Contents

Search

intracranial aneurysm

Includes: - brain aneurysm - cerebellar aneurysm - brainstem aneurysm - cerebral aneurysm * see cerebral aneurysm Laboratory: - higher genetically predicted serum magnesium associated with reduced risk of intracranial aneurysm & associated hemorrhage [6] Radiology: - catheter-based angiography necessary for definitive diagnosis [2] - imaging every 5 years for tiny (<= 3 mm) aneurysms [4] Complications: - rupture (5 year rupture rate) [2] - anterior circulation - internal carotid artery, middle cerebral artery, anterior communicating artery - < 7 mm (0%) - 7-12 mm (2.6%) - 13-24 mm (14.5%) - > 25 mm (40%) - posterior circulation - basilar artery, posterior communicating artery - < 7 mm (2.5%) - 7-12 mm (14.5%) - 13-24 mm (18.4%) - > 25 mm (50%) * ref [3] reports annual rupture rates of - 0% for aneurysms <= 3 mm - 0.5% for aneurysms <= 5 mm - <1% for aneurysms <= 7 mm * pooled clinical complication risk of repai = 5% [5] Management: - neurosurgery for symptomatic enlarging aneurysms - smoking cessation to reduce risk of aneurysm rupture [2] - for tiny aneurysms (<= 3 mm), no follow-up is the best strategy & is associated with the highest number of quality-adjusted life-years [4]

Specific

brain aneurysm

General

vascular aneurysm

References

  1. Thompson BG, Brown RD Jr, Amin-Hanjani S et al. Guidelines for the management of patients with unruptured intracranial aneurysms: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015 Jun 18 PMID: 26089327
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021.
  3. Malhotra A, Wu X, Forman HP et al Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms: A Systematic Review. Ann Intern Med. 2017. June 6 PMID: 28586893 http://annals.org/aim/article/2630765/growth-rupture-risk-small-unruptured-intracranial-aneurysms-systematic-review - Starke RM Small Cerebral Aneurysms: Can We Identify Patients at Risk for Rupture? Ann Intern Med. 2017. June 6 PMID: 28586919 http://annals.org/aim/article/2630767/small-cerebral-aneurysms-can-we-identify-patients-risk-rupture
  4. Malhotra A, Wu X, Forman HP et al. Management of tiny unruptured intracranial aneurysms: A comparative effectiveness analysis. JAMA Neurol 2017 Nov 20 PMID: 29159405
  5. Algra AM, Lindgren A, Vergouwen MDI et al Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial AneurysmsA Systematic Review and Meta-analysis. JAMA Neurol. Published online December 28, 2018 PMID: 30592482 https://jamanetwork.com/journals/jamaneurology/fullarticle/2719464
  6. Larsson SC, Gill D Association of Serum Magnesium Levels With Risk of Intracranial Aneurysm: A Mendelian Randomization Study. Neurology 2021, June 22 PMID: 34158381 https://n.neurology.org/content/early/2021/05/20/WNL.0000000000012244