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J Korean Soc Emerg Med > Volume 25(5); 2014 > Article
Journal of The Korean Society of Emergency Medicine 2014;25(5): 602-610.
Prediction of Rupture of Pre-existing Cerebral Aneurysm by CT Findings in Patients with Traumatic Brain Injury
Yong Oh Kim, Gab Teog Kim, Han Ju Choi
Department of Emergency Medicine, College of Medicine, Dankook University, Chunan, Korea. gtkim@dankook.ac.kr
ABSTRACT
PURPOSE:
Rupture of pre-existing cerebral aneurysms has occasionally been reported as a cause of traumatic subarachnoid hemorrhage (TSAH) and intraparenchymal hemorrhage (IPH). SAH due to rupture of pre-existing cerebral aneurysm is an important differential diagnosis in TSAH. The aim of our study was to determine whether a rupture in a pre-existing cerebral aneurysm could be predicted based on the pattern of hemorrhage on the initial computed tomography (CT) scan in patients with traumatic brain injury (TBI).
METHODS:
A total of 336 patients who had undergone computed tomography angiography (CTA) for detection of rupture of pre-existing cerebral aneurysm in TBI between the years 2004 and 2013 were retrospectively studied. In order to investigate CT findings of ruptured cerebral aneurysm, patients who had a lesion of SAH, IPH, or IVH were compared with the control group (who had intracranial lesions of contusion, epidural hematoma, subdural hematoma, or hemorrhagic contusion).
RESULTS:
Fifty eight (17.3%) patients with TSAH harbored cerebral aneurysms, and 45 (13.4%) patients had ruptured cerebral aneurysms. The ruptured aneurysms showed significant association with CT findings of a diffuse hemorrhage in the basal cisterns (29.2%, p=0.003, OR=23.130), unilateral sylvian fissure (13.8%, p=0.039, OR=8.842), anterior interhemispheric fissure (20.0%, p=0.028, OR=14.000), and associated IPH (22.6%, p=0.011, OR=16.333). However, the ruptured aneurysms did not show association with CT findings of hemorrhage on convexities, perimesencephalic cisterns, bilateral sylvian fissure, and IVH (p>0.1).
CONCLUSION:
Patterns of distribution of SAH and associated IPH on initial CT can be predicted of rupture pre-existing cerebral aneurysm in patients with TBI.
Key words: Subarachnoid hemorrhage, Traumatic, Computed tomography, Intracranial aneurysm
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