Old page wikitext, before the edit (old_wikitext) | '{{short description|Cerebrovascular disorder}}
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{{Infobox medical condition (new)
| name = Intracranial aneurysm
| synonyms = Cerebral aneurysm, brain aneurysm
| image = Cerebellar aneurysm.png
| caption = [[Aneurysm]] of the [[basilar artery]] and the [[vertebral arteries]]
| pronounce =
| field =
| symptoms = None, severe [[headache]], visual problems, [[nausea]] and [[vomiting]], [[confusion]]<ref name="mayoclinic.org">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/brain-aneurysm/symptoms-causes/syc-20361483|title=Brain aneurysm - Symptoms and causes|website=[[Mayo Clinic]] }}</ref>
| complications =
| onset = 30–60 years old
| duration =
| types =
| causes = [[Hypertension]], [[infection]], [[head trauma]]<ref>{{Cite web|url=https://www.webmd.com/heart-disease/understanding-aneurysm-basics|title = What is an Aneurysm?}}</ref>
| risks = old age, [[family history]], smoking, alcoholism, [[cocaine]] use<ref name="mayoclinic.org">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/brain-aneurysm/symptoms-causes/syc-20361483|title=Brain aneurysm - Symptoms and causes|website=[[Mayo Clinic]] }}</ref>
| diagnosis = [[Angiography]], [[CT scan]]
| differential =
| prevention =
| treatment = [[Endovascular coiling]], [[surgical clipping]], cerebral bypass surgery, pipeline embolization
| medication =
| prognosis =
| frequency =
| deaths =
}}
An '''intracranial aneurysm''', also known as a '''cerebral aneurysm''', is a [[cerebrovascular disorder]] in which weakness in the wall of a [[cerebral artery]] or [[cerebral vein|vein]] causes a localized [[vasodilation|dilation]] or ballooning of the [[blood vessel]].
[[Aneurysm]]s in the [[Cerebral circulation#Arterial cerebral circulation|posterior circulation]] ([[basilar artery]], [[vertebral arteries]] and [[posterior communicating artery]]) have a higher risk of rupture. Basilar artery aneurysms represent only 3–5% of all intracranial aneurysms but are the most common aneurysms in the posterior circulation.
==Classification==
{{See also|Aneurysm#Classification}}
[[Image:Cerebral aneurysm NIH.jpg|thumb|right|Diagram of cerebral aneurysm.]]
Cerebral aneurysms are classified both by size and shape. Small aneurysms have a diameter of less than 15 mm. Larger aneurysms include those classified as large (15 to 25 mm), giant (25 to 50 mm) (0.98 inches to 1.97 inches), and super-giant (over 50 mm).<ref name=HOPKINS8772>{{cite web|url=http://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/cerebral_aneurysm_85,P08772/|title=What You Should Know About Cerebral Aneurysms|website=www.hopkinsmedicine.org|date=8 August 2021 }}</ref>
===Berry (saccular) aneurysms===
Saccular aneurysms, also known as berry aneurysms, appear as a round outpouching and are the most common form of cerebral aneurysm.<ref name=HOPKINS8772 /><ref name=ROONGROJ2005>{{cite book|first1=Roongroj|last1=Bhidayasiri|first2=Michael F.|last2=Waters|first3=Christopher C.|last3=Giza|title=Neurological differential diagnosis : a prioritized approach|url=https://archive.org/details/neurologicaldiff00bhid|url-access=limited|year=2005|publisher=Blackwell Publishing|location=Oxford|isbn=978-1-4051-2039-5|page=[https://archive.org/details/neurologicaldiff00bhid/page/n147 133]|edition=3. Dr.}}</ref> Causes include connective tissue disorders, [[polycystic kidney disease]], arteriovenous malformations, untreated [[hypertension]], tobacco smoking, cocaine and amphetamines, intravenous drug abuse (can cause infectious mycotic aneurysms), alcoholism, heavy caffeine intake, head trauma, and infection in the arterial wall from [[bacteremia]] (mycotic aneurysms).<ref>Koutsothanasis G.A.; Sampath R., Berry Aneurysm (update: October 2, 2020). Link https://www.ncbi.nlm.nih.gov/books/NBK557480/</ref>
