Clinical signs pointing to the source of hemorrhage in multiple intracranial aneurysms.

Background: In multiple aneurysms of cerebral vessels it is essential to correctly identify the aneurysm that has caused the hemorrhage, since it must be operated first. On the basis of our own material, we have evaluated the usefulness of various clinical signs and examinations in diagnosing which of several aneurysms was the cause of an intracranial hemorrhage.

Material/methods: The material consisted of 163 patients with a total of 391 aneurysms. Diagnosis was based on panangiography and neurological examinations in all cases and CT in the majority.

Results: All the diagnostic examinations in question (neurological, angiography, CT and intraoperative evaluation) enabled a correct diagnosis in 72.6% of cases. In CT scanning, diagnostic value diminishes with time. Intracerebral hematoma is the most persistent sign. The highest rupture index involved aneurysms localized on the anterior communicating artery, while those on the internal carotid artery ranked second. Four patients in whom intraoperative evaluation showed that the order in which the aneurysms were treated surgically was erroneous died as the result of rebleeding that occurred prior to planned follow-up surgery.

Conclusions: It is vitally important for outcome to determine which of several aneurysms has ruptured, since errors in the sequencing of surgical repair significantly increase mortality due to rebleeding preceding the next stage of surgery. When diagnosing the source of a hemorrhage one should take into account neurological findings, angiography, EEG, CT, MRI, and the location of the aneurysms.