Saccular Intracranial Aneurysm Disease

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. 631-638 ◽  
Author(s):  
Terhi Huttunen ◽  
Mikael von und zu Fraunberg ◽  
Juhana Frösen ◽  
Martin Lehecka ◽  
Gerard Tromp ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Anterior Communicating Artery ◽  
Sporadic Group ◽  
Site Distribution ◽  
Median Diameter ◽  
Age And Sex ◽  
Eastern Finland ◽  
First Admission

Abstract OBJECTIVE Finnish saccular intracranial aneurysm (sIA) disease associates to 2q33, 8q11, and 9p21 loci and links to 19q13, Xp22, and kallikrein cluster in sIA families. Detailed phenotyping of familial and sporadic sIA disease is required for fine mapping of the Finnish sIA disease. METHODS Eastern Finland, which is particularly isolated genetically, is served by Kuopio University Hospital's Department of Neurosurgery. We studied the site and size distribution of unruptured and ruptured sIAs in correlation to age and sex in 316 familial and 1454 sporadic sIA patients on first admission from 1993 to 2007. RESULTS The familial and sporadic aneurysmic subarachnoid hemorrhage patients had slightly different median ages (46 vs 51 years in men; 50 vs 57 years in women), different proportion of males (50% vs 42%), equal median diameter of ruptured sIAs (7 mm vs 7 mm) with no correlation to age, and equally unruptured sIAs (30% vs 28%). The unruptured sIAs were most frequent at the middle cerebral artery (MCA) bifurcation (44% vs 39%) and the anterior communicating artery (12% vs 13%), in contrast to the ruptured sIAs at the anterior communicating artery (37% vs 29%) and MCA bifurcation (29% vs 29%). The size of unruptured sIAs increased by age in the sporadic group. CONCLUSION The MCA bifurcation was most prone to develop unruptured sIAs, suggesting that MCA branching during the embryonic period might be involved. The different site distribution of ruptured and unruptured sIAs suggests different etiologies for sIA formation and rupture. The lack of correlation of size and age at rupture (exposure to risk factors) suggests that the size at rupture is more dependent on hemodynamic stress.

Abstract WP87: Coronary Artery Disease and Intracranial Aneurysm; Identical Risk Factors but Different Vascular Responses

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Bum Joon Kim ◽  
Hyun Goo Kang ◽  
Jae Sung Ahn ◽  
Beyong Deok Kwon ◽  
Deok Hee Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Intracranial Aneurysm ◽  
Basilar Artery ◽  
Bypass Graft ◽  
Health Examination ◽  
Artery Disease ◽  
Valvular Insufficiency ◽  
Age And Sex

Background: Intracranial aneurysm (IA) is a vascular disease with localized abnormal outpouching in cerebral vessels. We have hypothesized that though the risk factors are similar between atherosclerosis and IA, the response of the vessel may be different. Methods: Subjects who received a routine health examination (health examination group) or coronary artery bypass graft surgery (CABG group) during the study period were enrolled. The incidence of IA was compared between the two groups. The incidence of valvular insufficiency was compared between patients with and without IA in the CABG group. The tortuosities of intracranial arteries were compared between patients with IA and age- and sex-matched control from the health examination group. Results: Finally, 367 of 18,954 health examination group and 49 of 2,734 patients of CABG group demonstrated IA. After adjusting for age and sex, the prevalence of IA was higher in the health examination group than the CABG group (1.81% vs.0.71%; p<0.001). The proportion of patients with mitral or aortic insufficiency was higher in patients with IA than those without in the CABG group (p=0.001 and p=0.003. respectively). Female sex (OR=2.25; p=0.01), smoking OR=3.94 p<0.001)and the presence of valvular insufficiency (mild:OR=2.57; p=0.003, Severe OR=4.11; p=0.01)was independently associated with IA. The tortuosity of basilar artery was higher in patients with IA than those without (p<0.001). Hypertension (OR=2.13; p<0.001), smoking (OR=1.59; p=0.03), coronary artery disease (OR=0.32; p<0.001) and the tortuosity of basilar artery (OR=1.065; p<0.001) were independently associated with IA. Conclusions: Patients with IA seems to have a weaker vascular structure which easily dilates or twine to tensile strength causing valvular insufficiency or high vascular tortuosity.

scholarly journals Spontaneous Disappearance of an Intracranial Aneurysm After Subarachnoid Hemorrhage

