Study of the predictors of rupture of a specific aneurysm in a patient diagnosed with multiple aneurysms - a prospective exploratory observational study
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Date
2019-12
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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.