Presence Of Intracranial Aneurysms Research Articles

Anatomical Markers Associated With the Presence of Intracranial Aneurysms in Individuals Screened for Aneurysms

Background Hemodynamic stress is linked to the development of intracranial aneurysms (IAs) and may be influenced by anatomic variation of intracranial arteries. We assessed diameters and bifurcation angles of intracranial arteries forming the circle of Willis in a cohort of individuals screened for the presence of IAs. Methods Individuals with and without IAs identified at screening with magnetic resonance angiography were compared. Diameters and bifurcation angles of the following arteries were measured using semiautomatic methods: A1 and A2 segments of the anterior cerebral artery, M1 and M2 segments of the middle cerebral artery, P1 segments of the posterior cerebral artery, posterior communicating artery (Pcom), internal carotid artery, vertebral artery, and basilar artery. We employed univariate general linear models to assess group differences. This included subgroup comparisons between individuals with IAs at specific locations and matched controls, and comparisons on group level between individuals with and without IAs, corrected for age and sex. Results In 94 of the 1049 individuals (9.0%) included, IAs were detected. Individuals with middle cerebral artery IAs had wider ipsilateral M2–M2 bifurcation angles compared with controls (121±25° versus 97±19°; P <0.01). Individuals with anterior communicating artery IAs showed smaller angles for the A1–A2 bifurcation (106±16° versus 120±17°; P = 0.02), while those with Pcom IAs had wider Pcom–C7 bifurcation angles (147±14° versus 127±17°; P = 0.02) and smaller diameters below the ipsilateral internal carotid artery top (2.86±0.36 mm versus 3.10±0.33 mm; P = 0.03) compared with controls. Conclusion We found associations between wider M2–M2 bifurcation angles or narrower A1–A2 bifurcation angles and IA presence, consistent with prior literature. Moreover, we uncovered previously unexplored associations, including wider Pcom–C7 bifurcation angles and smaller internal carotid artery diameters in individuals with Pcom IAs. Future research should explore the potential of these markers in predicting IAs in at‐risk populations during follow‐up screenings.

Factors associated with early-onset intracranial aneurysms in patients with autosomal dominant polycystic kidney disease.

Recently, the importance of attribute-based medicine has been emphasized. The effects of early-onset intracranial aneurysms on patients can be significant and long-lasting. Herein, we compared the factors associated with intracranial aneurysms in patients with autosomal dominant polycystic kidney disease (ADPKD) according to age categories (≥ 50years, < 50years). We included 519 ADPKD patients, with a median age of 44years, estimated glomerular filtration rate of 54.5mL/min/1.73 m2, and total follow-up duration of 3104 patient-years. Logistic regression analyses were performed to determine factors associated with intracranial aneurysms. Regarding the presence ofintracranial aneurysm, significant interactions were identified between the age category (age ≥ 50years), female sex (P = 0.0027 for the interaction) and hypertension (P = 0.0074 for the interaction). Female sex and hypertension were associated with intracranial aneurysm risk factors only in patients aged ≥ 50years. The presence of intracranial aneurysm was significantly associated with chronic kidney disease (CKD) stages 4-5 (odds ratio [OR] = 3.87, P = 0.0007) and family history of intracranial aneurysm or subarachnoid hemorrhage (OR = 2.30, P = 0.0217) in patients aged < 50years. For patients aged ≥ 50years, in addition to the abovementioned factors [OR = 2.38, P = 0.0355 for CKD stages 4-5; OR = 3.49, P = 0.0094 for family history of intracranial aneurysm or subarachnoid hemorrhage], female sex (OR = 4.51, P = 0.0005), and hypertension (OR = 5.89, P = 0.0012) were also associated with intracranial aneurysm. Kidney dysfunction and family history of intracranial aneurysm or subarachnoid hemorrhage are risk factors for early-onset intracranial aneurysm. Patients aged < 50years with a family history of intracranial aneurysm or subarachnoid hemorrhage or with CKD stages 4-5 may be at an increased risk of early-onset intracranial aneurysm.