1992 ◽  
Vol 19 (3) ◽  
pp. 389-391 ◽  
Author(s):  
Mark G. Hamilton ◽  
Oliver N.R. Dold
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Complete Disappearance ◽  
Slow Recovery ◽  
Spontaneous Thrombosis ◽  
Grade 5 ◽  
Spontaneous Disappearance

ABSTRACT:Spontaneous disappearance of an intracranial aneurysm after subarachnoid hemorrhage is an uncommon event and usually associated with severe cerebral vasospasm, giant aneurysms or the use of antifibrinolytics. We present a young woman who suffered a grade 5 subarachnoid hemorrhage with severe vasospasm caused by a small anterior communicating artery aneurysm. The patient underwent a slow recovery and two years later requested surgery. Angiography demonstrated complete disappearance of the aneurysm. The neurosurgeon should be aware that spontaneous thrombosis of cerebral aneurysms can occur and ensure that angiography is repeated when surgery is significantly delayed.

ANOSMIA AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Neurosurgery ◽  
2007 ◽  
Vol 61 (5) ◽  
pp. 918-923 ◽  
Author(s):  
Marieke J.H. Wermer ◽  
Maarten Donswijk ◽  
Paut Greebe ◽  
Bon H. Verweij ◽  
Gabriël J.E. Rinkel
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Visual Analog Scale ◽  
Independent Living ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Well Being ◽  
Anterior Communicating Artery ◽  
Structured Interviews ◽  
Analog Scale ◽  
The Impact

Abstract OBJECTIVE Anosmia has an important impact on well-being but is often neglected by physicians. In patients with subarachnoid hemorrhage (SAH), anosmia has mainly been reported after surgery for aneurysms of the anterior communicating artery. We studied the prevalence, predisposing factors (aneurysm site and type of treatment), impact, and prognosis of anosmia in patients with SAH. METHODS Of the patients with SAH who resumed independent living, we included all patients treated by coiling between 1997 and 2003 and a sample of patients treated by clipping between 1985 and 2001. Patients underwent structured interviews regarding the presence and duration of anosmia. The impact of anosmia was scored using a visual analog scale ranging from 0 (no influence) to 100 (the worst thing that ever happened to them). Risk factors for anosmia were assessed by logistic regression analysis. RESULTS Overall, 89 of the 315 interviewed patients (28%; 95% confidence interval [CI], 23–34%) reported anosmia after SAH (mean follow-up period, 7.4 yr), including 10 (15%) of the 67 coiled patients and 79 (32%) of the 248 clipped patients. The median visual analog scale impact score was 53 (range, 0–100). In 20 of the 89 patients (23%; 95% CI, 15–33), the symptoms had improved over time. Risk factors for anosmia were treatment by clipping (odds ratio [OR], 2.7; 95% CI, 1.3–5.7) and anterior communicating artery aneurysms (OR, 2.0; 95% CI, 1.2–3.3). CONCLUSION Anosmia after SAH has a high prevalence, considerable impact, and poor prognosis. Its occurrence after coiling suggests not only damage to the olfactory nerve by clipping but also that the SAH itself plays a role in its pathogenesis.

scholarly journals Modifiable Risk Factors for Intracranial Aneurysm and Aneurysmal Subarachnoid Hemorrhage: A Mendelian Randomization Study

2021 ◽  
Author(s):  
Ville Karhunen ◽  
Mark K. Bakker ◽  
Ynte M. Ruigrok ◽  
Dipender Gill ◽  
Susanna C. Larsson
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Mendelian Randomization ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Sensitivity Analyses ◽  
Modifiable Risk Factors

Background The aim of this study was to assess the associations of modifiable lifestyle factors (smoking, coffee consumption, sleep, and physical activity) and cardiometabolic factors (body mass index, glycemic traits, type 2 diabetes, systolic and diastolic blood pressure, lipids, and inflammation and kidney function markers) with risks of any (ruptured or unruptured) intracranial aneurysm and aneurysmal subarachnoid hemorrhage using Mendelian randomization. Methods and Results Summary statistical data for the genetic associations with the modifiable risk factors and the outcomes were obtained from meta‐analyses of genome‐wide association studies. The inverse‐variance weighted method was used as the main Mendelian randomization analysis, with additional sensitivity analyses conducted using methods more robust to horizontal pleiotropy. Genetic predisposition to smoking, insomnia, and higher blood pressure was associated with an increased risk of both intracranial aneurysm and aneurysmal subarachnoid hemorrhage. For intracranial aneurysm, the odds ratios were 3.20 (95% CI, 1.93–5.29) per SD increase in smoking index, 1.24 (95% CI, 1.10–1.40) per unit increase in log‐odds of insomnia, and 2.92 (95% CI, 2.49–3.43) per 10 mm Hg increase in diastolic blood pressure. In addition, there was weak evidence for associations of genetically predicted decreased physical activity, higher triglyceride levels, higher body mass index, and lower low‐density lipoprotein cholesterol levels with higher risk of intracranial aneurysm and aneurysmal subarachnoid hemorrhage, with 95% CI overlapping the null for at least 1 of the outcomes. All results were consistent in sensitivity analyses. Conclusions This Mendelian randomization study suggests that smoking, insomnia, and high blood pressure are major risk factors for intracranial aneurysm and aneurysmal subarachnoid hemorrhage.

