Cerebromeningeal hemorrhage: analysis of autopsies performed over a 10-year period

Martelli, Nelson; Colli, Benedicto Oscar; Assirati Jr., João Alberto; Machado, Hélio Rubens

doi:10.1590/S0004-282X1988000200007

Abstracts

A study was conducted on the medical records of 353 patients who died of a subarachnoid hemorrhage (SAH) and who were submitted to autopsy over the last 10 years. SAH was associated with arterial hypertension in 180 (51%) cases, with ruptured aneurysms in 102 (28.9%), and with other pathologies in 71 (20.1%). The patients with hemorrhage associated with arterial hypertension were mostly males, and those with hemorrhage due to aneurysms were mostly females. Of the patients with aneurysms, 36 (35.3%) had aneurysms in the anterior communicating artery, 30 (29.4%) in the internal carotid artery, and 23 (22.6%) in the middle cerebral artery. Among the patients with aneurysms who suffered rebleeding and vasospasm, 59.1% and 61.5%, respectively, were classified as grade I and II upon admission, and all evolved toward grade IV after these complications, Vasospasm predominated from the 3rd to the 10th day after hemorrhage, and rebleedine from the 9 to 16th day and both were most frequent among patients with aneurysms of the anterior communicant artery. Sixty eight percent of the patients with aneurysms died during the first 9 days after hemorrhage. Because of our conduct was to operate systematically late, a considerable number of patients lost the oportunity to be treated surgically with possible favorable evolution due to vasospasm or rebleeding.

Foram analisados 353 pacientes que faleceram por hemorragia subaracnóidea autopsiados nos últimos 10 anos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. A hemorragia subaracnóidea estava associada a hipertensão arterial em 180 casos, a ruptura de aneurismas em 102 e a outras patologias em 71 casos. O sexo masculino predominou nos pacientes com hemorragia associada a hipertensão arterial e o feminino nas hemorragias por ruptura de aneurismas. As hemorragias associadas a hipertensão arterial predominaram em faixas etárias mais altas em relação às hemorragias por aneurismas. Dos pacientes com aneurismas, 36 (35,3%) apresentaram aneurismas no complexo cerebral anterior/comunicante anterior, 30 (29,4%) na carótida interna e 23 (22,5%) na cerebral média. Nos casos de aneurismas, o vasoespasmo predominou no período do 3º ao 10º dia e o ressangramento predominou no período do 9º ao 16º e respectivamente 59,1% e. 61,5% desses pacientes apresentaram-se nos graus I e II na admissão e evoluíram para o grau IV após estas intercorrências. Ambas as intercorrências foram mais freqüentes entre os pacientes com aneurismas do complexo cerebral anterior/comunicante anterior. Sessenta e oito por cento dos óbitos por aneurismas ocorreram nos 9 primeiros dias após a hemorragia. Os pacientes admitidos em grau I e II e que sofreram vasoespasmo ou ressangramento e que poderiam beneficiar-se do tratamento cirúrgico precoce não tiveram esta oportunidade porque a nossa conduta naquela época era de operar sistematicamente no final da segunda ou no início da terceira semana após a hemorragia subaracnóidea.

Nelson Martelli^I; Benedicto Oscar Colli^I; João Alberto Assirati Jr.^II; Hélio Rubens Machado^II

^IProfessor Assistente Doutor - Division of Neurosurgery, Department of Surgery, Orthopedics and Traumatology; Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo

^IIMédico Assistente - Division of Neurosurgery, Department of Surgery, Orthopedics and Traumatology; Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo

