Highlights & Basics
- Cerebral aneurysms are typically asymptomatic until ruptured, resulting in a subarachnoid hemorrhage.
- Head CT usually confirms the diagnosis of subarachnoid hemorrhage if performed within 6 hours of symptom onset, but lumbar puncture is indicated if the CT is negative after 6 hours and suspicion persists.
- Cerebral angiogram is the definitive investigation. CT angiography or magnetic resonance angiography may also be used.
- Definitive treatment aims to obliterate the aneurysm from the cerebral circulation. Options include microsurgical clipping or endovascular techniques.
- Screening with noninvasive neuroangiography is recommended for at-risk populations.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Cerebral angiogram showing aneurysm
Comparison of 2-dimensional catheter angiography (left) with 3-dimensional catheter angiography (right) showing a basilar tip aneurysm
Three-dimensional catheter angiogram showing a basilar tip aneurysm
Example of a coil used to treat cerebral aneurysms
Progressive angiography images of a small dissecting aneurysm of the distal basilar artery after a subarachnoid and intraventricular hemorrhage on day 3 (A), day 23 (B), and day 30 (C), and 6 months after stent-assisted coiling (D). Arrows indicate proximal and distal stent markers
Citations
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 Aug;46(8):2368-400.[Abstract][Full Text]
Hoh BL, Ko NU, Amin-Hanjani S, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023 Jul;54(7):e314-70.[Abstract][Full Text]
Expert Panel on Neurological Imaging., Ledbetter LN, Burns J, et al. ACR Appropriateness Criteria® Cerebrovascular diseases - aneurysm, vascular malformation, and subarachnoid hemorrhage. J Am Coll Radiol. 2021 Nov;18(11s):S283-S304.[Abstract][Full Text]
Etminan N, de Sousa DA, Tiseo C, et al. European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms. Eur Stroke J. 2022 Sep;7(3):V.[Abstract][Full Text]
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