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Prevalence of Intracranial Aneurysms Found on Computed Tomography Angiogram in Patients Presented with Traumatic Subarachnoid Haemorrhage

Yeo CH and Bakhshayeshi BM

Introduction: In the setting of trauma, the cause of intracranial haemorrhage is frequently attributed to the physical, traumatic event. The actual incidence of underlying aneurysms in patients with SAH after a head trauma is not well clear or studied previously. The role for immediate Computed Tomography Angiography (CTA) still remains controversial to evaluate for non-traumatic causes.

Methods: This study reviewed a total of 797 CT angiograms of the brain conducted in the 2 major hospitals over period 48 months, between February 2013 and February 2017. 170 CTAs were performed on patient with classical thunderclap headache (spontaneous group) while 58 CTAs were performed on patient with head trauma (trauma group).

Results: This study found that 16 plain CT Brains with positive SAH for the Spontaneous group and Traumatic group. Meanwhile, 16 CTAs in Spontaneous group had positive findings intracranial aneurysms compared to 4 from the Traumatic group. Overall incidence of intracranial aneurysms in spontaneous group is 9.4% compared 6.8% in traumatic group (p=0.590) and has no statistically significant difference when comparing the groups.

In regards to primary outcome, 9 patients in Spontaneous group with SAH found to have intracranial aneurysms on CTA compared to 2 patients in Traumatic group (p=0.065). This comparison did not show statistically significant difference.

The study also shown that 7 patients in Spontaneous group with positive SAH on plain CT brain had no aneurysms on CTAs as compared to 12 in Traumatic group. In terms of incidental findings of pre-existing aneurysms, 7 patients from Spontaneous group found to have aneurysms without SAH compared to 2 from Traumatic group.

Conclusion: Prevalence of pre-existing aneurysms in patients with traumatic subarachnoid haemorrhage is comparable with spontaneous type and may had been underestimated and therefore performing CT cerebral angiogram is recommended to evaluate non-traumatic cause of SAH.