The influence of early craniectomy and microsurgical treatment of ruptured MCA aneurysm on neurological recovery accompained with extracranial complication
Fahrudin Alic, Anes Masovic, Hakija Beculic, Almir Dzurlic, Eldin Burazerovic, Edina Salihovic
Aim To emphasize the importance of early recognition, diagnostic processing and emergent surgical treatment of spontaneous rupture of intracranial aneurysms (aSAH) Methods A 41-year-old female presented with sudden impaired state of consciousness up to coma. A golden hour native computed tomography (CT) scan showed signs of voluminous subarachnoidal hemorrhage (SAH) into basal cisterns filled with hemorrhagic content (Fisher grade III) and patient was sent to referral neurovascular centre due suspicious right MCA aneurysmatic rupture. Results Repeted native CT scan showed signs of subarachnoidal hemorrhage (SAH) into basal cisterns, intracerebral hematoma into right temporal lobe accompanied with a cloak of right subdural haemathoma (Fisher grade IV). CT angiography scans (CTA) confirmed aneurysmatic rupture at bifurcation of right MCA. The patient underwent emergent decompressive craniectomy and clipping of ruptured aneurysm within 6 hours of symptoms onset. Conclusion Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating condition that we should to think about in patients presenting with sudden impaired state of consciousness up to coma like it was in our case. Computed tomography (CT) and CT angiography (CTA) present a gold standard and should be routinely performed in order to exlude or confirm the presence of ruptured intracranial aneurysm. Prompt surgical decompression and occlusion of ruptured aneurysm is an absolute surgical indication.
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