Abstract TMP114: The Role of Iron Mediated Oxidative Stress and Lipid Peroxidation in the Development of Intracranial Aneurysm Rupture

Introduction: Iron is an essential element for vascular wall maintenance. However, iron deposition in the vascular wall may cause oxidative stress, which can attack DNA, proteins, and lipid membranes via the Fenton/Haber-Weiss reaction. Iron-induced oxidative stress triggers lipid oxidation, inflammation, endothelial cell activation and intracranial aneurysmal formation, growth, and rupture. Subarachnoid hemorrhage from intracranial aneurysm rupture results in significant morbidity and mortality. This study used a mouse model of intracranial aneurysm to evaluate the effect of dietary iron restriction on aneurysm formation and rupture. Methods: Intracranial aneurysms were induced using deoxycorticosterone acetate-salt-induced hypertension and a single injection of elastase into the cerebrospinal fluid of the basal cistern. Mice were fed an iron-restricted diet or a normal diet. Aneurysm rupture was detected by neurological symptoms, while the presence of intracranial aneurysm with subarachnoid hemorrhage was confirmed by post-mortem examination. Results: The aneurysmal rupture rate was significantly lower in iron-restricted diet mice (37%) compared with normal diet mice (76%; p &lt; 0.05). Serum oxidative stress, iron accumulation, macrophage infiltration, and 8-hydroxy-2′-deoxyguanosine in the vascular wall were lower in iron-restricted diet mice ( p &lt; 0.01). The areas of iron positivity were similar to the areas of CD68 positivity and 8-hydroxy-2′-deoxyguanosine in both normal diet and iron-restricted diet mice aneurysms. Conclusions: Compared with a normal diet, an iron-restricted diet reduced the incidence of intracranial aneurysmal rupture in mice via inhibition of iron accumulation in the aneurysmal wall. Iron may be a potential therapeutic target to prevent intracranial aneurysm rupture. Long-term iron restriction may be required to affect aneurysm formationrupture.

Prevalence and Characteristics of Intracranial Aneurysms in Hereditary Hemorrhagic Telangiectasia.

The association between hereditary hemorrhagic telangiectasia and intracranial aneurysms remains controversial. This study evaluated the prevalence and characteristics of intracranial aneurysms in patients with hereditary hemorrhagic telangiectasia with brain vascular malformations. Between 2007 and 2021, patients enrolled in the Brain Vascular Malformation Consortium with definite hereditary hemorrhagic telangiectasia, the presence of brain vascular malformations, and available angiographic studies of the brain were retrospectively reviewed. Angiographic features of intracranial aneurysms and their relationship to coexisting brain vascular malformations were analyzed. We also examined the association between baseline clinical features and the presence of intracranial aneurysms. One hundred eighty patients were included. A total of 14 intracranial aneurysms were found in 9 (5%) patients, and 4 intracranial aneurysms were considered flow-related aneurysms. Patients with intracranial aneurysms were significantly older than patients without intracranial aneurysms (mean, 48.1 [SD, 18.2] years versus 33.5 [SD, 21.0] years; P = .042). If we excluded flow-related intracranial aneurysms, the prevalence of intracranial aneurysms was 3.3%. All intracranial aneurysms were in the anterior circulation, were unruptured, and had an average maximal diameter of 3.9 (SD, 1.5) mm. No intracranial aneurysms were found in pediatric patients with hereditary hemorrhagic telangiectasia. No statistically significant correlation was observed among other baseline demographics, hereditary hemorrhagic telangiectasia features, and the presence of intracranial aneurysms. The prevalence of intracranial aneurysms in this large cohort study is comparable with that in the general population and might be increased slightly due to hemodynamic factors associated with shunting brain vascular malformations.

