PubMed1975
The authors report a case of rupture of intracranial aneurysm by angiography which was done four hours after the subarachnoid hemorrhage. Case; A thirty-one year old male patient was brought to our outpatient's clinic by ambulance because of conscious loss and convulsive seizure on Feb. 5th, 1974. Lumbar puncture showed grossly hemorrhage in the CSF. Immediately he was hospitalized and administered anticonvulsants, hypotensive drugs, antibrinolytic agents and corticosteroid. His signs and symptoms on admission were mild headache, nausea, nuchal rigidity, anisocoria (right greater than left) and left hyper reflexia. This attach was his second. (He first noted the bleeding attack on January 30, 1974). Four hours after this attack cerebral angiography was done under local anesthesia with heavy premedication. Puncture of common carotid arteries were uneventful. Three injections of 60% Conray, at the dose of 8 ml each, were performed and three films were taken. Few minutes after injections, he suddenly became unconscious and ceased respiration for a few seconds. Blood pressure was 210 mmHg at systolic, although 120 mmHg two minutes before. Immediately resuscitation started. His respiration reappeared within 0.5 minute and his vital signs gradually improved. We stopped examination. When returned to his bed, right pupil dilated and optic fundi showed bleeding bilaterally. Arteriography showed a large dumbbell shaped aneurysm at the trification of the right middle cerebral artery but no finding of hematoma (Fig. 1). We decided emergency operation at once. When started the operation his both sides pupil dilated, B.P. was very low. OPERATION: Right side large frontolateral craniectomy was done. Large subdural hematoma (Fig. 2), severe diffuse subarachnoid hemorrhage (Fig. 3) and intracerebral hematoma were found. Aneurysmal neck clipping was successfully done. POSTOPERATIVE COURSE: His level of consciousness was semicomatous. But gradually his state deteriorated and died one week after the operation. AUTOPSY: There was severe edema in both sides cerebrum. The brain stem, especially interbrain, and pons, had fallen into softening, so called respirator brain. This complication of angiography is very rare. This case is the 24th reported case of the ruptured aneurysm by angiography.