Cerebral aneurysm - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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.

Cerebral angiogram showing aneurysm

From the personal collection of Dr M. Chen, Columbia College of Physicians and Surgeons

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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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

Key Articles

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]

Referenced Articles

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