Subarachnoid Hemorrhage Following Drainage of Chronic Subdural Hematoma: A Case Report

Background: Acute subarachnoid hemorrhage (SAH) is a rare but severe complication after burr hole surgery for Subarachnoid hemorrhage (CSDH). Case presentation: An 86-year-old male was found fainted. Computed tomography (CT) scans showed a right fronto-temporo-parietal CSDH with a shift in the midline structures. Under local anesthetic with medical sedation a closed-system drainage of the hematoma was performed via one burr hole. Two days after surgery the patient complained of headache and a subsequent CT scan revealed SAH. The presence of intracranial aneurysms was excluded by CT angiogram. The patient survived with medical management.

Three-Dimensional Morphometric Analysis of Anterior Cerebral Circulation Aneurysms.

This article assesses the association between anterior circulation morphometry and the presence of intracranial aneurysm using three-dimensional rotational angiography (3DRA). A retrospective analysis at a Peruvian academic medical center between December 2018 and February 2020 identified 206 patients with unruptured intracranial aneurysms and matched controls who underwent 3DRA. Angiographic images were obtained per standard of care, and measurements of the vasculature were performed using 3DRA vascular automated software. A total of 163 aneurysms and 43 control angiograms were evaluated. Women represented 82.5% of the cases and the mean age was 55.9 years (standard deviation ± 14.2). In multivariate analysis, five specific features were found to be statistically significant predictors for presence of an anterior circulation aneurysm: female sex (odds ratio [OR] = 2.71; p = 0.048), C-shape of the middle cerebral artery (MCA) (OR = 2.73; p = 0.018), distal internal carotid artery (ICA) diameter (OR = 3.42; p = 0.012), ICA bifurcation angle (OR = 1.02; p = 0.036), and length of the carotid siphon (OR = 1.08; p = 0.047). Features detected on 3DRA suggest morphological characteristics of the ICA and MCA may be predictive for intracranial aneurysm. Our findings build from prior reports by demonstrating five specific patient and imaging features associated with anterior circulation aneurysms. While 3DRA is the standard of care in many settings, medical centers with resource limitations may not have access to this technique. The demographic and morphological features identified in our study may have correlates that if detected on contrast computed tomography or magnetic resonance imaging studies, may be used to help screen for a higher level of care in select patients.

Cost-effectiveness of repeat delayed imaging for spontaneous subarachnoid hemorrhage.

In patients with intracranial aneurysm presenting with spontaneous subarachnoid hemorrhage (SAH), 15% of them could be missed by the initial diagnostic imaging. Repeat delayed imaging can help to identify previously undetected aneurysms, however, the cost-effectiveness of this strategy remains uncertain. The aim of this study is to assess the cost-effectiveness of repeat delayed imaging in patients with SAH who had a negative result during their initial imaging. A Markov model was developed to estimate the lifetime costs and quality-adjusted life-year (QALY) for patients who received or not received repeat delayed imaging. The analyses were conducted from a healthcare perspective, with costs reported in UK pounds and expressed in 2020 values. Extensive sensitivity analyses were performed to assess the robustness of the results. The base case incremental cost-effectiveness ratio (ICER) of repeat delayed imaging is £9,314 per QALY compared to no-repeat delayed imaging. This ICER is below the National Institute for Health and Care Excellence (NICE) £20,000 per QALY willingness-to-pay threshold. At the NICE willingness-to-pay threshold of £20,000 per QALY, the probability that repeat delayed imaging is most cost-effective is 0.81. The results are sensitive to age, the utility of survived patients with a favorable outcome, the sensitivity of repeat delayed imaging, and the prevalence of aneurysm. This study showed that, in the UK, it is cost-effective to provide repeat delayed imaging using computed tomographic angiography (CTA) for patients with SAH who had a negative result in their initial imaging.

