Typically asymptomatic until ruptured, resulting in a subarachnoid haemorrhage.
Head CT usually confirms the diagnosis of subarachnoid haemorrhage, but lumbar puncture is indicated if the CT is negative 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 endovascular coiling or open surgical clipping.
Screening with non-invasive neuroangiography is recommended for at-risk populations.
A cerebral aneurysm is a focal abnormal dilation of the wall of an artery in the brain. Intra-cranial aneurysms are most commonly located at branching points of the major arteries at the base of the brain, which course through the subarachnoid space. Cerebral aneurysms can, by nature of their size, compress neighbouring nerves or brain tissue or, more devastatingly, rupture and cause significant morbidity and mortality.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- nuchal rigidity
- decreased level of consciousness
- focal neurological deficit
- moderate- to high-level alcohol consumption
- FHx subarachnoid haemorrhage
- previous subarachnoid haemorrhage
- heritable connective tissue disease
- head trauma
- intracranial infection
- arteriovenous malformations or fistulas
- drug abuse
1st investigations to order
- conventional catheter-based angiogram
- CT angiography
- magnetic resonance angiography
- CT head scan
- lumbar puncture
Giovanni Grasso, MD, PhD
Department of Clinical Neurosciences
University of Palermo
GG declares that he has no competing interests.
Dr Grasso would like to gratefully acknowledge Dr Michael Chen, the previous contributor to this monograph. MC is an author of a reference cited in this monograph.
Jae H. Choi, MD
Stroke Center/The Neurological Institute
Columbia-Presbyterian Medical Center
JHC declares that he has no competing interests.
Peter Martin, MA, BM BCh, MD, FRCP
PM declares that he has no competing interests.
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- Hypertensive intra-cerebral haemorrhage
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- Guidelines for the management of patients with unruptured intracranial aneurysms
- Clinical practice guideline for the management of intracranial aneurysms
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