scholarly journals Endovascular Coiling of Multiple (More Than Four) Intracranial Aneurysms

2004 ◽  
Vol 10 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Y.J. Kim ◽  
K.Y. Song
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Gold Standard ◽  
Intracranial Aneurysms ◽  
Endovascular Procedure ◽  
Endovascular Coiling ◽  
Basal Cistern ◽  
Multiple Intracranial Aneurysms ◽  
Multiple Aneurysms ◽  
Multiple Aneurysm ◽  
Clear Line

The incidence of multiple intracranial aneurysms has been reported from 5% to 35%. But over four multiple aneurysms are extremely rare. Sometimes it is very difficult to draw a clear line between ruptured ones and unruptured others especially in multiple aneurysm cases with even distribution of subarachnoid haemorrhage on basal cistern. We present two cases of multiple aneurysms, more than four, which were successfully treated by endovascular coiling at the same time. Our experience suggests an endovascular procedure would be the gold standard of treatment for ruptured multiple intracranial aneurysms.

scholarly journals Estimating the annual rate of de novo multiple aneurysms: three statistical approaches

2004 ◽  
Vol 17 (5) ◽  
pp. 1-8 ◽  
Author(s):  
James Ju Yong Cheong ◽  
Narcyz Ghinea ◽  
James M. van Gelder
Keyword(s):  
Intracranial Aneurysms ◽  
De Novo ◽  
Annual Rate ◽  
Rate Of Development ◽  
Multiple Intracranial Aneurysms ◽  
Multiple Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Study Heterogeneity ◽  
Age Stratification

Object Individuals with unruptured intracranial aneurysms experience a higher rate of rupture if their history includes another aneurysm that has previously bled. The authors used systematic review and metaregression to estimate the annual rate of development of second de novo aneurysms after subarachnoid hemorrhage. Methods This investigation included studies in which more than 300 patients with intracranial aneurysms were described, and in which the age of the patients and the proportion with multiple aneurysms were documented. Studies describing delayed follow-up angiography that was performed after treatment of aneurysms were also reviewed. Twenty studies were included in a between-study analysis. The univariate odds ratio (OR) for multiple intracranial aneurysms per year of age was 1.085 (95% confidence interval [CI] 1.015–1.165); this value was calculated using a hierarchical model for between-study heterogeneity. Five studies were included that provided age stratification. The estimated OR for multiple intracranial aneurysms per year was 1.011 (95% CI 1.005–1.018). Four follow-up studies were available. Conclusions According to the three different approaches (study-level, patient-level, and follow-up analyses), the estimated annual rates of development of de novo aneurysms were 1.62% (95% CI 0.28–3.59%), 0.28% (95% CI 0.12–0.49%), and 0.92% (95% CI 0.64–1.25%), respectively. The estimated annual rate of development of second de novo aneurysms ranged from 0.28 to 1.62%.

scholarly journals Coccidioidal meningitis with multiple aneurysms presenting with pseudo–subarachnoid hemorrhage: illustrative case

2021 ◽  
Vol 2 (15) ◽  
Author(s):  
Rohin Singh ◽  
Visish M. Srinivasan ◽  
Joshua S. Catapano ◽  
Joseph D. DiDomenico ◽  
Jacob F. Baranoski ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
External Ventricular Drain ◽  
Severe Case ◽  
Western United States ◽  
Illustrative Case ◽  
Basal Cistern ◽  
Aneurysmal Rupture ◽  
Multiple Aneurysms ◽  
Prompt Treatment

BACKGROUND Coccidioidomycosis is a primarily self-limiting fungal disease endemic to the western United States and South America. However, severe disseminated infection can occur. The authors report a severe case of coccidioidal meningitis that appeared to be a subarachnoid hemorrhage (SAH) on initial inspection. OBSERVATIONS A man in his early 40s was diagnosed with coccidioidal pneumonia after presenting with pulmonary symptoms. After meningeal spread characterized by declining mental status and hydrocephalus, coccidioidal meningitis was diagnosed. The uniquely difficult aspect of this case was the deceptive appearance of SAH due to the presence of multiple aneurysms and blood draining from the patient’s external ventricular drain. LESSONS Coccidioidal infection likely led to the formation of multiple intracranial aneurysms in this patient. Although few reports exist of coccidioidal meningitis progressing to aneurysm formation, patients should be closely monitored for this complication because outcomes are poor. The presence of basal cistern hyperdensities from a coccidioidal infection mimicking SAH makes interpreting imaging difficult. Surgical management of SAH can be considered safe and viable, especially when the index of suspicion is high, such as in the presence of multiple aneurysms. Even if it is unclear whether aneurysmal rupture has occurred, prompt treatment is advisable.

Multiple intracranial aneurysms: determining the site of rupture

1985 ◽  
Vol 63 (3) ◽  
pp. 342-348 ◽  
Author(s):  
Daniel G. Nehls ◽  
Richard A. Flom ◽  
L. Philip Carter ◽  
Robert F. Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Simple Algorithm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Multiple Intracranial Aneurysms ◽  
Multiple Aneurysms

✓ A retrospective hospital chart and radiograph review was performed of all patients with multiple intracranial aneurysms seen over a 52-month period. Sixty-nine patients with a total of 205 aneurysms were studied. Among the patients with aneurysms, the incidence of multiple aneurysms was 33.5%. Multiple aneurysms were much more common in women, with a female to male ratio of 5:1 for all patients and 11:1 for patients with three or more aneurysms. Common locations for multiple aneurysms were the posterior communicating artery (22%), middle cerebral artery (21.5%), anterior communicating artery (12%), and ophthalmic artery (11%). However, locations with the highest probability of rupture were the anterior communicating artery (62%), posterior inferior cerebellar artery (50%), and basilar artery summit (50%). The middle cerebral artery was the least likely site for rupture. In contrast to previous studies, in this series irregularity of contour was more important than size in identifying the site of rupture. Using a simple algorithm outlined in the text, it was possible to identify the site of aneurysm rupture in 97.5% of cases.