Dietary Iron Restriction Protects against Aneurysm Rupture in a Mouse Model of Intracranial Aneurysm

Introduction: Iron accumulation in vessel walls induces oxidative stress and inflammation, which can cause cerebrovascular damage, vascular wall degeneration, and intracranial aneurysmal formation, growth, and rupture. Subarachnoid hemorrhage from intracranial aneurysm rupture results in significant morbidity and mortality. This study used a mouse model of intracranial aneurysm to evaluate the effect of dietary iron restriction on aneurysm formation and rupture. Methods: Intracranial aneurysms were induced using deoxycorticosterone acetate-salt-induced hypertension and a single injection of elastase into the cerebrospinal fluid of the basal cistern. Mice were fed an iron-restricted diet (n = 23) or a normal diet (n = 25). Aneurysm rupture was detected by neurological symptoms, while the presence of intracranial aneurysm with subarachnoid hemorrhage was confirmed by post-mortem examination. Results: The aneurysmal rupture rate was significantly lower in iron-restricted diet mice (37%) compared with normal diet mice (76%; p < 0.05). Serum oxidative stress, iron accumulation, macrophage infiltration, and 8-hydroxy-2′-deoxyguanosine in the vascular wall were lower in iron-restricted diet mice (p < 0.01). The areas of iron positivity were similar to the areas of CD68 positivity and 8-hydroxy-2′-deoxyguanosine in both normal diet and iron-restricted diet mouse aneurysms. Conclusions: These findings suggest that iron is involved in intracranial aneurysm rupture via vascular inflammation and oxidative stress. Dietary iron restriction may have a promising role in preventing intracranial aneurysm rupture.

Relationship between phenotypic features in Loeys-Dietz syndrome and the presence of intracranial aneurysms.

Loeys-Dietz syndrome (LDS) is a rare autosomal dominant condition characterized by aneurysms of the aorta, aortic branches, and intracranial arteries; skeletal and cutaneous abnormalities; and craniofacial malformations. Previous authors have reported that higher craniofacial severity index (CFI) scores, which indicate more severe craniofacial abnormalities, correlate with the severity of aortic aneurysm pathology. However, the association between syndromic features and the formation of intracranial aneurysms in LDS patients has yet to be determined. In this study, the authors evaluate the incidence of phenotypic abnormalities, craniofacial features, and Chiari malformation type I (CM-I) in a large LDS cohort and explore possible risk factors for the development of intracranial aneurysms. This was a retrospective cohort study of all patients with LDS who had been seen at the Marfan Syndrome and Aortopathy Center at Washington University School of Medicine in St. Louis in 2010-2022. Medical records were reviewed to obtain demographic, clinical, and radiographic data. The prevalence of craniofacial, skeletal, and cutaneous pathologies was determined. Bivariate logistic regression was performed to identify possible risk factors for the formation of an intracranial aneurysm. Eighty-one patients with complete medical records and intracranial vascular imaging were included in the analysis, and 18 patients (22.2%) had at least 1 intracranial aneurysm. Patients frequently demonstrated the thin or translucent skin, doughy skin texture, hypertelorism, uvular abnormalities, and joint hypermobility typical of LDS. CM-I was common, occurring in 7.4% of the patients. Importantly, the patients with intracranial aneurysms were more likely to have CM-I (22.2%) than those without intracranial aneurysms (3.2%). The mean CFI score in the cohort with available data was 1.81, with higher means in the patients with the TGFBR1 or TGFBR2 disease-causing variants (2.05 and 3.30, respectively) and lower in the patients with the SMAD3, TGFB2, or TGFB3 pathogenic variants (CFI < 1). No significant CFI difference was observed in patients with or without intracranial aneurysms (2.06 vs 1.74, p = 0.61). CM-I, and not the CFI, is significantly associated with the presence of intracranial aneurysms in patients with LDS. Surveillance for intracranial aneurysms is essential in all patients with LDS and should not be limited to those with severe phenotypes. Long-term monitoring studies will be necessary to determine whether a correlation between craniofacial abnormalities and adverse outcomes from intracranial aneurysms (growth, intervention, or rupture) exists.

Zerebrovaskuläre Komplikationen bei Neuroborreliose

Bei rezidivierenden und multilokulären Schlaganfällen sollte in Endemiegebieten an eine seltene zerebrovaskuläre Manifestation einer Neuroborreliose gedacht werden. Oft ist eine Prodromalphase mit unspezifischen Symptomen über Monate anamnestisch erhebbar. Das Auftreten intrakranieller Aneurysmen kann ein weiterer Hinweis sein. Im Liquor findet sich eine lymphomonozytäre Pleozytose mit Eiweißerhöhung, beweisend ist ein positiver Borrelien AI. Schon bei Verdacht sollte sofort eine leitliniengerechte antibiotische Therapie initiiert werden. Das Therapieansprechen wird klinisch definiert, die Liquorpleozytose kann über die klinische Remission hinaus persistieren.

