Intracranial aneurysm complications

SAH is complicated by intracerebral hemorrhage in 20–40%, by intraventricular hemorrhage in 13–28% and by subdural hematoma in 2–5%; usually due to p-comm aneurysm when over convexity, or distal anterior intracerebral artery (DACA) aneurysm with interhemispheric subdural hematoma.

The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured intracranial aneurysms suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management.

There are substantial differences in patient and aneurysm characteristics between ruptured and unruptured aneurysms. These findings support the hypothesis that different pathological mechanisms are involved in the formation of ruptured aneurysms and incidentally detected unruptured aneurysms. The potential protective effect of aspirin might justify randomized prevention trials in patients with unruptured aneurysms 1).

Intracerebral hematoma (ICH) with subarachnoid hemorrhage (SAH) indicates a unique feature of intracranial aneurysm rupture since the aneurysm is in the subarachnoid space and separated from the brain by pia mater.

Hostettler IC, Alg VS, Shahi N, Jichi F, Bonner S, Walsh D, Bulters D, Kitchen N, Brown MM, Houlden H, Grieve J, Werring DJ; Genetics and Observational Subarachnoid Haemorrhage (GOSH) Study investigators. Characteristics of Unruptured Compared to Ruptured Intracranial Aneurysms: A Multicenter Case-Control Study. Neurosurgery. 2018 Jul 1;83(1):43-52. doi: 10.1093/neuros/nyx365. PubMed PMID: 28973585.
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