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Basilar Artery Bifurcation Aneurysm: Spontaneous SAH and Recurrent Aneurysm Rupture During Computed Tomography Angiography

  • Georg GihrEmail author
  • Franziska Dorn
  • Hans Henkes
Living reference work entry
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Abstract

A 70-year-old female patient experienced a spontaneous subarachnoid hemorrhage (SAH) due to the rupture of an irregular-shaped saccular aneurysm of the basilar artery (BA) bifurcation. Upon admission, her condition was equivalent to Hunt and Hess III with a Fisher grade of IV. During computed tomography angiography (CTA) with IV contrast medium infusion, her clinical condition deteriorated. CTA revealed a ruptured BA bifurcation aneurysm and massive contrast medium extravasation into the subarachnoid space due to the re-rupture of said aneurysm. A ventricular drain was inserted, and the aneurysm was occluded with coils as an emergency procedure. Severe posthemorrhagic vasospasm occurred during the further course, and the patient suffered multiple hemispheric infarctions and eventually passed away. Recently, more and more cases of early aneurysm re-rupture during CTA have been described in the literature. Whether this is a matter of a mere coincidence or related to the general circumstances or even CTA-induced is a matter of controversy. Whether CTA has to be regarded as a risk factor for early aneurysm re-rupture is not yet known. Early aneurysm re-rupture during CTA is the main topic of this chapter.

Keywords

Basilar artery bifurcation aneurysm Computed tomography angiography, CTA Risk of re-rupture Coil occlusion Clipping AcomA aneurysm Vasospasm 

