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CEREBRAL ANEURYSMS

Introduction

Background:

Cerebral aneurysm rupture is a particularly devastating cause of neurological morbidity and mortality in the United States and throughout the world.  The incidence of cerebral aneurysm varies from 1-6% depending upon the study, but a recent paper published in the New England Journal of Medicine looking at incidental findings on brain MRI found a 1.8% incidence of unruptured aneurysms in the general population²⁰. The prevalence of aneurysms found on autopsy is approximately 0.2%-7.9% depending upon the methods used to detect the aneurysms¹.  In addition, aneurysms are multiple in 10-30% of all cases². The female to male ratio is approximately 5:1, though this increased to 11:1 when considering patients with 3 or more aneurysms².

Aneurysms present in a multitude of ways, but presentation profiles may be divided between those that have ruptured and those which are unruptured.  Unruptured aneurysms include those aneurysms which are asymptomatic and incidentally found on imaging, those which manifest with focal neurological deficits due to compression of the brain stem or cranial nerves, those which present with seizure due to encephalomalacia of surrounding brain parenchyma, those which present with sentinel hemorrhage, and those which present with headache¹,².  Ruptured aneurysms present with subarachnoid hemorrhage, causing the so-called “worst headache of ones life.”

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