===Fusiform aneurysms===
Fusiform [[intracranial dolichoectasias|dolichoectatic]] aneurysms represent a widening of a segment of an artery around the entire blood vessel, rather than just arising from a side of an artery's wall. They have an estimated annual risk of rupture between 1.6 and 1.9 percent.<ref>{{Cite journal|last1=Xu|first1=David S.|last2=Levitt|first2=Michael R.|last3=Kalani|first3=M. Yashar S.|last4=Rangel-Castilla|first4=Leonardo|last5=Mulholland|first5=Celene B.|last6=Abecassis|first6=Isaac J.|last7=Morton|first7=Ryan P.|last8=Nerva|first8=John D.|last9=Siddiqui|first9=Adnan H.|last10=Levy|first10=Elad I.|last11=Spetzler|first11=Robert F.|date=2017-04-07|title=Dolichoectatic aneurysms of the vertebrobasilar system: clinical and radiographic factors that predict poor outcomes|url=https://thejns.org/view/journals/j-neurosurg/128/2/article-p560.xml|journal=Journal of Neurosurgery|language=en-US|volume=128|issue=2|pages=560–66|doi=10.3171/2016.10.JNS161041|pmid=28387624|issn=1933-0693|doi-access=free}}</ref><ref>Fusiform and dolichoectatic aneurysms By James R Brorson MD (Dr. Brorson of the University of Chicago received consultation fees from CVS-Caremark, National Peer Review Corporation, and Medico-legal Consulting.) Originally released October 28, 1997; last updated January 29, 2017; expires January 29, 2020
https://tcapp.org/wp-content/uploads/2017/09/Fusiform-and-Dolichoectatic-Aneurysms.pdf</ref>
===Microaneurysms===
{{Main|Charcot–Bouchard aneurysm}}
Microaneurysms, also known as [[Charcot–Bouchard aneurysm]]s, typically occur in small [[blood vessel]]s (less than 300 [[micrometre]] diameter), most often the [[Anterolateral central arteries|lenticulostriate]] vessels of the [[basal ganglia]], and are associated with [[chronic (medicine)|chronic]] [[hypertension]].<ref name = robbins>{{cite book | editor1-last = Kumar | editor2-last = Abbas | editor3-last = Fausto | title = Robbins and Cotran Pathologic Basis of Disease | edition = 7th | year = 2005 | location = China | publisher = Elsevier | isbn = 978-0-7216-0187-8}}{{page needed|date=July 2020}}</ref> Charcot–Bouchard aneurysms are a common cause of [[intracranial hemorrhage]].<ref>{{Citation|last1=Gupta|first1=Kashvi|title=Charcot Bouchard Aneurysm|date=2021|url=http://www.ncbi.nlm.nih.gov/books/NBK553028/|work=|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=31971704|access-date=2021-05-06|last2=M Das|first2=Joe}}</ref>
==Signs and symptoms==
A small, unchanging aneurysm will produce few, if any, symptoms. Before a larger aneurysm ruptures, the individual may experience such symptoms as a sudden and unusually severe headache, [[nausea]], vision impairment, [[vomiting]], and [[unconsciousness|loss of consciousness]], or no symptoms at all.<ref name=BRISMAN2006 />
=== Subarachnoid bleed ===
{{Main|Subarachnoid hemorrhage#Signs and symptoms}}
If an aneurysm ruptures, blood leaks into the space around the brain. This is called a [[subarachnoid hemorrhage]]. Onset is usually sudden without [[prodrome]], classically presenting as a "[[thunderclap headache]]" worse than previous headaches.<ref name=Goljan2006/><ref name=stroke /> Symptoms of a subarachnoid hemorrhage differ depending on the site and size of the aneurysm.<ref name=stroke /> Symptoms of a ruptured aneurysm can include:<ref>{{Cite web|last=Publishing|first=Harvard Health|title=Subarachnoid Hemorrhage|url=https://www.health.harvard.edu/a_to_z/subarachnoid-hemorrhage-a-to-z|access-date=2021-05-06|website=Harvard Health|date=18 December 2018}}</ref>