Rupture pressure values of cerebral arteries in the presence of unruptured intracranial aneurysm

Cerebral arteries (CAs) are prone to the saccular aneurysm formation. Since aneurysms may be considered as balloon-like dilations of the locally weakened arterial wall, it should be determined whether the presence of intracranial aneurysm is related to the generalized weakening of CAs. Among 184 consecutive forensic autopsies, eight brains with a single unruptured saccular aneurysm were identified. Aneurysms with adjacent CAs and specific CA segments were excised, namely: the anterior communicating artery complex, and bifurcations of the basilar artery, internal carotid arteries, and middle cerebral arteries. Then, aneurysm and CA specimens were subjected to pressure-inflation tests until rupture occurred at the arterial bifurcation or at the wall of the CA or aneurysm. The same protocol was applied to the control group composed of CAs excised from eight brains without aneurysm. No significant differences were noted between the experimental and control groups, depending on the mean rupture pressure (1054 vs. 1048 mmHg) and rupture site (bifurcation vs. wall) of the analyzed specimens. These findings indicate that the presence of unruptured saccular aneurysm is not related to generalized weakening of CAs among autopsy subjects. Moreover, the CA bifurcations do not represent regions of decreased wall strength.

Agenesis of the internal carotid artery associated with intracranial aneurysms: Endovascular treatment and intraoperative complications management.

Agenesis of the internal carotid artery (ICA) is a rare condition, whereas the association of this condition and the presence of intracranial aneurysms is higher in comparison to patients with normal vasculature. Endovascular treatment of this particular subgroup of patients has been described, but complications associated during treatment have not. Herein, we describe the endovascular treatment of intracranial aneurysms in two cases complicated with coil protrusion and in-stent thrombosis in the setting of agenesis of the ICA which were treated successfully without clinical compromise. One-year follow-up digital subtraction angiography demonstrated the complete obliteration of both aneurysms. In most of the cases, coil protrusion does not require further intervention; nevertheless, in the setting of ICA agenesis, stent placement is a potential alternative. In-stent thrombosis should be treated promptly with the available tools, in our case intra-arterial Alteplase reperfused the parent vessel.

Case report of unilateral abducens nerve paresis: A common sign with an uncommon etiology

Sixth nerve paresis is a rare presentation of intracranial aneurysms. We report an uncommon case of unilateral sixth nerve paresis in a young adult as the main presenting feature of an intracavernous aneurysm. The patient presented with pain and double vision in the right eye for 1 month. Computerized Tomography scan brain done elsewhere was normal. Examination showed right sixth nerve paresis with sensory loss in the first and second divisions of the trigeminal nerve. We suspected a cavernous sinus lesion and conveyed the same to the radiologist who therefore did additional and appropriate imaging, which revealed an intracavernous carotid aneurysm. This case is unique as to the best of our knowledge, it is the first case of its kind reported from India.

Complete Spontaneous Thrombosis in Unruptured Non-Giant Fusiform Intracranial Aneurysm Presenting with Transient Ischemic Attack. Case Report

Welcome to BRAZILIAN JOURNAL OF NEUROSURGERY (JBNC), the official journal of the Brazilian Academy of Neurosurgery, is the oldest Neurosurgery journal in our country. It started in 1973 with the name of “Seara Médica Neurocirúrgica” and, since the beginning, it has been an extremely important information organ for Brazilian neurosurgeons. Brazil is the country with the third largest number of neurosurgeons in the world. Despite this large number of colleagues working in the specialty, we still do not have any journal indexed in PubMedTM, which is considered the most important database for medical journals in the world. Bem-vindo ao Jornal Brasileiro de Neurocirurgia - JBNC. Welcome to Brazilian Journal of Neurosurgery. O JORNAL BRASILEIRO DE NEUROCIRURGIA (JBNC), órgão oficial da Academia Brasileira de Neurocirurgia, é a revista de neurocirurgia mais antiga do nosso país. Iniciou no ano de 1973 com o nome de “Seara Médica Neurocirúrgica” e desde o início tem sido um órgão de informação de extrema importância para os neurocirurgiões brasileiros.

