Rupture of intracranial aneurysm accounts for the majority of non-traumatic subarachnoid hemorrhage with a mortality rate of 30-67%. The principal concern in dealing with intracranial ruptured aneurysm is to avoid rebleeding that carries an even more higher mortality rate of 80%. Generally speaking, rate of rehemorrhage are 4% at 24 hours, 20% at 2 weeks and 50% at 6 months. For that reason, early detection and accurate localization of the ruptured aneurysm is mandatory for the following treatment of neurovascular clipping or endovascular coiling. Traditionally,...

From June, 2007 to May, 2009, total 158 consecutive patients underwent four-section CT angiography in the emergency room of our hospital, a tertiary refer center. The indications in most cases are severe explosive headache with or without conscious change and SAH in the plain CT presumed to be aneurysm rupture. The patients with aneurysmal SAH confirmed by angiography or consensus by two neuro-interventionalists are included. Multi-section CT angiograms were obtained with a 4-slice MDCT (Lightspeed QX/I; General Electric Medical Systems, Milwaukee, WI) using helical scan...

According to the inclusion criteria, total 80 patients of which had 101 cerebral aneurysms are included (table 1). Among them, total six patients (five males and one female) with CTA evidence of aneurysm rerupture were found in three patterns: type 1 with active contrast extravasation in the arterial phase as contrast jet or swirl (2 cases); type 2 with delayed contrast extravasation as hyperdense contrast pooling in the delayed venous phase (2 cases) and type 3 with hematoma progression (2 cases). The radiological and clinical...

Releeding rate of aneurysmal SAH in the hyperacute stage < 2 hours is 7.5% per patient and 5.9% per aneurysm with dismal prognosis in this case series. Accordingly, the risk factor and poor prognostic sign include male, higher clinical/ radiological grading of SAH, medium/ large-sized cerebral aneurysm (> 6mm) and direct demonstration of contrast extravasation during CTA.

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