* a sudden severe headache that can last from several hours to days
* nausea and vomiting
* drowsiness, confusion and/or loss of consciousness
* visual abnormalities
* [[meningism]]
* dizziness
Almost all aneurysms rupture at their apex. This leads to hemorrhage in the subarachnoid space and sometimes in brain [[parenchyma]]. Minor leakage from aneurysm may precede rupture, causing warning headaches. About 60% of patients die immediately after rupture.<ref name=autopsy /> Larger aneurysms have a greater tendency to rupture, though most ruptured aneurysms are less than 10 mm in diameter.<ref name=stroke />
===Microaneurysms===
A ruptured microaneurysm may cause an [[intracerebral hemorrhage]], presenting as a focal neurological deficit.<ref name=stroke />
Rebleeding, [[hydrocephalus]] (the excessive accumulation of [[cerebrospinal fluid]]), [[vasospasm]] (spasm, or narrowing, of the blood vessels), or multiple aneurysms may also occur. The risk of rupture from a cerebral aneurysm varies according to the size of an aneurysm, with the risk rising as the aneurysm size increases.<ref>{{Cite journal|last1=Korja Miikka|last2=Lehto Hanna|last3=Juvela Seppo|date=2014-07-01|title=Lifelong Rupture Risk of Intracranial Aneurysms Depends on Risk Factors|journal=Stroke|volume=45|issue=7|pages=1958–63|doi=10.1161/STROKEAHA.114.005318|pmid=24851875|doi-access=free}}</ref>
=== Vasospasm ===
{{see also|Subarachnoid hemorrhage#Vasospasm}}
[[Vasospasm]], referring to blood vessel constriction, can occur secondary to subarachnoid hemorrhage following a ruptured aneurysm. This is most likely to occur within 21 days and is seen radiologically within 60% of such patients. The vasospasm is thought to be secondary to the [[apoptosis]] of [[Inflammation|inflammatory]] cells such as [[macrophage]]s and [[neutrophil]]s that become trapped in the subarachnoid space. These cells initially invade the subarachnoid space from the circulation in order to [[phagocytose]] the hemorrhaged red blood cells. Following apoptosis, it is thought there is a massive degranulation of vasoconstrictors, including [[endothelin]]s and [[free radical]]s, that cause the vasospasm.<ref>{{cite journal|last=Gallia|first=Gary L.|author2=Tamargo, Rafael J.|s2cid=27713975|title=Leukocyte-endothelial cell interactions in chronic vasospasm after subarachnoid hemorrhage|journal=Neurological Research|date=1 October 2006|volume=28|issue=7|pages=750–58|doi=10.1179/016164106X152025|pmid=17164038}}</ref>
==Risk factors==
Intracranial aneurysms may result from diseases acquired during life, or from genetic conditions. [[Hypertension]], [[smoking]], [[alcoholism]], and [[obesity]] are associated with the development of brain aneurysms.<ref name=Goljan2006/><ref name=stroke>{{cite book|editor-first1=David |editor-last1=Alway |editor-first2=John Walden |editor-last2=Cole|title=Stroke Essentials for Primary Care: A Practical Guide|url=https://archive.org/details/strokeessentials00alwa_561 |url-access=limited |year=2009|publisher=Humana Press|location=New York|isbn=978-1-934115-01-5|pages=[https://archive.org/details/strokeessentials00alwa_561/page/n95 86]–88, 153}}</ref><ref name=Kemp2008>{{cite book|last=Brown|first=Walter L. Kemp, Dennis K. Burns, Travis G.|title=Pathology the big picture|year=2008|publisher=McGraw-Hill Medical|location=New York|isbn=978-0-07-159379-3|page=148}}</ref> [[Cocaine]] use has also been associated with the development of intracranial aneurysms.<ref name = stroke/>
