Contrast-Medium Extravasation From Aneurysmal Rupture During Cerebral-Angiography

The radiographic demonstration of contrast medium extravasation from a rupturing intracranial aneurysm is rare. We have detected this occurrence a mere thrice in 15 years, a period in which angiography was routinely used for the investigation of subarachnoid haemorrhage. We have added these three cases to 14 others that were previously reported in the literature and summarised the total. There does not appear to be a common aetiological factor, though further experimental studies on intracarotid pressures distal to the site of injection seem to be warranted. Ventricular opacification during cerebral angiography occurred in five of the 17 cases: in our most recent case the contrast medium outlined intraventricular haematomata, a finding not hitherto reported in the literature and a feature of prognostic significance. Mortality in this series was extremely high and in excess of that usually found either with an aneurysmal re-bleed or an intracerebral haematoma or both. However, although a combination of these two lesions is notoriously hazardous, perhaps the added insult of the contrast medium extravasation is the cause for the inordinately high fatality rate. Only three of these 17 cases survived, two of whom had a significant residual neurological deficit.