Intracranial Aneurysm (IA)

• Surgery Versus Endovascular Treatment for Proximal Anterior Cerebral Artery Aneurysms: A Meta-Analysis
• Association of serum uric acid level with intracranial aneurysms: A Mendelian randomization study
• Endovascular treatment of ruptured lobulated anterior communicating artery aneurysms: A retrospective study of 24 patients
• Absent right common carotid artery with associated anterior communicating aneurysm: embryology and imaging correlation
• Persistent Coma from Contrast-Induced Encephalopathy Following Stent-Assisted Coiling Intracranial Aneurysm: A Case Report
• Assessment of intracranial aneurysm neck deformation after contour deployment
• Prediction of aneurysmal subarachnoid hemorrhage in comparison with other stroke types using routine care data
• Defining light transmission aggregometry cutoff values for clopidogrel and aspirin resistance in flow diversion treatment of intracranial aneurysms

An intracranial aneurysm is a bulging, weakened area in the wall of an artery, which can rupture.

see Intracranial Aneurysm Natural history

see Intracranial Aneurysm History.

see Intracranial Aneurysm Epidemiology.

see Intracranial Aneurysm classification.

Until now, the exact etiology of intracranial aneurysms formation remains unclear.

The development of intracranial aneurysms is a complex process influenced by various factors, including genetic predisposition, hemodynamic stress, inflammation, and underlying vascular conditions. While the exact cause of intracranial aneurysms is not always clear, researchers have identified several contributing factors that play a role in their development.

Intracranial Aneurysm risk factors

see Intracranial aneurysm pathogenesis.

see Computational fluid dynamics for intracranial aneurysm

The clinical presentation is varied, ranging from asymptomatic lesions to those presenting with major rupture

see Ruptured intracranial aneurysm.

Intracranial Aneurysm Diagnosis.

• Prediction of aneurysmal subarachnoid hemorrhage in comparison with other stroke types using routine care data
• Time-of-Flight MRA of Intracranial Aneurysms with Interval Surveillance, Clinical Segmentation and Annotations
• Diagnosis of Unruptured Intracranial Aneurysms Using Proton-Density Magnetic Resonance Angiography: A Comparison With High-Resolution Time-of-Flight Magnetic Resonance Angiography
• A Systematic Review and Case Illustrations of Misdiagnosing Intracranial Aneurysms
• Predicting who has delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage using machine learning approach: a multicenter, retrospective cohort study
• Follow-Up Care Compliance Among Patients Diagnosed with Unruptured Intracranial Aneurysms
• QTc prolongation after aneurysmal subarachnoid hemorrhage might be associated with worse neurologic outcome in patients receiving microsurgical clipping or embolization of the intracranial aneurysms: a retrospective observational study
• Pearls & Oy-sters: What Came First, the Bleed or the Fall?: An Aneurysmal Subdural Hemorrhage

Intracranial aneurysm screening is a medical practice aimed at identifying and evaluating the presence of aneurysms in the blood vessels within the brain, particularly in individuals who may be at higher risk due to various factors. The primary goal of screening is to detect unruptured intracranial aneurysms before they cause a potentially life-threatening subarachnoid hemorrhage (SAH).

Screening is not recommended for the general population and should be reserved for patients who have at least one family member with a history of intracranial aneurysm or subarachnoid hemorrhage or when there is a high index of suspicion for those with certain medical conditions associated with an increased incidence of intracranial aneurysms. Physicians who treat patients with headache should be aware of the spectrum of clinical presentation of aneurysmal subarachnoid hemorrhage because not all patients present with the classic thunderclap headache. The Ottawa Subarachnoid Hemorrhage Rule is a validated clinical decision tool to help determine which patients with a sudden, acute headache require imaging with noncontrast computed tomography. Based on the results of initial computed tomography and duration of symptoms, the patient may require a lumbar puncture or additional imaging to confirm the diagnosis. Prompt diagnosis of an aneurysmal subarachnoid hemorrhage is essential to patients receiving definitive treatment ¹⁾.