Other acquired associations with intracranial aneurysms include head trauma and infections.<ref name = Goljan2006 />
===Genetic associations===
Coarctation of the aorta is also a known risk factor,<ref name=Goljan2006>{{cite book |author=Goljan, Edward F. |title=Rapid Review Pathology |publisher=Mosby |location=St. Louis |year=2006 |edition=2nd |isbn=978-0-323-04414-1|page=158}}</ref> as is [[arteriovenous malformation]].<ref name=autopsy>{{cite book|first1=Vincent J.|last1=DiMaio|first2=Dominick|last2=DiMaio|title=Forensic pathology|year=2001|publisher=CRC Press|location=Boca Raton, FL |isbn=978-0-8493-0072-1|page=[https://archive.org/details/forensicpatholog0000dima/page/61 61]|edition=2nd|url-access=registration|url=https://archive.org/details/forensicpatholog0000dima/page/61}}</ref> Genetic conditions associated with [[connective tissue disease]] may also be associated with the development of aneurysms.<ref name=Goljan2006 /> This includes:<ref>{{cite journal|last=Caranci|first=F.|author2=Briganti, F. |author3=Cirillo, L. |author4=Leonardi, M. |author5= Muto, M. |title=Epidemiology and genetics of intracranial aneurysms|journal=European Journal of Radiology|volume=82|issue=10|pages=1598–605|year=2012|doi=10.1016/j.ejrad.2012.12.026|pmid=23399038}}</ref>
* [[autosomal dominant polycystic kidney disease]],
* [[neurofibromatosis type I]],
* [[Marfan syndrome]],
* [[multiple endocrine neoplasia]] type I,
* [[pseudoxanthoma elasticum]],
* [[hereditary hemorrhagic telangiectasia]] and
* [[Ehlers-Danlos syndrome]] types II and IV.
Specific genes have also had reported association with the development of intracranial aneurysms, including [[perlecan]], [[elastin]], [[collagen]] type 1 A2, endothelial [[nitric oxide synthase]], [[endothelin]] receptor A and [[cyclin dependent kinase inhibitor]]. Recently, several [[genetic loci]] have been identified as relevant to the development of intracranial aneurysms. These include 1p34–36, 2p14–15, 7q11, 11q25, and 19q13.1–13.3.<ref>{{cite journal|last=van der Voet|first=M|author2=Olson, J |author3=Kuivaniemi, H |author4=Dudek, D |author5=Skunca, M |author6=Ronkainen, A |author7=Niemelä, M |author8=Jääskeläinen, J |author9=Hernesniemi, J |author10= Helin, K |title=Intracranial Aneurysms in Finnish Families: Confirmation of Linkage and Refinement of the Interval to Chromosome 19q13.3|journal=The American Journal of Human Genetics|date=1 March 2004|volume=74|issue=3|pages=564–71|doi=10.1086/382285 |pmid=14872410 |pmc=1182270}}</ref>
==Pathophysiology==
{{See also|Aneurysm#Pathophysiology}}
[[Aneurysm]] means an outpouching of a [[blood vessel]] wall that is filled with blood. Aneurysms occur at a point of weakness in the vessel wall. This can be because of acquired disease or hereditary factors. The repeated trauma of blood flow against the vessel wall presses against the point of weakness and causes the aneurysm to enlarge.<ref name=Haberfield2007 /> As described by the [[law of Young-Laplace]], the increasing area increases tension against the aneurysmal walls, leading to enlargement.<ref>{{Cite journal|last1=Humphrey|first1=J. D.|last2=Kyriacou|first2=S. K.|date=June 1996|title=The use of Laplace's equation in aneurysm mechanics|url=https://pubmed.ncbi.nlm.nih.gov/8837052/|journal=Neurological Research|volume=18|issue=3|pages=204–08|doi=10.1080/01616412.1996.11740404|issn=0161-6412|pmid=8837052}}</ref><ref>{{Cite web|title=Laplace's Law and Aneurysms|url=https://sciencedemonstrations.fas.harvard.edu/presentations/laplaces-law-and-aneurysms|access-date=2021-05-06|website=sciencedemonstrations.fas.harvard.edu|language=en}}</ref><ref>{{Cite journal|last=Hademenos|first=George J.