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Cerebral AneurysmAka: Intracranial Aneurysm, Berry Aneurysm

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  1. See Also
    1. Neurovascular Anatomy
    2. Subarachnoid Hemorrhage
  2. Epidemiology: Incidence
    1. Incidental finding in 6% of U.S. population
    2. Family History >1 with aneurysm: 9% of population
  3. Risk Factors
    1. General risk factors
      1. Age over 50 years
      2. More common in women
      3. Tobacco abuse
      4. Cocaine abuse
      5. Head Trauma
      6. Intracranial neoplasm
      7. Hypertension
      8. Alcohol use
      9. Oral Contraceptive
      10. Hyperlipidemia
    2. Inherited conditions
      1. Polycystic Kidney Disease (10-15% have aneurysms)
      2. Type IV Ehlers-Danlos Syndrome
      3. Pseudoxanthoma elasticum
      4. Hereditary Hemorrhagic Telangiectasia
      5. Neurofibromatosis Type I
      6. Alpha-1-Antitrypsin Deficiency
      7. Klinefelter's Syndrome
      8. Tuberous sclerosis
      9. Noonan's Syndrome
      10. Alpha-glucosidase deficiency
      11. Hypertensive conditions (e.g. Pheochromocytoma)
      12. No relationship to Marfan's Syndrome
  4. Types
    1. Saccular Aneurysm (Berry Aneurysm)
      1. Most common cerebral aneurysm (90%)
      2. Defect in artery tunica muscularis
      3. Usually occurs at vessel bifurcation
    2. Fusiform Aneurysm
      1. Originates in tortuous arteries
      2. More commonly occurs in vertebrobasilar vessels
    3. Dissecting Aneurysm
      1. Result of cystic medial necrosis or trauma
      2. Blood follows false lumen
  5. Most common sites of aneurysm
    1. Anterior Communicating Artery (35%)
    2. Posterior Communicating Artery (35%)
    3. Middle Cerebral Artery (20%)
  6. Symptoms
    1. Asymptomatic until rupture in most patients
    2. See Subarachnoid Hemorrhage
    3. Headache
    4. Vision changes or Oculomotor Nerve dysfunction
    5. Seizures
    6. Ischemic changes in specific anatomic distribution
      1. Anterior Cerebral Artery CVA
      2. Middle Cerebral Artery CVA
      3. Vertebro-Basilar CVA
      4. Posterior Cerebral Artery CVA
      5. Posterior Inferior Cerebellar Artery CVA
  7. Radiology
    1. Intra-arterial digital subtraction angiography
      1. Gold Standard
      2. Permanent neurologic complications in 0.5% cases
    2. MR angiography
    3. CT angiography
    4. Transcranial Doppler ultrasound
  8. Complications: Subarachnoid Hemorrhage
    1. Mortality: 50% for ruptured aneurysm
    2. Risk of rupture
      1. Aneurysm >9 mm: 1% annual risk
      2. Aneurysm <10 mm
        1. Prior Subarachnoid Hemorrhage: 0.5% annual risk
        2. No prior Subarachnoid Hemorrhage: 0.05% annual risk
          1. Recent study suggests 0.1% annual risk if <7 mm
          2. (2003) Lancet 362:103
  9. Management: Neurosurgery Options
    1. Open repair via craniotomy
      1. Mortality: 2.6%
      2. Morbidity: 10.9% (decreased neurologic function)
    2. Endovascular treatment (Guglielmi detachable coil)
      1. New procedure with unclear efficacy
  10. Prevention
    1. Screening asymptomatic patients is not recommended
    2. Screening patients with significant risk factors
      1. May be indicated in high risk cases
      2. Example: Two or more family members with aneurysm
  11. References
    1. (1998) N Engl J Med 339:1725
    2. Raaymakers (1998) Stroke 29:1531
    3. Vega (2002) Am Fam Physician 66(4):601
    4. Wardlaw (2000) Brain 123:205

Berry Aneurysm (C0005136)

ConceptsDisease or Syndrome (T047) , Anatomical Abnormality (T190)
MSHD002532
EnglishBerry Aneurysm, Berry aneurysm - disorder, Berry Aneurysms, Saccular Aneurysm, Saccular Aneurysms
Spanishaneurisma en frambuesa, aneurisma sacular
Parent ConceptsBrain Aneurysm (C0751003), Aneurysm (C0002940), Intracranial Aneurysm (C0007766)
SourcesCOSTAR, CSP, MSH, MTH, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Intracranial Aneurysm (C0007766)

Definition (MSH)Abnormal outpouching in the wall of intracranial blood vessels. Most common are the saccular (berry) aneurysms located at branch points in CIRCLE OF WILLIS at the base of the brain. Vessel rupture results in SUBARACHNOID HEMORRHAGE or INTRACRANIAL HEMORRHAGES. Giant aneurysms (>2.5 cm in diameter) may compress adjacent structures, including the OCULOMOTOR NERVE. (From Adams et al., Principles of Neurology, 6th ed, p841)
ConceptsDisease or Syndrome (T047)
MSHD002532
EnglishANEURYSM INTRACRANIAL, Intracranial Aneurysm, Intracranial aneurysms
Spanishaneurisma intracraneal
Parent ConceptsArterial and Arteriolar Disorders (C0549520), Arterial vessel disorders (C0549603), Aneurysm (C0002940), Intracranial Arterial Diseases (C0752138), Cerebral Arterial Diseases (C0007774), Cerebrovascular Disorders (C0007820), Arterial aneurysm (C0340613), Intracerebral vascular finding (C0428712), Systemic arterial finding (C0577829)
SourcesCSP, CST, LCH, MSH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Cerebral Aneurysm (C0917996)

Definition (CSP)congenital or acquired abnormal outpouching of an intracranial blood vessel wall; saccular (berry) aneurysms are the most common variant, and tend to form at arterial branch points near the base of the brain; rupture results in subarachnoid hemorrhage or intracranial hemorrhages; giant aneurysms (>2.5 cm in diameter) may compress adjacent structures, including the oculomotor nerve.
ConceptsDisease or Syndrome (T047)
ICD9430
MSHD002532
EnglishANEURYSM CEREBRAL, Cerebral Aneurysm, Cerebral Aneurysms
Spanishaneurisma cerebral
Parent ConceptsAneurysm (C0002940), Cerebrovascular Disorders (C0007820)
SourcesCOSTAR, CSP, CST, MSH, MTHICD9, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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