Here are key points regarding intracranial aneurysm screening:

Indications for Screening:

Family History: Individuals with a first-degree relative (parent, sibling, child) who has had a cerebral aneurysm may have a higher genetic predisposition, and screening might be considered. Polycystic Kidney Disease (PKD): People with PKD have a higher risk of intracranial aneurysms, and screening may be recommended. Connective Tissue Disorders: Certain connective tissue disorders, such as Ehlers-Danlos syndrome and Marfan syndrome, are associated with an increased risk of aneurysm formation. Previous Aneurysm: Individuals who have had a prior intracranial aneurysm may be advised to undergo regular screenings to detect new aneurysms. Certain Symptoms: In some cases, when patients present with specific neurological symptoms that could be related to aneurysm presence, screening may be considered. Screening Methods:

Imaging Studies: The most common screening method is non-invasive imaging, such as magnetic resonance angiography (MRA) or computed tomography angiography (CTA). These tests provide detailed images of the blood vessels in the brain. Cerebral Angiography: In some cases, where there is a strong clinical suspicion or a need for precise evaluation, conventional cerebral angiography may be performed. This is an invasive procedure involving the injection of contrast dye into the blood vessels to visualize the arteries and any aneurysms. Frequency of Screening:

The frequency of screening depends on individual risk factors and the results of initial screening. For most individuals with familial or genetic risk factors, initial screening may occur in early adulthood, and then the frequency of subsequent screenings is determined by the findings. Risks and Benefits:

Screening has the potential to detect aneurysms before they rupture, which can be lifesaving. However, there are also potential risks, including false-positive results, anxiety, and, in the case of invasive angiography, procedural risks.

If an unruptured aneurysm is detected, the management approach may vary depending on factors such as the aneurysm's size, location, and individual patient characteristics. Options include close monitoring, endovascular coiling, surgical clipping, or other interventional procedures. Shared Decision-Making: The decision to undergo screening should be made in consultation with a healthcare provider, taking into consideration individual risk factors and preferences.

It's essential to note that not everyone needs intracranial aneurysm screening. The decision to screen should be based on an individual's specific risk factors and clinical considerations. If there is a strong family history or other relevant risk factors, individuals should consult with a healthcare professional for guidance on whether screening is appropriate for them.

miR 16, miR 143, and miR 200 showed statically significant higher expression among cases with cerebral aneurysms in comparison to controls. Thus, these preliminary results of miRNAs biomarkers are promising future tool to be used for aneurysmal screening ²⁾

Subarachnoid hemorrhage from a ruptured intracranial aneurysm is a type of stroke leading to death or permanent disability in most affected patients ^{3) 4)}.

Intracranial aneurysm rupture risk factors

Peripheral blood biomarkers, as common clinical test samples, reflecting the immune and inflammatory state of the body in real-time, have shown promise in providing additional information for risk stratification and treatment in IA patients, which may improve their outcomes after aneurysm rupture through anti-inflammatory therapy ⁵⁾.

see Intracranial aneurysm complications.

see Intracranial Aneurysm treatment.

Intracranial Aneurysm research

Intracranial aneurysm Systematic Review and Meta-Analysis.

see Intracranial aneurysm case series.

A prospective case-control study conducted among patients with IA. All patients' computed tomography angiography (CTA) and interventional angiogram were assessed and studied. The miRNAs were isolated and quantified from peripheral blood samples and the expression profiling was done using TaqMan chemistry on Real-Time PCR.

A total of 37 samples were included. Three cases had double aneurysms and 10 cases presented with aneurysmal rupture. miRNA-16, miRNA-143, and miRNA-200 were upregulated with an absolute fold-change of >8 in the CA group in comparison to controls (p<0.05). miRNA-200 showed double expression in patients with single aneurysm. A statically significant increase was observed in the expression of miRNA-143 in patients who had an aneurysmal rupture with p<0.05. Diabetic patients showed an obvious increase in miRNA-200 (13.03 folds) and miRNA-16 (26.82 folds) expression. Also, there was a notable elevation in miRNA-16, miRNA-143, and miRNA-200 in patients who had hypertension in comparison to those who did not.

miRNA-16, miRNA-143, and miRNA-200 showed statically significant higher expression among cases with cerebral aneurysms in comparison to controls. Thus, these preliminary results of miRNAs biomarkers are promising future tool to be used for aneurysmal screening ⁶⁾.

see Intracranial Aneurysm Books.