Fund Correction: Unrecognized Ruptured Intracranial Aneurysm Presenting as Cerebral Vasospasm-Induced Ischemic Stroke: A Case Report.

Fund Correction: Unrecognized Ruptured Intracranial Aneurysm Presenting as Cerebral Vasospasm-Induced Ischemic Stroke: A Case Report.

Multiple Intracranial Aneurysms Presented with Subarachnoid Hemorrhage; Which to Secure and How?

BACKGROUND: Dealing with multiple intracranial aneurysms (MIA) presenting with subarachnoid hemorrhage (SAH) is challenging. OBJECT: To make a proposal for the decision-making regarding which aneurysm to secure and how, as the most challenging part in the management of MIA. METHODS: This descriptive study included 25 patients presenting with SAH and having multiple intracranial aneurysms. All patients had a brain computed tomography (CT) scan, CT angiography (CTA), and digital subtraction angiography (DSA). Patients were treated in our institution using microsurgical clipping and/or endovascular embolization according to the clinical and radiological situation. Functional outcome was assessed by modified Rankin scale. RESULTS: Fifteen females and 10 males with average age of 48 years were included. All patients (100%) presented with hemorrhage. Ten patients (40%) were hunt and Hess (HH 19 patients (76%) had 2 aneurysms and 6 patients (24%) had 3 aneurysms. Clipping was done for 40 aneurysms (71%), wrapping for 2 aneurysms (3%), 4 aneurysms (7%) were followed up, 8 aneurysms (14%) were coiled, and 2 aneurysms (3%) were treated by flow diverters. Twenty patients (80%) had a good outcome on the modified Rankin scale, 4 patients (16%) had mental changes and one patient (4%) had residual neurological deficit. CONCLUSION: The ruptured one in multiple intracranial aneurysms can be suspected by its size and wall irregularity especially in the absence of localizing sign in the CT scan. High-resolution CTA and/or 3D DSA are highly helpful. These cases should be managed in specialized centers where the surgical and endovascular treatment modalities are available.

The role of CE-MRA of the supraortic vessels in the detection of associated intracranial pathology.

Contrast-enhanced magnetic resonance angiography (CE-MRA) has become a very popular imaging technique in the evaluation of the extracranial vessels pathology, while it is not commonly used to rule out intracranial vascular pathology. On the contrary, 3D time of flight MRA (TOF-MRA) has a solid role in the study of intracranial arterial vessels disease. One hundred and eight patients were consecutively included in the study. All patients were submitted to a 3 Tesla 3D CE-MRA imaging to rule out extracranial vessels pathology. A comparison was made with a 3D-TOF sequence acquired at the same time in the assessment of intracranial vessels diseases such as steno-occlusion, dissection, and aneurysms. With regard to steno-occlusive disease, Spearman's rank correlation coefficient was of 0.56 for stenosis detection and of 0.57 for occlusive disease detection. The two techniques shared similar results in the evaluation of anterior circulation, while 3D-TOF found higher grades of stenosis for posterior circulation. With regard to dissection, Spearman's rank correlation coefficient was of 0.7. 3D-TOF depicted more intramural hematoma (Spearman's rank = 0.46), while CE-MRA showed more pseudo-aneurysms (Spearman's rank = 0.56). Both the technique equally evaluated the presence of intracranial aneurysms (Spearman's rank = 1). CE-MRA can be considered a reliable tool to rule out intracranial pathology associated to supraortic steno-occlusive disease, also allowing time reduction. In the suspicion of dissection a T1-weighted sequence has to be added to detect the presence of a subacute vessel wall hematoma.

