Cerebral aneurysms are 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
- family history of 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
Investigations to consider
- CT head scan
- lumbar puncture
- Arteriovenous malformation
- Hypertensive intra-cerebral haemorrhage
- Cerebral venous sinus thrombosis
- Guidelines on management of unruptured intracranial aneurysms
- Cerebrovascular diseases - aneurysm, vascular malformation, and subarachnoid hemorrhage
Emergency treatment for a strokeMore Patient leaflets
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