SUMMARY

A study was conducted on the medical records of 353 patients who died of a subarachnoid hemorrhage (SAH) and who were submitted to autopsy over the last 10 years. SAH was associated with arterial hypertension in 180 (51%) cases, with ruptured aneurysms in 102 (28.9%), and with other pathologies in 71 (20.1%). The patients with hemorrhage associated with arterial hypertension were mostly males, and those with hemorrhage due to aneurysms were mostly females. Of the patients with aneurysms, 36 (35.3%) had aneurysms in the anterior communicating artery, 30 (29.4%) in the internal carotid artery, and 23 (22.6%) in the middle cerebral artery. Among the patients with aneurysms who suffered rebleeding and vasospasm, 59.1% and 61.5%, respectively, were classified as grade I and II upon admission, and all evolved toward grade IV after these complications, Vasospasm predominated from the 3rd to the 10th day after hemorrhage, and rebleedine from the 9 to 16th day and both were most frequent among patients with aneurysms of the anterior communicant artery. Sixty eight percent of the patients with aneurysms died during the first 9 days after hemorrhage. Because of our conduct was to operate systematically late, a considerable number of patients lost the oportunity to be treated surgically with possible favorable evolution due to vasospasm or rebleeding.

RESUMO

Foram analisados 353 pacientes que faleceram por hemorragia subaracnóidea autopsiados nos últimos 10 anos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. A hemorragia subaracnóidea estava associada a hipertensão arterial em 180 casos, a ruptura de aneurismas em 102 e a outras patologias em 71 casos. O sexo masculino predominou nos pacientes com hemorragia associada a hipertensão arterial e o feminino nas hemorragias por ruptura de aneurismas. As hemorragias associadas a hipertensão arterial predominaram em faixas etárias mais altas em relação às hemorragias por aneurismas. Dos pacientes com aneurismas, 36 (35,3%) apresentaram aneurismas no complexo cerebral anterior/comunicante anterior, 30 (29,4%) na carótida interna e 23 (22,5%) na cerebral média. Nos casos de aneurismas, o vasoespasmo predominou no período do 3º ao 10º dia e o ressangramento predominou no período do 9º ao 16º e respectivamente 59,1% e. 61,5% desses pacientes apresentaram-se nos graus I e II na admissão e evoluíram para o grau IV após estas intercorrências. Ambas as intercorrências foram mais freqüentes entre os pacientes com aneurismas do complexo cerebral anterior/comunicante anterior. Sessenta e oito por cento dos óbitos por aneurismas ocorreram nos 9 primeiros dias após a hemorragia. Os pacientes admitidos em grau I e II e que sofreram vasoespasmo ou ressangramento e que poderiam beneficiar-se do tratamento cirúrgico precoce não tiveram esta oportunidade porque a nossa conduta naquela época era de operar sistematicamente no final da segunda ou no início da terceira semana após a hemorragia subaracnóidea.

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Acknowledgement - "We are grateful to Professor Humberto de Queiroz Menezes of the Department of Pathology, Ribeirão Preto Medical School of University of São Paulo, for the permission to use the autopsy data.

Departamento de Cirurgia, Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - 14048 Ribeirão Preto SP - Brasil.

1. Hook O, Norlén G - Aneurysms of the internal carotid artery. Acta Neurol Scand 40: 200, 1964.
2. Hook O, Norlén G - Aneurysms of the anterior communicating artery. Acta Neurol Scand 40: 219, 1964.
3. Hunt WE, Hess RM - Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14, 1968.
⁴
IX Recenseamento Geral do Brasil - Censo Demográfico - São Paulo. Volume 1 - Tomo 4 - Número 19. Fundação Instituto Brasileiro de Geografia e Estatística (IBGE), 1980.
5. Jane JA, Kassel NF, Torner JC, Winn HR - The natural hystory of aneurysms and arteriovenous malformations. J Neurosurg 62: 321, 1985.
6. Kassel NF, Torner JC - Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13: 479, 1983.
7. Lpcksley HB - Natural hystory of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Section V, Parte I. J Neurosurg 25: 219, 1966.
8. Locksley HB - Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Section V, Part II. J Neurosurg 25: 321, 1966.
9. Locksley HB, Sahs AL, Knowler L - General survey of cases in the Central Registry and characteristics of the sample population. J Neurosurg 24: 922, 1966.
10. McKissock W, Paine KWE - Subarachnoid hemorrhage. Brain 82: 356, 1982.
11. McKissock W, Paine KWE, Walsh LS - Further observations on subarachnoid hemorrhage. J Neurol Neurosurg Psychiat 21: 239, 1958.
12. McKissock W, Paine KWE, Walsh LS - An analysis of the results of treatment of ruptured intracranial aneurysm: report of 772 consecutive cases. J Neurosurg 17: 762, 1960.
13. McKissock W, Richardson A, Walsh LS, Owen E - Multiple intracranial aneurysms. Lancet 1: 623, 1964.
14. Nishioka H - Evaluation of the conservative management of ruptured intracranial aneurysms. J Neurosurg 25: 574, 1966.
15. Perret G, Nishioka H - Arteriovenous malformations: an analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported to the Cooperative Study. J Neurosurg 25:467, 1966.
16. Sahs AL, Perret G, Locksley HB, Nishioka H, Skultety FM - Preliminary remarks on subarachnoid hemorrhage. J Neurosurg 24: 782, 1966.
17. Suzuki J, Hori S, Sakurai Y - Intracranial aneurysms in the neurosurgical clinics in Japan. J Neurosurg 35: 34, 1971.
18. Yoshimoto T, Kayama T, Kodama N, Suzuki J - Distribution of intracranial aneurysms. Tohuku J Exp Med 126: 125, 1978.

