Heinrich Heine University, Department of Neurosurgery, Duesseldorf, Germany.
Heinrich Heine University, Institute of Legal Medicine, Duesseldorf, Germany.
Clin Neurol Neurosurg. 2020 Dec;199:106208. doi: 10.1016/j.clineuro.2020.106208. Epub 2020 Sep 9.
With a prevalence of 1-5 %, intracranial aneurysms are common. However, only 20-50 % of these aneurysms will rupture during a person's lifetime. This often happens spontaneously without exogenous factors. In the present study we reviewed the literature concerning the relation between trauma and rupture of a pre-existing aneurysm.
All studies that reported a causal relation between trauma and rupture of a pre-existing aneurysm were included, irrespective of study design. They were limited though to those written in English or German. Excluded were studies with traumatic aneurysms, studies where the rupture of an aneurysm lead to trauma and studies with doubts about the order of events.
Thirteen studies with twenty-two cases of ruptured aneurysm in context with trauma and two unpublished cases were included. Fourteen patients were involved in a fight, seven patients in a bike/motorbike/bus accident and three got hit on the head in a setting outside of interpersonal violence. The aneurysm was located in internal carotid artery in most cases (7/24). The clear majority of patients (19/24) did not survive.
Arteries and aneurysms can rupture in context with head trauma although this is rarely the case. Patients after head trauma with typical blood pattern for aneurysmal SAH in the native CT scan should receive conventional angiography to exclude a vascular or aneurysmal rupture, even when CT-angiography is inconspicuous.
颅内动脉瘤的患病率为 1-5%，较为常见。然而，这些动脉瘤中只有 20-50%会在患者的一生中破裂。这种破裂通常是自发性的，没有外在因素。在本研究中，我们回顾了有关创伤与先前存在的动脉瘤破裂之间关系的文献。
所有报告创伤与先前存在的动脉瘤破裂之间存在因果关系的研究，无论其设计如何，均被包括在内。但这些研究仅限于用英语或德语撰写的研究。排除了外伤性动脉瘤的研究、动脉瘤破裂导致创伤的研究以及对事件顺序有疑问的研究。
共纳入了 13 项研究，涉及 22 例创伤相关破裂的动脉瘤病例和 2 例未发表的病例。14 例患者参与了打斗，7 例患者发生了自行车/摩托车/公共汽车事故，3 例患者在非人际暴力环境中头部受到撞击。大多数情况下，动脉瘤位于颈内动脉（7/24）。大多数患者（19/24）没有存活。
尽管这种情况很少见，但动脉和动脉瘤可能会在头部创伤的情况下破裂。头部创伤后的患者，如果在原始 CT 扫描中出现典型的动脉瘤性蛛网膜下腔出血的血液模式，应进行常规血管造影以排除血管或动脉瘤破裂，即使 CT 血管造影无异常。