References

  1. Broderick JP, Brott TG, Duldner JE, Tomsick T, Leach A. Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke. 1994;25(7):1342–7.CrossRefGoogle Scholar
  2. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711–37.  https://doi.org/10.1161/STR.0b013e3182587839.CrossRefPubMedGoogle Scholar
  3. Desai S, Friedman JA, Hlavin J, Kash F. Actively bleeding intracranial aneurysm demonstrated by CT angiography. Clin Neurol Neurosurg. 2009;111(1):94–6.  https://doi.org/10.1016/j.clineuro.2008.07.013.CrossRefPubMedGoogle Scholar
  4. Dmytriw AA, Martinez JL, Spears J, Marotta TR. Cerebral aneurysm debuting as rupture during diagnostic CT angiography: an unexpected worst-case scenario. Neuroradiol J. 2016;29(3):216–8.  https://doi.org/10.1177/1971400916638357.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Koike T, Tanaka R. Ultra-early rebleeding in spontaneous subarachnoid hemorrhage. J Neurosurg. 1996;84(1):35–42.  https://doi.org/10.3171/jns.1996.84.1.0035.CrossRefPubMedGoogle Scholar
  6. Gosselin MV, Vieco PT. Active hemorrhage of intracranial aneurysms: diagnosis by CT angiography. J Comput Assist Tomogr. 1997;21(1):22–4.CrossRefGoogle Scholar
  7. Hashiguchi A, Mimata C, Ichimura H, Morioka M, Kuratsu JI. Rebleeding of ruptured cerebral aneurysms during three-dimensional computed tomographic angiography: report of two cases and literature review. Neurosurg Rev. 2007;30(2):151–4.  https://doi.org/10.1007/s10143-007-0068-6.CrossRefPubMedGoogle Scholar
  8. Hassan MF, Mahmood S, Dhamija B, Chandran H, Whitfield PC, Adams W. An association between cerebral aneurysm re-bleed and CT angiography – more than a coincidence? Br J Neurosurg. 2011;25(6):734–5.  https://doi.org/10.3109/02688697.2011.584984.CrossRefPubMedGoogle Scholar
  9. Holodny AI, Farkas J, Schlenk R, Maniker A. Demonstration of an actively bleeding aneurysm by CT angiography. Am J Neuroradiol. 2003;24(5):962–4.PubMedGoogle Scholar
  10. Im SH, Oh CW, Hong SK, Kwon OK, Kim SH. CT angiography demonstration of the development of intraventricular hemorrhage during aneurysm rupture. Clin Neurol Neurosurg. 2007;109(3):299–301.  https://doi.org/10.1016/j.clineuro.2006.11.008.CrossRefPubMedGoogle Scholar
  11. Inagawa T. Ultra-early rebleeding within six hours after aneurysmal rupture. Surg Neurol. 1994;42(2):130–4.CrossRefGoogle Scholar
  12. Josephson SA, Dillon WP, Dowd CF, Malek R, Lawton MT, Smith WS. Continuous bleeding from a basilar terminus aneurysm imaged with CT angiography and conventional angiography. Neurocrit Care. 2004;1(1):103–6.  https://doi.org/10.1385/NCC:1:1:103.CrossRefPubMedGoogle Scholar
  13. Kobata H, Sugie A, Yoritsune E, Miyata T, Toho T. Intracranial extravasation of contrast medium during diagnostic CT angiography in the initial evaluation of subarachnoid hemorrhage: report of 16 cases and review of the literature. Springerplus. 2013;28(2):413.  https://doi.org/10.1186/2193-1801-2-413.CrossRefGoogle Scholar
  14. Kusumi M, Yamada M, Kitahara T, Endo M, Kan S, Iida H, Sagiuchi T, Fujii K. Rerupture of cerebral aneurysms during angiography – a retrospective study of 13 patients with subarachnoid hemorrhage. Acta Neurochir. 2005;147(8):831–7.  https://doi.org/10.1007/s00701-005-005-0541-3.CrossRefPubMedGoogle Scholar
  15. Li Q, Lv F, Li Y, Luo T, Li K, Xie P. Evaluation of 64-section CT angiography for detection and treatment planning of intracranial aneurysms by using DSA and surgical findings. Radiology. 2009;252(3):808–15.  https://doi.org/10.1148/radiol.2523081911.CrossRefPubMedGoogle Scholar
  16. Limbruno U, De Caterina R. Vasomotor effects of iodinated contrast media: just side effects? Curr Vasc Pharmacol. 2003;1(3):321–8.CrossRefGoogle Scholar
  17. Morcos SK, Dawson P, Pearson JD, Jeremy JY, Davenport AP, Yates MS, Tirone P, Cipolla P, de Haen C, Muschick P, Krause W, Refsum H, Emery CJ, Liss P, Nygren A, Haylor J, Pugh ND, Karlsson JO. The haemodynamic effects of iodinated water soluble radiographic contrast media: a review. Eur J Radiol. 1998;29(1):31–46.CrossRefGoogle Scholar
  18. Nagai M, Koizumi Y, Tsukue J, Watanabe E. A case of extravasation from a cerebral aneurysm during 3-dimensional computed tomography angiography. Surg Neurol. 2008;69(4):411–3.  https://doi.org/10.1016/j.surneu.2007.02.048.CrossRefPubMedGoogle Scholar
  19. Nakada M, Akaike S, Futami K. Rupture of an aneurysm during three-dimensional computerized tomography angiography. J Neurosurg. 2000;93(5):900.  https://doi.org/10.3171/jns.2000.93.5.0900.CrossRefPubMedGoogle Scholar
  20. Nakatsuka M, Mizuno S, Uchida A. Extravasation on three-dimensional CT angiography in patients with acute subarachnoid hemorrhage and ruptured aneurysm. Neuroradiology. 2002;44(1):25–30.CrossRefGoogle Scholar
  21. Papke K, Kuhl CK, Fruth M, Haupt C, Schlunz-Hendann M, Sauner D, Fiebich M, Bani A, Brassel F. Intracranial aneurysms: role of multidetector CT angiography in diagnosis and endovascular therapy planning. Radiology. 2007;244(2):532–40.  https://doi.org/10.1148/radiol.2442060394.CrossRefPubMedGoogle Scholar
  22. Perez-Nunez A, Alen JF, Ramos A, Millan JM. Aneurysm re-rupture during computed tomography angiography. Acta Radiol. 2006;47(4):419–21.CrossRefGoogle Scholar
  23. Ryu CW, Kim SJ, Lee DH, Suh DC, Kwun BD. Extravasation of intracranial aneurysm during computed tomography angiography: mimicking a blood vessel. J Comput Assist Tomogr. 2005;29(5):677–9.CrossRefGoogle Scholar
  24. Saitoh H, Hayakawa K, Nishimura K, Okuno Y, Murayama C, Miyazawa T, Zieroth BF, Shimizu Y. Intracarotid blood pressure changes during contrast medium injection. Am J Neuroradiol. 1996;17(1):51–4.PubMedGoogle Scholar
  25. Scholtes F, Signorelli F, Bojanowski MW. Rupture of anterior communicating artery aneurysms during computed tomography angiography: description of the pathway for intraseptal and intraventricular hemorrhage. J Neurosurg. 2011;115(3):617–20.  https://doi.org/10.3171/20011.4.JNS101629.CrossRefPubMedGoogle Scholar
  26. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35(2):93–112.  https://doi.org/10.1159/000346087.CrossRefPubMedGoogle Scholar
  27. Tang C, Zhang TS, Zhou LF. Risk factors for rebleeding of aneurismal subarachnoid hemorrhage: a meta-analysis. PLoS One. 2014;9(6):e99536.  https://doi.org/10.1371/journal.pone.0099536.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Tanno Y, Homma M, Oinuma M, Kodama N, Ymamato T. Rebleeding from ruptured intracranial aneurysms in North Eastern Province of Japan. A cooperative study. J Neurol Sci. 2007;258(1–2):11–6.  https://doi.org/10.1016/j.jns.2007.01.074.CrossRefPubMedGoogle Scholar
  29. Tsuang FY, Su IC, Chen JY, Lee JE, Lai DM, Tu YK, Wang KC. Hyperacute cerebral aneurysm rerupture during CT angiography. J Neurosurg. 2012;116(6):1244–50.  https://doi.org/10.3171/2012.2.JNS111175.CrossRefPubMedGoogle Scholar
  30. Yokota H, Ida Y. Ongoing intracerebral and intraventricular hemorrhages from ruptured anterior communicating artery aneurysm demonstrated by CT angiography. Acta Neurol Belg. 2015;115(3):375–7.  https://doi.org/10.1007/s13760-014-0386-8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Neuroradiologische Klinik, NeurozentrumKlinikum StuttgartStuttgartGermany
  2. 2.Institut für NeuroradiologieKlinikum der Universität MünchenMünchenGermany

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