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Ruptured Cerebral Aneurysm


Presentation

  • The presentation in adulthood with rupture of the aneurysm and the successful surgical treatment of both abnormalities are unusual.[ncbi.nlm.nih.gov]
Normal Hearing
  • Completely normalized hearing was found in five patients at 3-6 months follow-up, whereas two cases noticed a partial loss and one made no recovery.[ncbi.nlm.nih.gov]
Cesarean Section
  • A combined surgical procedure (cesarean section followed by clipping of the aneurysm) was performed with good maternal and fetal outcome. The differential diagnosis, the timing of neurosurgery, and the anesthetic techniques used are discussed.[ncbi.nlm.nih.gov]
Cognitive Deficit
  • If a full IQ as defined by WAIS-III and 1SD below the mean is considered as the main measure of cognitive deficits, 5.4% of the sample suffered from cognitive deficits. There were no differences between clipped and coiled patients (t 0.03; p 0.97).[ncbi.nlm.nih.gov]
Quadriplegia
  • The patient had residual moderate disturbance of consciousness and quadriplegia before transfer for rehabilitation.[ncbi.nlm.nih.gov]
Dysphasia
  • Other symptoms may include nausea, vomiting, impaired consciousness, nuchal rigidity, orbital pain, focal neurologic deficits, dysphasia, lightheadedness, and dizziness.[aafp.org]

Workup

  • Workup for Patients with Suspected Nontraumatic SAH Figure 1. Algorithm for evaluating patients with suspected nontraumatic SAH.[aafp.org]
  • The workup may include: Physical exam - The physician checks blood pressure, feels the body for masses and listens to blood flow sounds.[innerbody.com]
  • See Workup for more detail.[emedicine.medscape.com]
Macrocytic Anemia
  • At a referring institution, he showed evidence of macrocytic anemia (white blood cell count, 9,000/μL; red blood cell count, 104 10(4)/μL; hemoglobin, 4.0 g/dL; hematocrit, 12.2%; and platelet count, 26.6 10(4)/μL).[ncbi.nlm.nih.gov]

Treatment

  • BACKGROUND: Endovascular coil embolization and craniotomy with clip ligation are the 2 most commonly used treatments for ruptured cerebral aneurysm.[ncbi.nlm.nih.gov]

Prognosis

  • Abstract Subpial hematoma is a rare type of intracranial hemorrhage with a poor prognosis.[ncbi.nlm.nih.gov]
  • The prognosis of patients with early reruptured aneurysms is discouraging. A rerupture of an aneurysm with active bleeding is extremely rare, and the mechanisms involved remain unclear.[ajnr.org]
  • Therefore, early diagnosis and proper treatment are crucial for a good prognosis.[skullbaseinstitute.com]

Etiology

  • Loculated intracranial aneurysms: angiography and possible etiology. Radiology 1974 ; 113 : 101 Gailloud P, Murphy KJ. Rupture of cerebral aneurysm during angiography. N Engl J Med 1999 ; 340 : 1442 Yousem DM, Trinh BC.[ajnr.org]
  • Pathophysiology The pathogenesis of cerebral aneurysms is related inherently to structural aberrations of the cerebrovasculature, although the etiology of these abnormalities may be diverse.[emedicine.medscape.com]
  • Size Small, 15 mm Large, 15–25 mm Giant, 25–50 mm Supergiant, 50 mm Shape Berry: Most common (95%); berry-shaped aneurysm with a neck or stem Sacular: Any aneurysm with a sacular outpouching Fusiform: Outpouching of an arterial wall but with no stem Etiology[medical-dictionary.thefreedictionary.com]

Epidemiology

  • BACKGROUND: To review the epidemiology of sporadic ruptured cerebral aneurysm.[ncbi.nlm.nih.gov]
  • Aneurysm subarachnoid hemorrhage outcomes epidemiology national inpatient sample unruptured aneurysm hemorrhage coil statistics Statistics from Altmetric.com Aneurysm subarachnoid hemorrhage outcomes epidemiology national inpatient sample unruptured aneurysm[jnis.bmj.com]
  • Epidemiology of subarachnoid hemorrhage in Finland from 1983 to 1985. Stroke. 1991. 22: 848-53 23. Szikora I, Berentei Z, Kulcsar Z, Marosfoi M, Vajda ZS, Lee W.[surgicalneurologyint.com]
  • Controversies in epidemiology of intracranial aneurysms and SAH . Nat. Rev. Neurol. 12 , 50–55 (2016). 115. Etminan, N. et al .[nature.com]
  • "Epidemiology and genetics of intracranial aneurysms". European Journal of Radiology. 82 (10): 1598–605. doi : 10.1016/j.ejrad.2012.12.026. PMID 23399038.[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Blister aneurysms were not considered in this series since they differ both morphologically and histologically from saccular aneurysms and likely represent a distinct pathophysiology.[surgicalneurologyint.com]
  • The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol (Oxf). 2006 Mar. 64(3):250-4. [Medline]. Sluzewski M, van Rooij WJ.[emedicine.medscape.com]
  • Recent genome-wide association studies (GWAS) provide molecular evidence for shared biological function and activities (pathophysiology) of these aneurysms.[ninds.nih.gov]
  • These include 1p34-36, 2p14-15, 7q11, 11q25, and 19q13.1-13.3. [11] Pathophysiology [ edit ] Aneurysm means an outpouching of a blood vessel wall that is filled with blood. Aneurysms occur at a point of weakness in the vessel wall.[en.wikipedia.org]

Prevention

  • The rationale of this emergency procedure is to prevent early rerupture and also to prevent neurological ischaemic consequences of the subarachnoid haemorrhage likely to develop in the first week after a rupture.[ncbi.nlm.nih.gov]
  • An aneurysm that has not burst can be managed or treated to prevent it from rupturing. An aneurysm can happen anywhere in your brain. They most commonly form between the brain and the base of the skull.[drugs.com]

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