Cerebromeningeal hemorrhage: analysis of autopsies performed over a 10-year period

Hemorragia cerebromeníngea: análise de autópsias em período de 10 anos

Publication Dates

Publication in this collection
21 June 2011
Date of issue
June 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Hook O, Norlén G - Aneurysms of the internal carotid artery. Acta Neurol Scand 40: 200, 1964.

[2] 2. Hook O, Norlén G - Aneurysms of the anterior communicating artery. Acta Neurol Scand 40: 219, 1964.

[3] 3. Hunt WE, Hess RM - Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14, 1968.

[4] ⁴
IX Recenseamento Geral do Brasil - Censo Demográfico - São Paulo. Volume 1 - Tomo 4 - Número 19. Fundação Instituto Brasileiro de Geografia e Estatística (IBGE), 1980.

[5] 5. Jane JA, Kassel NF, Torner JC, Winn HR - The natural hystory of aneurysms and arteriovenous malformations. J Neurosurg 62: 321, 1985.

[6] 6. Kassel NF, Torner JC - Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13: 479, 1983.

[7] 7. Lpcksley HB - Natural hystory of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Section V, Parte I. J Neurosurg 25: 219, 1966.

[8] 8. Locksley HB - Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Section V, Part II. J Neurosurg 25: 321, 1966.

[9] 9. Locksley HB, Sahs AL, Knowler L - General survey of cases in the Central Registry and characteristics of the sample population. J Neurosurg 24: 922, 1966.

[10] 10. McKissock W, Paine KWE - Subarachnoid hemorrhage. Brain 82: 356, 1982.

[11] 11. McKissock W, Paine KWE, Walsh LS - Further observations on subarachnoid hemorrhage. J Neurol Neurosurg Psychiat 21: 239, 1958.

[12] 12. McKissock W, Paine KWE, Walsh LS - An analysis of the results of treatment of ruptured intracranial aneurysm: report of 772 consecutive cases. J Neurosurg 17: 762, 1960.

[13] 13. McKissock W, Richardson A, Walsh LS, Owen E - Multiple intracranial aneurysms. Lancet 1: 623, 1964.

[14] 14. Nishioka H - Evaluation of the conservative management of ruptured intracranial aneurysms. J Neurosurg 25: 574, 1966.

[15] 15. Perret G, Nishioka H - Arteriovenous malformations: an analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported to the Cooperative Study. J Neurosurg 25:467, 1966.

[16] 16. Sahs AL, Perret G, Locksley HB, Nishioka H, Skultety FM - Preliminary remarks on subarachnoid hemorrhage. J Neurosurg 24: 782, 1966.

[17] 17. Suzuki J, Hori S, Sakurai Y - Intracranial aneurysms in the neurosurgical clinics in Japan. J Neurosurg 35: 34, 1971.

[18] 18. Yoshimoto T, Kayama T, Kodama N, Suzuki J - Distribution of intracranial aneurysms. Tohuku J Exp Med 126: 125, 1978.