Abstract
BackgroundTo identify the clinical features, rebleed risk, timing and method of diagnosis, complications and outcome for subarachnoid haemorrhage (SAH) from traumatic intracranial aneurysm (TICA) of the posterior circulation. Subjects included 26 patients aged 3–54 (mean 24.8).MethodsCase series and literature search to identify all reported cases.ResultsIn our series, two of three cases were fatal as a result of rebleed, and one case had a good outcome with no deficit, following prompt diagnosis and embolisation. Our key findings from the literature review were: 30.7 % of patients were age 16 and under; 88 % had an acute drop in consciousness, 46 % in a delayed manner; the mean time to diagnosis was 7.5 days; initial cerebrovascular imaging was normal in 23 %; the rebleed rate was 23 %; 61 % required emergency diversion of cerebrospinal fluid; 11 % developed vasospasm requiring treatment; 19.2 % had deficits that rendered them unable to live independently. The mortality rate was 27 %.ConclusionsSAH from ruptured posterior circulation TICA is associated with significant morbidity and mortality. A high index of suspicion as well as prompt diagnosis, repeat imaging in selected cases, and treatment of any associated TICA can be crucial to a favourable outcome.
Highlights
Subarachnoid haemorrhage (SAH) secondary to traumatic intracranial aneurysm (TICA) of the posterior cerebral circulation is a rare but treatable cause of neurological morbidity and mortality in young patients [1]
We present a case series and a review of the literature for all reported cases of subarachnoid haemorrhage (SAH) from posterior circulation TICA
Falls accounted for the trauma mechanism in eight cases (30.7 %), assault to the head in seven (27 %) cases and a contact sport in four (15 %) cases
Summary
Subarachnoid haemorrhage (SAH) secondary to traumatic intracranial aneurysm (TICA) of the posterior cerebral circulation is a rare but treatable cause of neurological morbidity and mortality in young patients [1]. We present a case series and a review of the literature for all reported cases of SAH from posterior circulation TICA. To identify the clinical features, rebleed risk, timing and method of diagnosis, complications and outcome for subarachnoid haemorrhage (SAH) from traumatic intracranial aneurysm (TICA) of the posterior circulation. Our key findings from the literature review were: 30.7 % of patients were age 16 and under; 88 % had an acute drop in consciousness, 46 % in a delayed manner; the mean time to diagnosis was 7.5 days; initial cerebrovascular imaging was normal in 23 %; the rebleed rate was 23 %; 61 % required emergency diversion of cerebrospinal fluid; 11 % developed vasospasm requiring treatment; 19.2 % had deficits that rendered them unable to live independently. A high index of suspicion as well as prompt diagnosis, repeat imaging in selected cases, and treatment of any associated TICA can be crucial to a favourable outcome
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