Abstract
The purpose of this paper is to elucidate clinical characteristics in subarachnoid hemorrhage (SAH) following rupture of a distal anterior cerebral artery aneurysm (DACA AN). Subjects were 29 patients (13 male, 16 female) of the ruptured DACA AN who were admitted from 1976 to 1986. Mean age of them was 55 years. The incidence of the ruptured DACA AN was 4.1% out of all the patients with a ruptured aneurysm during these 10 years. Computed tomography and angiography was performed in all of them on admission and followed in 20 patients with surgical treatment. Follow-up (mean time : 3.4 years) was performed to evaluate outcomes. Azygos ACA was seen in 6 patients (21%) out of the 29. Multiple aneurysms were demonstrated in 10 patients (34%) out of them, and out of the 15 incidental aneurysms, nine (60%) were in the territory of the ACA. These findings suggest that hemodynamic stress may play an important role in the formation, growth and rupture of the DACA AN.
Intracerebral hematoma (ICH) were seen in 15 patients (52%) out of the 29. Out of the 9 patients with conservative treatment, 8 dead patients showed the following consciousness level on admission : stupor in one, semicoma in 2, coma in one, deep coma in 4. Another surviving patient, who refused aneurysmal operation, showed clear consciousness on admission. Most of the former 8 had either large ICH or massive intraventricular hematomas (IVH). On the other hand, outcomes of the 20 patients with surgical treatment were as follows : fully recovered in 13, self-managing in 2, partially dependent in one, fully dependent in 2, dead in 2. Preoperative consciousness level was clear in 15, drowsy in 2, stupor in one, semicoma in one and coma in one. Eighteen patients out of the 20 had either no or small ICH, while the another patient of coma had large ICH. From these findings, the clinical course of the ruptured DACA AN seems to be divied into 2 groups : fulminant SAH group, developing severe consciousness disturbance soon after SAH, associated with large ICH and massive IVH, resulting in poor outcomes whether the operation is performed or not; mild SAH group, having less than mild consciousness disturbance and small ICH, following good outcomes after the operation.
