Cerebral aneurysms are typically asymptomatic until ruptured, resulting in a subarachnoid hemorrhage.
Head CT usually confirms the diagnosis of subarachnoid hemorrhage if performed within 6 hours of symptom onset, but lumbar puncture is indicated if the CT is negative after 6 hours 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 microsurgical clipping or endovascular techniques.
Screening with noninvasive neuroangiography is recommended for at-risk populations.
A cerebral aneurysm is a focal abnormal dilation of the wall of an artery in the brain. Intracranial 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 neighboring nerves or brain tissue or, more devastatingly, rupture and cause significant morbidity and mortality.
History and exam
Key diagnostic factors
Other diagnostic factors
- nuchal rigidity
- decreased level of consciousness
- focal neurologic deficit
- moderate- to high-level alcohol consumption
- family history of subarachnoid hemorrhage
- previous subarachnoid hemorrhage
- heritable connective tissue disease
- head trauma
- intracranial infection
- arteriovenous malformations or fistulas
- drug abuse
1st investigations to order
- CT head scan
- conventional catheter-based angiogram
- CT angiography
- magnetic resonance angiography (MRA)
Investigations to consider
- lumbar puncture
- Arteriovenous malformation
- Hypertensive intracerebral hemorrhage
- Cerebral venous sinus thrombosis
- Guidelines for the management of patients with aneurysmal subarachnoid hemorrhage
- Guidelines on management of unruptured intracranial aneurysms
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