The relationship of blunt head trauma, subarachnoid hemorrhage, and rupture of pre-existing intracranial saccular aneurysms

Patients with a history of closed head trauma and subarachnoid hemorrhage a re uncommonly diagnosed with an intracranial saccular aneurysm. This study presents a group of patients in whom a pre-existing aneurysm was discovered during work-up for traumatic subarachnoid hemorrhage. Without an accurate pre-trauma clinical history, it is difficult to define the relationship bet ween trauma and the rupture of a preexisting intracranial saccular aneurysm . We retrospectively reviewed 130 patients who presented to Detroit Receivi ng Hospital between 1993 and 1997 with a diagnosis of subarachnoid hemorrha ge (SAH). Of these 130 patients, 70 were spontaneous, and 60 had a history of trauma. Mechanisms of trauma include motor vehicle accident, assault, or fall from a height Of the 60 patients with subarachnoid hemorrhage and a h istory of trauma, 51 (86%) did not undergo conventional four-vessel angiogr aphy, and had no further neurological sequelae. Nine patients (14%) had a s uspicious quantity of blood within the basal cisterns or Sylvian fissure an d had a four-vessel angiogram. Five patients (8%) were diagnosed with a sac cular intracranial aneurysm, and all underwent surgical clipping of the ane urysm. We conclude that the majority of patients (92%), with post-traumatic SAH do not harbor intracranial aneurysms. However, during initial evaluati on, a high level of suspicion must be entertained when post-traumatic subar achnoid hemorrhage is encountered in the basal cisterns or Sylvian fissure, as 8% of our population were diagnosed with aneurysms.