We examined 40 patients with ruptured middle cerebral aneurysms showing local symptoms in the brain as well as disturbance of consciousness. The overall mortality of those 40 cases was 27.5%. This was much lower than the mortality of 44.4% for cases with ruptured aneurysms of Hunt and Kosnik Grade IV which we also observed at approximately the sane time.
The 40 cases consisted of 29 patients who survived (Group S) and 11 patients who died (Group D). A comparison between the two groups revealed that Group D had a higher rate of signs of cerebral herniation, with cases showing signs of bilateral herniation all ending in death. The CT scan of the groups revealed SAH and midline shifts to a great extent in Group D but no significant differences in the largest diameters of hematoma between Groups S and D. There were more cases of severe delayed ischemic neurological deficit (DIND) in Group D. An examination of the nine cases with signs of unilateral herniation (five cases of survival and four cases of death) showed that all the patients who survived underwent operation within 12 hours of the attack. This suggested the necessity of rapid treatment for these serious cases. The 29 survival cases were composed of 23 cases which could take care of themselves and six cases which, at least partially, required the assistance of others. Five of these six cases had hematoma of the left hemisphere.
It has suggested that possibility of improvement in functional prognosis would depend on the management of the intra Sylvian hematoma extending into the rear part of the Sylvian fissure.
