RUPTURED ANEURYSMS OF THE SUPRACLINOID PORTION OF THE INTERNAL CAROTID AND OF THE MIDDLE CEREBRAL ARTERIES1

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Abstract
Three pathologic groups were delineated in 17 patients with ruptured aneurysms of the supraclinoid internal carotid and middle cerebral arteries. In the 1st group, bleeding was confined to the subarachnoid space. The 2d group was marked by diffuse subarachnoid hemorrhage and by disruption of brain tissue with penetration of the bleeding into the ventricular system. The usual route of rupture into the ventricular system was through the rostral hippocampal cortex of the temporal lobe in the vicinity of the uncus. Typically, cases of the 2d group were associated with aneurysms arising at the junction of the internal carotid and posterior communicating arteries. The 3d group was characterized anatomically by formation of a large hematoma within the Sylvian fissure. The brain and contained ventricular system were displaced and compressed, but hemorrhage did not penetrate into the latter. Cases of the 3d group were caused by aneurysms of the Sylvian arteries.

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