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Cerebral aneurysm

Last reviewed: 8 Apr 2025
Last updated: 14 Jul 2023

Summary

Definition

History and exam

Key diagnostic factors

  • headache
Full details

Other diagnostic factors

  • seizures
  • nuchal rigidity
  • decreased level of consciousness
  • focal neurologic deficit
Full details

Risk factors

  • smoking
  • moderate- to high-level alcohol consumption
  • family history of subarachnoid hemorrhage
  • previous subarachnoid hemorrhage
  • heritable connective tissue disease
  • hypertension
  • head trauma
  • intracranial infection
  • tumor
  • arteriovenous malformations or fistulas
  • drug abuse
Full details

Diagnostic tests

1st tests to order

  • CT head scan
  • conventional catheter-based angiogram
  • CT angiography
  • magnetic resonance angiography (MRA)
Full details

Tests to consider

  • lumbar puncture
Full details

Treatment algorithm

ACUTE

unruptured aneurysm

ruptured aneurysm

Contributors

Authors

Brendan Eby, MD

Assistant Professor

Departments of Neurology, Neurosurgery, and Radiology

Washington University School of Medicine

St. Louis

MO

Disclosures

BE has been a paid speaker at a national neurointervention fellows course sponsored by Penumbra Inc; the talk was unrelated to the sponsor's products or services.

Acknowledgements

Dr Eby would like to gratefully acknowledge Dr Grasso and Dr Michael Chen, the previous contributors to this topic.

Disclosures

MC is an author of a reference cited in this topic.

Peer reviewers

David Altschul, MD

Chief of Neurovascular Surgery

Montefiore Medical Center

New York

NY

Disclosures

DA declares that he has no competing interests.

Peter Martin, MA, BM BCh, MD, FRCP

Consultant Neurologist

Addenbrookes Hospital

Cambridge

UK

Disclosures

PM declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Thompson BG, Brown RD Jr, Amin-Hanjani S, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015 Aug;46(8):2368-400.Full text  Abstract

Hoh BL, Ko NU, Amin-Hanjani S, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023 Jul;54(7):e314-70.Full text  Abstract

Expert Panel on Neurological Imaging., Ledbetter LN, Burns J, et al. ACR Appropriateness Criteria® Cerebrovascular diseases - aneurysm, vascular malformation, and subarachnoid hemorrhage. J Am Coll Radiol. 2021 Nov;18(11s):S283-S304.Full text  Abstract

Etminan N, de Sousa DA, Tiseo C, et al. European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms. Eur Stroke J. 2022 Sep;7(3):V.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Cerebral aneurysm images
  • Differentials

    • Arteriovenous malformation
    • Hypertensive intracerebral hemorrhage
    • Cerebral venous sinus thrombosis
    More Differentials
  • Guidelines

    • Guidelines for the management of patients with aneurysmal subarachnoid hemorrhage
    • Guidelines on management of unruptured intracranial aneurysms
    More Guidelines
  • Patient information

    Emergency treatment for a stroke

    More Patient information
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