On the relationship between ruptured intracranial aneurysm and cerebral infarction

Abstract

A study was made of the cerebral pathology in 105 cases of ruptured, "congenital" intracranial aneurysms with particular reference to the occurrence of cerebral infarction. Infarcts occurred in 55% of the total group. The incidence of infarction appeared to increase with the more vigorous use of diagnostic and therapeutic measures. The etiology of these lesions appeared wholly or partly explicable in 72%. Surgical procedures, vascular or tissue compression by hematomas, and occasionally arteriography were the major evident causative factors. In a number of instances, the age of the infarct appeared to be younger than the neurological signs or date of aneurysm rupture. Cerebral vasospasm by itself, if it does occur spontaneously after aneurysm rupture, does not seem to cause cerebral infarction commonly. It may possibly produce initial cerebral ischemia which is converted into infarction by the changes induced by a 2nd factor (for example, surgery, or compression by hematomas). Infarction was usually ipsilateral to, and in territory supplied by, the affected vessel. Anterior cerebral and anterior communicating aneurysms were often associated with bilateral infarcts. No correlation was noted between infarction and age, sex, papilledema, or hypertension except possibly for severe systolic hypertension. Sub-dural hematomas of varying volumes were found in 20% of the autopsies while intracerebral hematomas were noted in 56%. Middle cerebral aneurysms in men an internal carotid aneurysms in women were associated with intracerebral hematomas in an extremely high proportion of cases. In 4 patients pituitary necrosis due to failure of circulation in the internal carotid artery was found.