Clinico-pathological study of ruptured intracranial aneurysm in acute stage. Clinical review of cases admitted with 24 hours after the attack and postmortem study of the acute death (author's transl)

Abstract

During the past three years, we admitted 326 cases of cerebro-vascular disease which included 109 cases of intracranial hematoma and 67 cases of ruptured intracranial aneurysm. Of those aneurysm cases, 36 cases were admitted in acute stage or within 24 hours after the attack. On admission, 27 cases of them showed severe disturbance of consciousness with the grade of 4 or 5. 12 cases died in acute stage and 11 cases of them were autopsied. On postmortem examination all of them showed severe primary cerebral damage and massive subarachnoid or intracerebral hemorrhage. The extension of subarachnoid and intracerebral hematoma depended upon the location of the aneurysm and the direction of its dome. Among 11 autopsy cases 8 cases had massive subarachnoid hematoma and 8 cases had intracerebral hematoma. 6 cases of them had associated ventricular perforation. Though it was difficult to clarify the mechanism of the acute death, the following conditions seemed to be contributing; massive subarachnoid hematoma in basal cistern surrounded the brain stem and constricted it. The basal artery was streched and separated from the brain stem. Ventricular perforation often caused early tentorial herniation and developed secondary midbrain hemorrhage. There would be still considerable cases in which if they were admitted in the early stage after the attack and had the hematoma removed, they could be rescued with satisfactory function. In our series of acute cases, one third of them was succeeded to return to the social life.