Management of multiple and unruptured cerebral aneurysms

Abstract

The incidence of multiple aneurysms was 10.7–34% of CA. Multiple associated factors were found; hypertension was the most significant one and others like advancing age and female sex were also documented. The estimated prevalence of UA is 5–10%. They include those aneurysms that did not rupture and discovered incidentally and those presented with symptoms rather than SAH, e.g., cranial nerve palsy or mass effect. Unruptured intracranial aneurysms are diagnosed with higher frequency nowadays as a result of imaging techniques improvement. The reported annual rate of rupture of UA is approximately 0.7–1%. The natural history of unruptured cerebral aneurysms cannot be extrapolated from the evaluation of individuals with ruptured aneurysms. Multiple cerebral aneurysms pose an even greater risk than a single aneurysm; the risk of rebleeding from the original aneurysm is larger and occurs sooner. The natural course of the disease has led to a consensus that all multiple unruptured aneurysms should be treated when technically viable. However, the prophylactic treatment of multiple unruptured is still controversial. Weighing the risk of intervention to the risk of observation is a mandatory pathway. Factors like age of patients, size and location of the aneurysms influence the decision-making and the type of therapy to be elected.

Multiple fusiform and saccular aneurysms in a person living with Human Immunodeficiency Virus

“…The medical literature delineates surgical, endovascular, and pharmacological therapeutic strategies, although the substantiating evidence base largely comprises case reports and case series. 9,10,15–17 Despite a paucity of definitive treatment guidelines for HIV-associated multiple cerebral aneurysms, there are instances where diligent adherence to antiretroviral therapy has been associated with decelerated aneurysm progression or even reduction in size. 18…”

Multiple cerebral aneurysms as a late complication of atrial myxoma: imaging findings

“…There are similarities with intracranial mycotic aneurysm formation secondary to septic emboli, with aneurysms developing in peripheral intracranial branches after vascular wall damage 6. Other causes of multiple cerebral aneurysm formation include polycystic kidney disease and hypertension 7 8…”