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Oulun yliopiston väitöskirjat

COMPUTED TOMOGRAPHY IN SUBARACHNOID HAEMORRHAGE, ACTA UNIVERSITATIS OULUENSIS D Medica 1068

ISBN-13:	978-951-42-6288-3
Kieli:	englanti
Kustantaja:	Oulun yliopisto
Oppiaine:	Lääketiede, farmasia
Painosvuosi:	2010
Sidosasu:	pehmeäkantinen
Sijainti:	Print Tietotalo
Sivumäärä:	135
Tekijät:	JARTTI PEKKA

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Subarachnoid haemorrhage (SAH) is a life-threatened disease with poor outcome. It is usuallycaused by an intracranial aneurysm (IA) rupture and rapid diagnosis and treatment are of greatimportance. Computed tomography (CT) is a reliable method to detect the blood in thesubarachnoid (SA) spaces. Digital subtraction angiography (DSA) offers dynamic andmorphological information of a ruptured IA. The treatment options for excluding an aneurysmfrom the main circulation are neurosurgical clipping and endovascular procedures. The purpose of the present study was to evaluate the risk factors of acute hydrocephalus (HC)and the reliability to localize the ruptured aneurysm based on non-contrast CT. The aim was alsoto compare the effect of neurosurgical and endovascular treatment on the development of chronicHC, and evaluate the incidence and the risk factors of early rebleeding (< 30 days) after coiling. The data of 180 operated patients with a ruptured IA were checked. Two neuroradiologistsseparately located the IAs based on non-contrast CT. The analyses of blood amount anddistribution was a reliable method for estimating the location of ruptured middle cerebral artery(MCA) aneurysms and anterior communicate artery (ACoA) aneurysms. Intracerebralhaemorrhage (ICH) was a predictor for detecting the precise site. The results confirmed thatintraventricular haemorrhage (IVH) was the most consistent single risk factor for the developmentof acute HC. Haemorrhage in the basal region and the large total blood amount in the SA spaceswere strong predictors. The effect of early treatment modality for ruptured IAs on the development of chronic HC with102 clipped and 107 coiled patients was compared. The treatment method used was notsignificantly associated with the occurrence of chronic HC or the need for shunt operation. The incidence and risk factors of early rebleeding after coiling were investigated in 194consecutive acutely (within 3 days) coiled patients with ruptured IAs. The incidence of earlyrehaemorrhage was 3.6%. The presence of ICH at admission and poor clinical condition weresignificant predictors for rebleeding. An early rehaemorrhage appeared as an enlargement of theICH in all of these patients. In conclusion, the non-contrast CT is a reliable method to detect the location of ruptured IA inpatients with MCA and ACoA aneurysms. The risk factor for the development of acute HC is IVH.Other predictors are the total SA blood amount and blood in the basal regions. The treatmentmethod used for acutely ruptured IA has no significant effect on the occurrence of chronic HC.The incidence of early rebleeding after coiling is low. The risk factors of rebleeding are thepresence of ICH and poor clinical condition. Rehaemorrhage appears often as an enlargement ofthe ICH.

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