Stent-assisted coil embolization of anterior communicating artery aneurysms: safety, effectiveness, and risk factors for procedural complications or recanalization

2018 ◽  
Vol 11 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Hyun Ho Choi ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
Sang Jun Ahn ◽  
Won-Sang Cho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
Significant Risk ◽  
Binary Logistic Regression ◽  
Anterior Communicating Artery ◽  
Significant Relation ◽  
Aneurysm Size ◽  
Alternative Treatment Option ◽  
Procedural Complications

IntroductionStent-assisted coil (SAC) embolization is an alternative treatment option for anterior communicating artery (AcoA) aneurysms. This study was undertaken to assess the safety and effectiveness of SAC embolization in treating AcoA aneurysms and to determine risk factors for related procedural complications or recanalization.MethodsBetween August 2008 and December 2016, 184 patients with AcoA aneurysms were treated with SAC embolization. Cumulative medical record and radiologic data were analyzed using binary logistic regression to identify factors predisposing to procedural complications or recanalization.ResultsContralateral A1 segment hypoplasia was observed in 59 patients (32.1%). Three types of stents (LVIS, Enterprise, and Neuroform) were variably placed by one of two routes: (1) ipsilateral A1 to ipsilateral A2 (75.5%) or (2) ipsilateral A1 to contralateral A2 (24.5%). Procedural complications occurred in 17 patients (thromboembolism 12; procedural leakage 3; both 2), showing a significant relation to subarachnoid hemorrhage at presentation (OR 57.750; P<0.01). Occlusion was documented immediately after embolization in 130 aneurysms (70.6%) and, in 23 (13.1%) of 175 AcoA aneurysms followed by angiography (median 25.9±18.5 months), recanalization developed (minor, 15; major, 8). Stent configuration (ipsilateral A1 to contralateral A2, P=0.024), maximum aneurysm size (>7 mm, P<0.01), and A1 segment hypoplasia (P=0.039) were identified as risk factors for recanalization.ConclusionSAC embolization is a safe and effective method of treating unruptured AcoA aneurysms, regardless of anatomic or clinical features. However, in the event of rupture, procedural complications are likely. Stent configuration, aneurysm size, and A1 segment hypoplasia were identified as significant risk factors for recanalization.

Terson sign:

2020 ◽  
Vol 2 (1) ◽  
pp. 38-43
Author(s):  
Luiz Severo Bem Junior ◽  
Gustavo De Souza Andrade ◽  
Joao Ribeiro Memória Júnior ◽  
Hildo Rocha Cirne de Azevedo Filho
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Early Recognition ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Reports ◽  
Clinical Status ◽  
Vitreous Hemorrhage ◽  
Anterior Communicating Artery ◽  
Inclusion Criteria ◽  
Relationship Of ◽  
The Relationship

Terson's sign (TS) is classically defined as vitreous hemorrhage associated with subarachnoid hemorrhage of aneurysmal origin, being an important predictor of severity, indicating greater morbidity and mortality when compared to patients without the sign. The objective of this study is to review the relationship of Terson syndrome/Terson sign with the prognosis of aneurysmal subarachnoid hemorrhage. A search for original articles, research and case reports was performed on the PubMed, Scielo, Cochrane and ScienceDirect platform, with the following descriptors: Terson sign and subarachnoid hemorrhage. Retrospective, prospective articles and case reports published in the last 5 years and which were in accordance with the established objective and inclusion criteria were selected. Ten (10) articles were selected, in which the available results show an unfavorable prognostic relationship of TS and subarachnoid hemorrhage, because these patients had a worse clinical status assessed on the Glasgow scales ≤ 8, Hunt & Hess > III, Fisher > 3, in addition to intracranial hypertension and location of the aneurysm in the anterior communicating artery complex. The early recognition of this condition described by Albert Terson in 1900 brought an important contribution to neurosurgery, being recognized until nowadays.

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