RT Journal Article
SR Electronic
T1 Cerebral Ischemia Complicating Intracranial Aneurysm: A Warning Sign of Imminent Rupture?
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1862
OP 1865
DO 10.3174/ajnr.A2645
VO 32
IS 10
A1 B. Guillon
A1 B. Daumas-Duport
A1 O. Delaroche
A1 K. Warin-Fresse
A1 M. Sévin
A1 F. Hérisson
A1 E. Auffray-Calvier
A1 H. Desal
YR 2011
UL http://www.ajnr.org/content/32/10/1862.abstract
AB BACKGROUND AND PURPOSE: Patients harboring nongiant cerebral aneurysms may rarely present with an ischemic infarct distal to the aneurysm. The aim of this case series was to report clinical and radiologic characteristics of these patients, their management, and outcome. MATERIALS AND METHODS: We undertook a single-center retrospective analysis of consecutive patients admitted during an 8-year period with an acute ischemic stroke revealing an unruptured nongiant (<25 mm) sacciform intracranial aneurysm. Clinical, radiologic, therapeutic, and follow-up data were analyzed. RESULTS: Nine patients were included. The mean size of aneurysms was 9.6 ± 6 mm, and 5 were partially or totally thrombosed. Two patients had a fatal SAH within 3 days after stroke-symptom onset, whereas asymptomatic meningeal bleeding was diagnosed or suspected in 2 others. Most of the patients with unthrombosed aneurysms were successfully treated by endovascular coiling in the acute phase. Thrombosed aneurysms were usually treated with antithrombotics, and most recanalized secondarily, requiring endovascular treatment or surgical obliteration. No recurrence of an ischemic event or SAH was observed during the 31 ± 12 months of follow-up (from 4 to 53 months). CONCLUSIONS: In this single-center series, the frequency of early SAH in patients with ischemic stroke distal to an unruptured intracranial aneurysm was high. Acute management should be undertaken with care regarding antithrombotic use, and early endovascular coiling should be considered. MCAmiddle cerebral arterymRSmodified Rankin ScaleNIHSSNational Institutes of Health Stroke ScalePCAposterior cerebral arteryPICAposterior inferior cerebellar arterySAHsubarachnoid hemorrhage