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Title: Study of the predictors of rupture of a specific aneurysm in a patient diagnosed with multiple aneurysms - a prospective exploratory observational study
Authors: Yogesh Madhukar Sawakare
Issue Date: Dec-2019
Publisher: SCTIMST
Abstract: Cerebral aneurysms rupture leads to subarachnoid hemorrhage which leads to significant morbidity and mortality. The outcome after subarachnoid hemorrhage due to aneurysmal rupture is still poor; mortality rates ranges from 40-50%, severe disability in 10-20% and only 40% reach independent status1,2 . Contributing causes to mortality and morbidity is bleed, rebleed, vasospasm and cerebral ischemia. Thereby “prevention is better than cure” can be applied for cerebral aneurysms if causative factors are known and will result in effective treatment of this patients. Predictive factors for bleeding in aneurysm are studied well in literature series. Multiple intracranial aneurysms occur in approximately one third (15–45%) of patients presenting with Subarachnoid hemmorhage. 3,4,9 The exact mechanism of intracranial aneurysm formation per se remains obscured; however, congenital and/or acquired degenerative changes in the arterial wall have been implicated.5,6,7 The presence of multiple aneurysms is sometimes associated with poor outcome because of the complex management issues that are involved and the higher incidence of complications arising from both the hemorrhage and any treatment 6 . It follows, therefore, that the identification of modifiable risk factors for formation of multiple aneurysms is important and has implications both for the prevention of SAH and a more detailed understanding of the pathogenesis of multiple cerebral aneurysms. It is also important to know which aneurysm has bled so as to deal with it at first. Consideration of radiological and clinical parameters is necessary for the assessment of the rupture. Many criteria on the basis of radiology i.e angiographic studies has been taken into account such as shape, size, location . neck, aspect ratio, etc have been evaluated in various studies. 6,7,8 Clinical assessment is also carried out in many studies for the same such as age, gender, cigarette smoking, alcohol, familial, hypertension, collagen vascular diseases, etc.3,4 ,5 Cerebrovascular disease risk factors such as hypertension, cigarette smoking, and alcohol consumption have been shown to increase the risk of SAH and spontaneous intracerebral hematoma.5 However, the role of these risk factors in the formation of multiple, as opposed to single, aneurysms is less well defined. To have an insight of this factors determining rupture of specific aneurysm we carried out a prospective exploratory study of multiple aneurysm in our institute.
Appears in Collections:Neurosurgery

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