Co-existence of unruptured cerebral aneurysms in patients with hypertensive intracerebral hemorrhage.

Objective: Primary hypertensive intracerebral hemorrhage (PICH) is caused by a rupture of a small endartery, and diagnosis is made either by computed tomography (CT) or magnetic resonance imaging (MRI). Vascular abnormalities are not always evaluated in detail. In this study, we aimed to clarify the incidence of co-existing vascular abnormalities, especially unruptured cerebral aneurysms by reviewing selective intraarterial digital subtraction angiography (DSA) images in PICH patients.

Methods: The cases of 169 hypertensive PICH patients who underwent selective intra-arterial DSA were reviewed. In all cases, CT or MRI showed no abnormality other than PICH, such as subarachnoid hemorrhage, component of arterio-venous malformation or cerebral tumor. The main reason for performing DSA was to exclude other causes of intracerebral hemorrhage such as ruptured cerebral aneurysm or small arterio-venous malformation prior to surgical removal of the hematoma.

Results: There were 33 patients with vascular abnormalities: unruptured cerebral aneurysm (n = 24, 14.2%), major vessels occlusion or stenosis (n= 8, 4.7%), and dural arterio-venous fistula (n = 1). Unruptured cerebral aneurysms were found in 9.4% of men and 20.5% of women.

Conclusion: Vascular abnormalities co-existing with PICH are not rare, suggesting the necessity for angiographic evaluation. Special attention should be given to female PICH patients who have a high incidence of having an unruptured cerebral aneurysm.