English

Cerebral aneurysms are pathological focal dilatations of cerebral vasculature that are prone to rupture1. Pathogenesis involves aberrations of cerebral vasculature resulting in compromised integrity of internal elastic lamina with associated defects in adjacent media and adventia.1 Apart from posterior communicating artery aneurysm, internal carotid artery aneurysms account for 4 % of all cerebral aneurysms.2 Paraclinoid aneurysms are defined as those originating from the ICA between the infra clinoid portion (C3) and proximal of the posterior communicating artery. Their classification is given by Al Rodhan3 is as follows: Type Ia – superior hypophyseal, type Ib – ventral paraclinoid, type II – true ophthalmic, type III – carotid cave, type IV – transitional, type V – intra cavernous. In literature many cases of cerebral aneurysms presenting with visual symptoms have been reported 4 in which, aneurysms were located on internal carotid artery near ophthalmic artery called as paraclinoid aneurysms. The unruptured cerebral aneurysms cause mass effect hence producing symptoms of nausea, vomiting and severe headache and later on by compressing surrounding cranial nerves produce ocular symptoms like ophthalmoplegia and ptosis. The aneurysms may rupture and result in intracranial bleed which again by mass effect can produce the above told symptoms. We report a case of unruptured intracranial aneurysm presenting with total ophthalmoplegia with visual deficit as the primary symptom.

Clinical Features of Patients With Cervical Artery Dissection and Fibromuscular Dysplasia.

Observational studies have suggested a link between fibromuscular dysplasia and spontaneous cervical artery dissection (sCeAD). However, whether patients with coexistence of the two conditions have distinctive clinical characteristics has not been extensively investigated. In a cohort of consecutive patients with first-ever sCeAD, enrolled in the setting of the multicenter IPSYS CeAD study (Italian Project on Stroke in Young Adults Cervical Artery Dissection) between January 2000 and June 2019, we compared demographic and clinical characteristics, risk factor profile, vascular pathology, and midterm outcome of patients with coexistent cerebrovascular fibromuscular dysplasia (cFMD; cFMD+) with those of patients without cFMD (cFMD-). A total of 1283 sCeAD patients (mean age, 47.8±11.4 years; women, 545 [42.5%]) qualified for the analysis, of whom 103 (8.0%) were diagnosed with cFMD+. In multivariable analysis, history of migraine (odds ratio, 1.78 [95% CI, 1.13-2.79]), the presence of intracranial aneurysms (odds ratio, 8.71 [95% CI, 4.06-18.68]), and the occurrence of minor traumas before the event (odds ratio, 0.48 [95% CI, 0.26-0.89]) were associated with cFMD. After a median follow-up of 34.0 months (25th to 75th percentile, 60.0), 39 (3.3%) patients had recurrent sCeAD events. cFMD+ and history of migraine predicted independently the risk of recurrent sCeAD (hazard ratio, 3.40 [95% CI, 1.58-7.31] and 2.07 [95% CI, 1.06-4.03], respectively) in multivariable Cox proportional hazards analysis. Risk factor profile of sCeAD patients with cFMD differs from that of patients without cFMD. cFMD and migraine are independent predictors of midterm risk of sCeAD recurrence.

An overview of intracranial aneurysms

Intracranial aneurysms are relatively common, with a prevalence of approximately 4%. Unruptured aneurysms may cause symptoms mainly due to a mass effect, but the real danger is when an aneurysm ruptures, leading to a subarachnoid hemorrhage. Most aneurysms are asymptomatic and will not rupture, but they grow unpredictably and even small aneurysms carry a risk of rupture. Intracranial aneurysms are diagnosed and monitored with imaging including intra-arterial digital subtraction angiography, computed tomography angiography, magnetic resonance angiography, and recently transcranial Doppler ultrasonograpy has been proposed as a potential modality. Treatment options include observation, endovascular coiling, and surgical clipping. This paper will review the epidemiology, pathogenesis, clinical presentation, diagnosis, natural history, and management of unruptured saccular intracranial aneurysms.