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. 2013 Aug 28;2(1):413.
doi: 10.1186/2193-1801-2-413. eCollection 2013.

Intracranial extravasation of contrast medium during diagnostic CT angiography in the initial evaluation of subarachnoid hemorrhage: report of 16 cases and review of the literature

Hitoshi Kobata  1 , Akira Sugie, Erina Yoritsune, Tomo Miyata, Taichiro Toho
Affiliations

Intracranial extravasation of contrast medium during diagnostic CT angiography in the initial evaluation of subarachnoid hemorrhage: report of 16 cases and review of the literature

Hitoshi Kobata et al. Springerplus. .

Abstract

Introduction: Three-dimensional CT angiography (3D-CTA) is increasingly used in the initial evaluation of subarachnoid hemorrhage (SAH). However, there is a risk of aneurysm re-rupture in the hyperacute phase. We sought to clarify the incidence of re-rupture and characterize the subgroup in which extravasation of contrast media was seen on 3D-CTA.

Methods: We examined the records of 356 consecutive patients presenting to our institution with non-traumatic SAH between October 2003 and December 2011. After resuscitation, patients with poor grade SAH underwent CT then 3D-CTA while sedated, mechanically ventilated and with a target systolic blood pressure of 120 mmHg.

Results: 336 patients underwent 3D-CTA; 20 died without return of spontaneous circulation. Extravasated contrast medium was seen in 16 (4.8%), 15 (4.5%) at the initial evaluation. Their World Federation of Neurosurgical Societies Grade was V; one patient was resuscitated from cardiac arrest. The mean times from onset to arrival and to CTA were 43.7 minutes and 71.8 minutes, respectively. Ten patients (62.5%) had episodes suggestive of aneurysm re-rupture before 3D-CTA. Surgical clipping, evacuation of hematoma and wide decompressive craniectomy was completed in six patients and one underwent coil embolization. Two of 16 patients survived: one with moderate disability and one made a good recovery.

Conclusions: Contrast extravasation was detected by 3D-CTA in 4.5% of cases despite intensive resuscitation, suggesting that continuous or intermittent rebleeding may occur frequently in the hyperacute phase. The consequences of rebleeding are devastating; however, favorable results can be obtained with immediate aneurysm repair with decompression and intensive neurocritical care.

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Figures

Figure 1
Figure 1
Flow chart showing diagnostic and therapeutic procedures used in 356 cases of non-traumatic subarachnoid hemorrhage (SAH). Abbreviations: WFNS, World federation of neurosurgical societies; ROSC, Return of spontaneous circulation; 3D-CTA, 3 dimensional-computed tomography angiography; DSA, Digital subtraction angiography; IVR, Interventional radiology.
Figure 2
Figure 2
Graph showing systolic blood pressure on arrival, before 3D-computed tomography angiography (3D-CTA) and after 3D-CTA. * Good functional outcome. ** Re-rupture on Day 2 after intensive blood pressure management was withdrawn.
Figure 3
Figure 3
Three- and two-dimensional computed tomography angiography showing a right middle cerebral artery aneurysm and extravasation of contrast media into the Sylvian hematoma.
Figure 4
Figure 4
Three- and two-dimensional computed tomography angiography showing an aneurysm at the left vertebral artery-posterior inferior cerebellar artery junction associated with cauliflower-like extravasated contrast medium. Lack of drainage indicates that this lesion is not an arteriovenous malformation but a ruptured aneurysm.
See this image and copyright information in PMC

References

    1. Broderick JP, Brott TG, Duldner JE, Tomsick T, Leach A. Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke. 1994;25:1342–1347. doi: 10.1161/01.STR.25.7.1342. - DOI - PubMed
    1. Connolly ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–1737. doi: 10.1161/STR.0b013e3182587839. - DOI - PubMed
    1. Desai S, Friedman JA, Hlavin J, Kash F. Actively bleeding intracranial aneurysm demonstrated by CT angiography. Clin Neurol Neurosurg. 2009;111:94–96. doi: 10.1016/j.clineuro.2008.07.013. - DOI - PubMed
    1. Diringer MN, Bleck TP, Hamphill JC, 3rd, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the neurocritical care society’s multidisciplinary consensus conference. Neurocrit Care. 2011;15:211–240. doi: 10.1007/s12028-011-9605-9. - DOI - PubMed
    1. Drake CG. Report of world federation of neurological surgeons committee on a universal subarachnoid haemorrhage grading scale. J Neurosurg. 1988;68:985–986. - PubMed

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