Therapeutic evaluation of a patient with ruptured intracranial aneurysm without subarachnoid hemorrhage by CT imaging: a case report

Meiling Xu,Guangyong Chen,Chengyan He,Long Ma,Yufei Gao,Jinnan Zhang

doi:10.1186/s12883-018-1197-y

Meiling Xu, Guangyong Chen + Show 4 more

Open Access

https://doi.org/10.1186/s12883-018-1197-y

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Journal: BMC Neurology	Publication Date: Nov 29, 2018
License type: open-access

Affiliation: Jilin University, Union Hospital

Abstract

BackgroundThe majority of ruptured intracranial aneurysms are combined with subarachnoid hemorrhage, but patients with only intracerebral hematoma without any subarachnoid hemorrhage are extremely rare.Case presentationThe patient was hospitalized due to sudden dizziness combined with slurred speech. The patient showed considerable decreased physical activity without any nuchal rigidity. Head CT showed hematoma in the left temporal lobe, and the shape of hematoma was extremely irregular. MRI indicated the absence of any vascular malformations. The patient was diagnosed with middle cerebral artery bifurcation aneurysm in the left by head CTA. Intracranial aneurysm clip and removal of hematoma in the left temporal lobe were performed under general anesthesia. The patient did not show any significant neurological dysfunction after the surgery and was followed up for 4 months after discharge with GOS score of 5 points.ConclusionsIntracranial hematoma with irregular morphology around the lateral fissure of the brain should be considered critical in order to avoid misdiagnosis and any possibility of missed diagnosis of vascular lesions, so as to ensure an exact therapeutic strategy with good prognosis for the patients.

Highlights

The majority of ruptured intracranial aneurysms are combined with subarachnoid hemorrhage, but patients with only intracerebral hematoma without any subarachnoid hemorrhage are extremely rare.Case presentation: The patient was hospitalized due to sudden dizziness combined with slurred speech
Intracranial hematoma with irregular morphology around the lateral fissure of the brain should be considered critical in order to avoid misdiagnosis and any possibility of missed diagnosis of vascular lesions, so as to ensure an exact therapeutic strategy with good prognosis for the patients
There are two manifestations of intracranial aneurysm rupture: 1 The first is simple subarachnoid hemorrhage (SAH), accounting for 85%. 2 The second is intraparenchymal/ intracranial hematoma (IPH/ICH), accounting for 15%, which can be combined with subarachnoid hemorrhage or intraventricular hematoma (IVH)

Summary

Conclusions

Intracranial hematoma with irregular morphology around the lateral fissure of the brain should be considered critical in order to avoid misdiagnosis and any possibility of missed diagnosis of vascular lesions, so as to ensure an exact therapeutic strategy with good prognosis for the patients.

Background

Discussion and conclusions