Rupture Of Saccular Intracranial Aneurysm Research Articles

Aneurysm Wall Contrast on Magnetic Resonance Imaging: A New Predictor of Rupture of Saccular Intracranial Aneurysms

Background. Recent studies suggest that accumulation of contrast agent in the aneurysm’s wall may predict a high risk of aneurysm growth or rupture.Objective. To compare the enhancement of the aneurysm wall with other characteristics that affect at the risk of rupture.Materials and Methods. The study included 95 patients with 132 previously identified saccular aneurysms, who underwent magnetic resonance imaging (MRI) according to a specialized protocol using 3.0 Tesla MRI scanner. The presence or absence of aneurysm’s wall enhancement compared with the following characteristics: gender and age of the patient, the size and shape of the aneurysm, the presence of arterial hypertension, and the PHASES score.Results. Accumulation of contrast agent by the aneurysm’s wall was associated with the aneurysm dome size (p < 0,001, Sp = 78,1 %, Se = 72,1 %) and PHASES score (p < 0,001, Sp = 64,1 %, Se =57,1 %). No relationship between age, gender, arterial hypertension, shape, and aneurysm location and contrast enhancement was found (p > 0,05).Conclusion. Contrast enhancement of the aneurysm wall on MRI can be considered an additional risk marker of its rupture.

Impact of Young Age on the Presentation of Saccular Intracranial Aneurysms: Population-Based Analysis of 4082 Patients.

Formation and rupture of saccular intracranial aneurysms (sIAs) may have different pathobiologies in patients with younger age at first diagnosis of sIA disease. To study the phenotype of sIA disease and formation of new (de novo) sIAs in patients below 40 yr. A population-based cohort study was conducted in 613 young (<40 yr) sIA patients with first diagnosis between 1980 and 2014 and total angiographic follow-up of 3768 yr. Of the 613 sIA patients <40 yr, 508 had aneurysmal subarachnoid hemorrhage (sIA-SAH) and 105 unruptured sIA(s) at first sIA diagnosis. Hypertension was 2 times less common among <40 than >40-yr-old patients (unruptured and ruptured). Smoking was very prevalent in <40-yr-old patients (33% in SAH, 68% unruptured). SAH patients <40 yr more often had family history of sIA, and lower PHASES scores (age omitted, P< .001). Ruptured sIAs were small (<7 mm) in 33% of 39 to 30 yr patients, in 44% of 29 to 20 yr patients, and 57% of <19 yr patients. Their shape was irregular in 90%, 94%, and 95%, respectively. Smoking history (hazard ratio [HR] 2.8, 95% confidence interval [CI] 1.2-7.0), family history for sIAs (HR 3.1, 95% CI 1.3-7.7), and age at presentation (HR .91 per year, 95% CI .85-.98) were risk factors for de novo sIA formation, diagnosed in 4% even after 20 yr (median 11.8 yr). Smoking and family history are risk factors for sIA formation and aneurysmal SAH at young age. Young aneurysmal SAH patients had lower PHASES scores and often rupture from a small sIA, suggesting need for more aggressive management.

NF-κB-Mediated Inflammation in the Pathogenesis of Intracranial Aneurysm and Subarachnoid Hemorrhage. Does Autophagy Play a Role?

The rupture of saccular intracranial aneurysms (IA) is the commonest cause of non-traumatic subarachnoid hemorrhage (SAH)—the most serious form of stroke with a high mortality rate. Aneurysm walls are usually characterized by an active inflammatory response, and NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) has been identified as the main transcription factor regulating the induction of inflammation-related genes in IA lesions. This transcription factor has also been related to IA rupture and resulting SAH. We and others have shown that autophagy interacts with inflammation in many diseases, but there is no information of such interplay in IA. Moreover, NF-κB, which is a pivotal factor controlling inflammation, is regulated by autophagy-related proteins, and autophagy is regulated by NF-κB signaling. It was also shown that autophagy mediates the normal functioning of vessels, so its disturbance can be associated with vessel-related disorders. Early brain injury, delayed brain injury, and associated cerebral vasospasm are among the most serious consequences of IA rupture and are associated with impaired function of the autophagy–lysosomal system. Further studies on the role of the interplay between autophagy and NF-κB-mediated inflammation in IA can help to better understand IA pathogenesis and to identify IA patients with an increased SAH risk.

EHMTI-0119. Increased prevalence of migraine in patients with unruptured saccular intracranial aneurysms (SIA)

Rupture of SIA causes thunderclap headache but it remains unclear whether headache in general and migraine in particular is more prevalent in patients with unruptured SIA.