scholarly journals Role of magnetic resonance vessel wall imaging in detecting and managing ruptured aneurysms among multiple intracranial aneurysms

2021 ◽  
Vol 12 ◽  
pp. 460
Author(s):  
Kohei Yoshikawa ◽  
Junta Moroi ◽  
Kohei Kokubun ◽  
Nobuharu Furuya ◽  
Yasuyuki Yoshida ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Vessel Wall Imaging ◽  
Multiple Intracranial Aneurysms ◽  
Unruptured Aneurysms ◽  
Multiple Aneurysms ◽  
Ruptured Aneurysms ◽  
Rupture Site ◽  
Wall Imaging

Background: Wall enhancement of intracranial saccular aneurysms in high-resolution magnetic resonance vessel wall imaging (MR-VWI) might indicate a ruptured aneurysm. Therefore, this study aimed to determine the diagnostic ability of wall enhancement to detect the ruptured aneurysms among multiple aneurysms. Methods: Patients with subarachnoid hemorrhage (SAH) and multiple intracranial aneurysms who underwent MR-VWI before craniotomy and clipping were included in the study. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after gadolinium injection. Aneurysm rupture was estimated based on the subarachnoid clot distribution, aneurysmal contours, and MR-VWI findings. We selectively performed surgical clipping and confirmed the rupture site intraoperatively. Results: Thirteen patients with SAH with 13 ruptured and 17 unruptured aneurysms were treated at out facility. The accuracy rate of rupture site diagnosis using MR-VWI was 69.2% (9/13 cases). Each unruptured aneurysm was equally or more strongly enhanced in the other four cases than the ruptured aneurysms. In three of the four unruptured aneurysms with positive MR-VWI findings, atherosclerosis of the aneurysmal wall was observed during simultaneous or elective clipping surgery. Further, clipping surgery was performed without intraoperative rupture in two cases with the help of MR-VWI findings. Conclusion: Correct diagnosis of the rupture site using MR-VWI alone was unreliable due to false positives caused by the wall enhancement of unruptured aneurysms with atherosclerosis. Therefore, ruptured aneurysms should be detected using more information in addition to MR-VWI images. MR-VWI may be advantageous to determine surgical strategies when managing patients with SAH and multiple aneurysms.

scholarly journals Vascular Anomalies and the Risk of Multiple Aneurysms Development and Bleeding

2002 ◽  
Vol 8 (1) ◽  
pp. 15-20 ◽  
Author(s):  
M. Mazighi ◽  
P. J. Porter ◽  
G. Rodesch ◽  
H. Alvarez ◽  
N. Aghakhani ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Ophthalmic Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Vascular Anomaly ◽  
Vascular Anomalies ◽  
High Rate ◽  
Anterior Communicating Artery ◽  
Multiple Intracranial Aneurysms ◽  
Multiple Aneurysms ◽  
Cerebellar Artery

The pathogenesis of aneurysmal subarachnoid hemorrhage is still debated and the prognosis remains severe, especially in multiple aneurysms, where the therapeutic management is complex. The aim of this study was to look for vascular anomalies and assess their relationship with aneurysm formation and bleeding in patients with multiple intracranial aneurysms. A prospective angiographical review was performed on 141 patients with multiple intracranial aneurysms seen from 1992 to 2000. Three hundred and fifty three aneurysms were studied. In 88% of the patients vascular anomalies were found. The most common were: asymmetric caudal basilar fusion (43.2%), variations of the anterior communicating artery (AcoA) complex (31.2%), symmetric caudal basilar fusion (26.2%), antero-inferior cerebellar artery-postero-inferior cerebellar artery (AICA-PICA) (15.6%), extradural origin of the PICA (10.6%), cavernous origin of the ophthalmic artery or dorsal ophthalmic artery (dOPH) (3.5%). Some aneurysm locations were associated with a high rate of vascular anomalies, e.g.: posterior cerebral aneurysm with asymmetric caudal fusion, AcoA aneurysm with AcoA complex variation, basilar tip aneurysm with extradural PICA or symmetric caudal fusion, PI CA aneurysm with AICA-PICA, para-ophthalmic aneurysm with dOPH. These aneurysm locations bled proportionally more frequently when associated with the related vascular anomaly. In conclusion, these results suggest that vascular anomalies are associated with aneurysm development and bleeding.

Murphey’s teat: history and insight into an enigmatic cerebrovascular eponym

2020 ◽  
Vol 133 (2) ◽  
pp. 369-373
Author(s):  
Daniel M. Heiferman ◽  
Daphne Li ◽  
Joseph C. Serrone ◽  
Matthew R. Reynolds ◽  
Anand V. Germanwala ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Important Work ◽  
Multiple Intracranial Aneurysms ◽  
Angiographic Evidence ◽  
Insight Into

Dr. Francis Murphey of the Semmes-Murphey Clinic in Memphis recognized that a focal sacculation on the dome of an aneurysm may be angiographic evidence of a culpable aneurysm in the setting of subarachnoid hemorrhage with multiple intracranial aneurysms present. This has been referred to as a Murphey’s “teat,” “tit,” or “excrescence.” With variability in terminology, misspellings in the literature, and the fact that Dr. Murphey did not formally publish this important work, the authors sought to clarify the meaning and investigate the origins of this enigmatic cerebrovascular eponym.

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