Ruptured aneurysm

Hemorrhagic (excessive bleeding from a ruptured blood vessel e.g., ruptured aneurysm)... 

Approximately 85% of spontaneous SAHs are caused by ruptured aneurysm 10% are perimesencephalic and the remainder are caused by rare disorders (van Gijn and Rinkel 2001). The pattern of bleeding on CT is a clue to the underlying cause. Blood in the interhemispheric fissure suggests an anterior communicating artery aneurysm and in the sylvian fissure suggests internal carotid artery or middle cerebral artery aneurysm (Fig. 30.1). 

Pinto AN, Ferro JM, Canhao P et al. (1993). How often is a perimesencephalic subarachnoid haemorrhage CT pattern caused by ruptured aneurysms Acta Neurochirurgie 124 79-81... 

Wermer MJ, Kool H, Albrecht KW et al. (2007). Aneurysm Screening after Treatment for Ruptured Aneurysms Study Group. Subarachnoid hemorrhage treated with clipping long-term effects on employment, relationships, personality and mood. Neurosurgery 60 91-97... 

Spontaneous rupture of a retroperitoneal aneurysm occurred in a 70-year-old woman who had been taking phentermine hydrochloride, 30 mg/day, for about 1 month (6). Other long-term medications included fluoxetine and amitriptyline, and she had no history of coronary artery disease, hypertension, diabetes, or complications of pregnancy. Although it is plausible that phentermine could have contributed to the ruptured aneurysm, other possibilities should be considered, particularly rupture of an anomalous retroperitoneal blood vessel. 

After 7 days of antibiotic therapy with intravenous vancomycin, gentamicin, and ticarciUin + clavulanate for Pseudomonas aeruginosa and S. aureus sepsis, confluent erythematous-based vesicobuUae developed in a 65-year-old woman with subarachnoid hemorrhage secondary to a ruptured aneurysm (72). Other medications included ranitidine, glyceryl trinitrate, nimodipine, ferrous sulfate, and phenjrtoin. 

Even at the age of 90 Sumio Umezawa was active and full of energy. He presided at a March 2000 Council meeting of the Microbial Chemistiy Research Foundation (MCRF), but two days later, in the early morning of March 30, he suddenly passed away as the result of a ruptured aneurysm. He had been a fixture on the Japanese scientific scene for so long that his co-workers felt that his presence would continue indefinitely. 

In rare cases, dissecting or rupturing aneurysms of the retroperitoneal vessels may cause right lower quadrant pain. 

Fig. 25.4. Oblique coronal volume-rendered multi-detector row CT angiogram of a ruptured aneurysm (white asterisk) of the abdominal aorta in a patient suffering from acute abdomen. Demonstration of the extensive retroperitoneal hemorrhage (arrows)...

Natural History of Ruptured Aneurysms and Patient Outcome 180 ... 

The first treatment option in ruptured aneurysms should be via the endovascular route if judged feasible by the neurointerventionalist Wide necked aneurysms are less prone to rupture compared to small necked aneurysms First degree relatives of patients with SAH have a much higher risk of harbouring an aneurysm compared to the normal population... 

The high morbidity and mortality in patients with ruptured aneurysms prompted interest in repair of aneurysms that are diagnosed before they have ruptured. Following publication of the initial results of the International Study of Unruptured Intracranial Aneurysms (ISUIA 1998), enthusiasm for this strategy was markedly reduced. In this study patients were classified in those with no history and those with history of SAH. The risk posed by unruptured aneurysms was reported lower than had been previously expected and also morbidity and mortality to treat aneurysms were higher than had previously been reported. The updated results of the same group analysed 6544 patients years of prospective follow up of untreated aneurysms, 1692 had no treatment, 1917 had surgical repair and 451 had their unruptured aneurysm coiled. The cut off... 

In a study analyzing 219 patients with ruptured aneurysms, Mayfrank et al. (2001) reported increased mortality and unfavourable outcome in patients with additional moderate and severe intraventricular hemorrhage, indicating that severity of intraventricular hemorrhage is an independent predictor of mortality and functional outcome. 

Aneurysms of the posterior circulation account for about 15% of all intracranial aneurysms saccular aneurysms and those of the basilar tip are the most frequent accounting for 5%-8% of all intracranial aneurysms. Ruptured aneurysms in the posterior circulation have a worse prognosis than patients with a ruptured aneurysm in another location (Schievink et al. 1995) and early rerupture occurs more often in this location. Despite improvement in microsurgi-cal therapy, clipping for posterior circulation aneurysms remains challenging. The main problems are the deep location, the presence of many eloquent... 

Atherosclerotic vascular disease is more frequent in elderly patients and may be associated with more tortuous vessel anatomy. Superselective catheterizations of distal cerebral vessels might thus become technically more difficult. Atherosclerotic carotid bifurcation disease is frequently associated in patients with advanced age and might increase the risk of thromboembolic complications. In selected cases, a combined approach, first stenting of the carotid artery stenosis and subsequently coil embolization of the ruptured aneurysm might be a therapeutic option. 

Le Roux PD, Winn HR (1998) Management of the ruptured aneurysm. Neurosurg Clin North Am 9 525-540... 

Raymond J, Roy D (1997) Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41 1235-1245 discussion 1245-1246... 

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