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anterior_communicating_artery_aneurysm_clinical_features

Anterior communicating artery aneurysm clinical features

Anterior communicating artery aneurysms are usually silent until they rupture.

Suprachiasmatic pressure may cause altitudinal visual field deficits, abulia or akinetic mutism, amnesia, or hypothalamic dysfunction.

Neurologic deficits in aneurysmal rupture may reflect intraventricular hemorrhage (79%), brain hemorrhage (63%), acute hydrocephalus (25%), or frontal lobe signs (20%).

May also present with diabetes insipidus (DI) or other hypothalamic dysfunction.

Visual symptoms

Hyponatremia

Sayama et al. studied the incidence and timing of hyponatremia (Na < 135 mEq l-1) after subarachnoid hemorrhage (SAH) with special reference to ruptured anterior communicating artery (A-com) aneurysms. Hunt and Kosnik (HK) grading, symptomatic vasospasm in A-com aneurysm, and hydrocephalus were analyzed for connections to hyponatremia in 55 patients with ruptured A-com aneurysms, 65 with ruptured internal cerebral artery (ICA) aneurysms, and 49 with ruptured middle cerebral artery (MCA) aneurysms. Hyponatremia occurred in 28 (51%) of 55 patients with A-com aneurysms and in nine (18%) of 49 patients with MCA aneurysms. Severe hyponatremia (Na < 130 mEq l-1) occurred in 16 patients (29%) in the A-com group, four patients (6%) in the ICA group, and three patients (6%) in the MCA group. The A-com aneurysm group had a significantly higher incidence of mild hyponatremia (p < 0.01) and severe hyponatremia (p < 0.001) than other groups. Among A-com cases, hyponatremia occurred significantly more often in HK grade III and IV cases (p < 0.05), in cases with vasospasm (p < 0.001), and in cases with hydrocephalus (p < 0.01). Respective days of onset for symptomatic vasospasm and for hyponatremia were day 7.6 +/- 4.4 and day 10.6 +/- 5.8 following SAH, representing a 3-day delay for hyponatremia (p < 0.05). In most patients hyponatremia resolved within 28 days following SAH. Hyponatremia occurred more often with A-com aneurysms, possibly because of vasospasm around the A-com or hydrocephalus causing hypothalamic dysfunction. Since hypervolemic therapy can cause hyponatremia, particularly careful observation is required during such therapy in patients with A-com aneurysm 1).

Amnesia

Talland et al reported in 1967 a amnesic syndrome with anterior communicating artery aneurysm 2).

References

1)
Sayama T, Inamura T, Matsushima T, Inoha S, Inoue T, Fukui M. High incidence of hyponatremia in patients with ruptured anterior communicating artery aneurysms. Neurol Res. 2000 Mar;22(2):151-5. PubMed PMID: 10763501.
2)
Talland GA, Sweet WH, Ballantine HT Jr. Amnesic syndrome with anterior communicating artery aneurysm. J Nerv Ment Dis. 1967 Sep;145(3):179-92. PubMed PMID: 6066072.
anterior_communicating_artery_aneurysm_clinical_features.txt · Last modified: 2019/11/07 20:48 by administrador