authors.lastname: Li
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D019723:Endoscopes; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009666:Nose / Q000601:surgery
keywords: Aneurysmal subarachnoid hemorrhage; Early sequential aneurysm rupture; Multiple intracranial aneurysms; Simultaneous aneurysm rupture