Aneurysmal and clinical characteristics as risk factors for intracerebral haematoma from aneurysmal rupture

Intracerebral haematoma (ICH) occurs in one-third of patients with aneurysmal subarachnoid haemorrhage (SAH) and is associated with poor prognosis. Identification of risk factors for ICH from aneurysmal rupture may help in balancing risks of treatment of unruptured aneurysms. We assessed potential clinical and aneurysmal risk factors for ICH from aneurysmal rupture. In all 310 SAH patients admitted to our service between 2005 and 2007, we compared clinical risk factors (gender, age, smoking, hypertension, history of SAH and family history) of patients with and without an ICH. From the latest admitted, 50 patients with and 50 without ICH, we compared the location, shape and direction of blood flow of the aneurysms on CT-angiography. Relative risks (RRs) of ICH were 1.2 (95% confidence interval, CI):0.7-1.8) for males, 1.0 (95%CI:0.7-1.4) for age ≥ 55 year, 1.0 (95%CI:0.6-1.6) for smoking, 0.9 (95%CI:0.5-1.5) for hypertension, 0.6 (95%CI:0.1-3.8) for history of SAH and 0.5 (95%CI:0.2-1.3) for family history of SAH. RRs of ICH were 1.8 (95%CI:1.2-2.5) for MCA aneurysms, 0.5 (95%CI:0.3-1.0) for ICA aneurysms, 0.4 (95%CI:0.1-1.3) for posterior circulation aneurysms, and 0.7 (95%CI:0.3-1.3) for multilobed aneurysms. The RRs of other aneurysmal characteristics varied between 0.9 and 1.2. Patients with MCA aneurysms are at a higher risk of developing ICH. The other aneurysmal or clinical factors have no or only minor influence on the risk of ICH after rupture and are, therefore, not helpful in deciding on treatment of unruptured aneurysms.