Introduction: It is known that the clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) accompanying intracerebral hematoma (ICH) are unfavorable. In this study, we focused on rupture of anterior communicating artery (AcomA) aneurysm to investigate the association between ICH and cinical outcomes.
Methods: A retrospective study identified 76 patients, who presented from 2008 to 2012 with ruptured AcomA aneurysm. The SAH and ICH were identified by computed tomography, and the diagnosis for AcomA aneurysm was rendered by angiography. An early endovascular embolization is our first choice for ruptured AcomA aneurysms. Aneurysms, which are unsuitable for embolization, are treated by clipping. Radiological findings, clinical course and outcomes were analyzed.
Results: Twenty-three patients (30.3%) revealed SAH accompanying ICH. The hematomas were located in the septum pellucidum (SP) in 8 cases, the rectal gyrus (RG) in 8 cases, the interhemispheric fissure (IH) in 4 cases, the corpus callosum (CC) in 2 cases, the frontal lobe (FL) in 2 cases, the sylvian fissure (SF) in 1 case, and the basal ganglia (BG) in 1 case. The clinical outcomes at 3 months were favorable (modified Rankin scale [mRS] 0-2) for 61 patients and unfavorable (mRS 3-6) for 15 patients. A logistic regression analysis predicted the following independent risk factors for unfavorable outcomes: ICH (OR 12.134; 95%CI 1.453-89.114; p=0.019) and age > 75 (OR 16.282; 95%CI 2.153-350.398; p=0.005). The number of cases with unfavorable outcomes was 8 of 14 cases in the midline hematoma group (SP, IH and CC), and 1 of 9 cases in the lateral hematoma group (LG, FL, BG and SF), which was significantly different between 2 groups (p=0.039). The number of cases with unfavorable outcomes did not differ between the group with hematoma volume over 10 ml and the group with hematoma volume under 10 ml (p=0.34).
Conclusions: Intracerebral hematoma was one of the independent risk factors for unfavorable outcomes after rupture of AcomA aneurysms. The localization of the hematoma, not the volume of the hematoma, was associated with unfavorable outcomes.
Patient Care: We can predict the clinical outcomes of the cases with ruptured anterior communicating artery aneurysm based on the findings of initial computed tomography.
Learning Objectives: The localization of the hematoma, not the volume of the hematoma, was associated with unfavorable outcomes.