Aneurysmal isolated intracerebral hemorrhage and/or intraventricular hemorrhage without subarachnoid hemorrhage: a rare and perplexing scenario in neurosurgical practice

Ruptured aneurysms with a presentation of intracerebral hemorrhage (ICH) and/or intraventricular hemorrhage (IVH)without subarachnoid hemorrhage (SAH) are rarely reported.Issues on the clinical characteristics,mechanism,diagnosis,treatment and prognosis of this rare entity are obscure to us.We present two cases of ruptured aneurysms with a presentation of isolated ICH.A systematic review of the literature was also conducted.There were 21 cases plus our cases.Good recovery was achieved in 10 patients (47.6 ％).Pertaining to location,38 ％ of presenting aneurysms were on the right side,52 ％ were on the left side,and 10 ％ were midline.Anterior circulation aneurysms were identified in 81％ of patients (7 PComA,8 MCA,1 ICA,1 AComA) and posterior in 19 ％ of patients (3 PCA,1 BA).Sizes of the aneurysms ranged from 3 mm to 40 mm (16.21 ± 8.45).Ruptured aneurysms at the main trunks of the Willis cycle with a presentation of isolated ICH and/or IVH without SAH is extremely rare.The cause of this rare entity is multifactorial.The diagnosis and management of this entity pose a great challenge to us.The prognosis was discouraging based on the now available data.