Biological Mechanisms Underlying Growth and Rupture of Saccular Intracranial Aneurysm

Biological Mechanisms Underlying Growth and Rupture of Saccular Intracranial Aneurysm

Type 2 Diabetes and Risk of Rupture of Saccular Intracranial Aneurysm in Eastern Finland

OBJECTIVEType 2 diabetes is a risk factor for other forms of stroke, but its association with subarachnoid hemorrhage (SAH) from ruptured saccular intracranial aneurysm (sIA) has remained unclear.RESEARCH DESIGN AND METHODSKuopio Intracranial Aneurysm Database (www.uef.fi/ns) includes all ruptured and unruptured sIA cases from a defined catchment population in eastern Finland since 1980. We compared the age-adjusted incidences of type 2 diabetes in 1,058 ruptured and 484 unruptured sIA patients during 1994–2008, using the national registry of prescribed medicine purchases.RESULTSOf the 1,058 ruptured sIA patients, 43% were males and 57% females, with a median age at rupture of 51 and 56 years, respectively. From 1994 to 2008 or until death, 9% had been prescribed antidiabetes medication (ADM) with a median starting age of 58 years for males and 66 years for females. Of the 484 unruptured sIA patients, 44% were males and 56% females, with a median age at the diagnosis of 53 and 55 years, respectively, and 9% had used ADM, with a median starting age of 61 years for males and 66 years for females. The incidence of type 2 diabetes was highest in the age-group 60–70 years, with no significant differences between the ruptured and unruptured sIA patients.CONCLUSIONSOur study suggests that type 2 diabetes does not increase the risk of rupture of sIA, which is by far the most frequent cause of nontraumatic SAH.

The relationship of closed-head trauma to rupture of saccular intracranial aneurysms.

It is often asserted, especially in worker's compensation cases, that blunt trauma or work-related physical exertion can be responsible for the rupture of a preexisting saccular intracranial aneurysm. However, a critical review of the literature and extensive personal experience indicates no or at best a very weak relationship between blunt closed-head trauma and the rupture of a preexisting saccular intracranial aneurysm. This report is based on a 19-year study of the effects of trauma on aneurysms in a clinical and autopsy-derived population.

INTRACRANIAL ANEURYSM RUPTURE, VASOSPASM, AND INFARCTION.

During a recent study of the relationship between spontaneous rupture of saccular intracranial aneurysms and cerebral infarction, a preliminary comparison with angiographic reports of cerebral vasospasm was made. 1 Infarcts were found in the brains of 65% of patients in whose angiograms vasospasm had been noted, while 82% of patients for whom vasospasm had not been reported also had infarcts. These figures suggested that there was no correlation between these two factors. However, since many of these reports were from the early days of cerebral angiography and represented the reading of many radiologists, it was felt that a more thorough study of this relationship was indicated to better assess the role of vasospasm in the production of cerebral infarcts in these patients. Material and Methods Eighty-five cerebral angiograms performed on 53 patients after rupture of an intracranial aneurysm were reviewed by one of us (I. K.) with-out prior knowledge

"An Autocratic Manner"

<i>BACKGROUND AND PURPOSE:</i> Distinguishing whether forces resulting from the impingement of central blood flow streams at a curved arterial segment or at the apex of an intracranial bifurcation could be important for the understanding of aneurysm formation. Using finite element models, our purpose was to investigate the hemodynamics related to intracranial saccular aneurysm formation through computer simulations. <i>METHODS:</i> We present two-dimensional finite element models describing several distinct stages of aneurysm formation in both curved and bifurcating arteries. For each model, a description of the numeric solutions and results are presented. <i>RESULTS:</i> Our results suggest that the pressures and shear stresses that develop along the outer (lateral) wall of a curved artery and at the apex of an arterial bifurcation create a hemodynamic state that promotes saccular aneurysm formation. The impingement of the central stream results in greatly increased velocity/pressure gradients and high shear stresses at the apex compared with those in the proximal parent or distal daughter branches. The results also indicate that the maximal pressure generated at the apex of the arterial bifurcation ranges from two to three times the peak luminal pressure in the proximal parent artery. <i>CONCLUSION:</i> These data suggest that, in the absence of any underlying disease process, aneurysm development is a mechanically mediated event. These models offer a plausible hypothesis regarding the initiation, growth, and subsequent rupture of saccular intracranial aneurysms as they relate to the hemodynamics of intracranial arterial blood flow.