|date=2008-01-11|title=The Physics of Cerebral Aneurysms|url=https://physicstoday.scitation.org/doi/abs/10.1063/1.881442|journal=Physics Today|language=en|volume=48|issue=2|page=24|doi=10.1063/1.881442|issn=0031-9228}}</ref> In addition, a combination of computational fluid dynamics and morphological indices have been proposed as reliable predictors of cerebral aneurysm rupture.<ref>{{Cite journal|last1=Amigo|first1=Nicolás|last2=Valencia|first2=Alvaro|last3=Wu|first3=Wei|last4=Patnaik|first4=Sourav|last5=Finol|first5=Ender|date=2021-03-08|title=Cerebral aneurysm rupture status classification using statistical and machine learning methods|url=https://pubmed.ncbi.nlm.nih.gov/33685288|journal=Proceedings of the Institution of Mechanical Engineers, Part H|volume=235|issue=6|pages= 655–662|doi=10.1177/09544119211000477|issn=2041-3033|pmid=33685288|s2cid=232161029}}</ref>
Both high and low wall [[shear stress]] of flowing blood can cause aneurysm and rupture. However, the mechanism of action is still unknown. It is speculated that low shear stress causes growth and rupture of large aneurysms through inflammatory response while high shear stress causes growth and rupture of small aneurysm through mural response (response from the blood vessel wall). Other risk factors that contributes to the formation of aneurysm are: cigarette smoking, hypertension, female gender, family history of cerebral aneurysm, infection, and trauma. Damage to structural integrity of the arterial wall by shear stress causes an inflammatory response with the recruitment of [[T cell]]s, [[macrophage]]s, and [[mast cell]]s. The inflammatory mediators are: [[interleukin 1 beta]], [[interleukin 6]], [[tumor necrosis factor alpha]] (TNF alpha), [[MMP1]], [[MMP2]], [[MMP9]], [[prostaglandin E2]], [[complement system]], [[reactive oxygen species]] (ROS), and [[angiotensin II]]. However, [[smooth muscle cell]]s from the [[tunica media]] layer of the artery moved into the [[tunica intima]], where the function of the smooth muscle cells changed from contractile function into pro-inflammatory function. This causes the fibrosis of the arterial wall, with reduction of number of smooth muscle cells, abnormal collagen synthesis, resulting in a thinning of the arterial wall and the formation of aneurysm and rupture. No specific gene loci has been identified to be associated with cerebral aneurysms.<ref name="AHA journal">{{cite journal|last1=Chalouhi|first1=Nohra|last2=Loh|first2=Brian L|last3=Hasan|first3=David|title=Review of Cerebral Aneurysm Formation, Growth, and Rupture|journal= Stroke|date=25 November 2013|volume=44|issue=12|pages=3613–22|doi=10.1161/STROKEAHA.113.002390|pmid=24130141|doi-access=free}}</ref>
Generally, aneurysms larger than 7 mm in diameter should be treated because they are prone for rupture. Meanwhile, aneurysms less than 7 mm arise from the [[anterior communicating artery|anterior]] and [[posterior communicating artery]] and are more easily ruptured when compared to aneurysms arising from other locations.<ref name="AHA journal"/>
===Saccular aneurysms===
[[File:Wikipedia intracranial aneurysms - inferior view - heat map.jpg|thumb|right|The most common sites of intracranial saccular aneurysms]]
Saccular aneurysms are almost always the result of hereditary weaknesses in blood vessels and typically occur within the arteries of the [[circle of Willis]],<ref name=Haberfield2007>{{cite book|last=Haberland|first=Catherine|title=Clinical neuropathology : text and color atlas|url=https://archive.org/details/clinicalneuropat00habe_423|url-access=limited|year=2007|publisher=Demos|location=New York|isbn=978-1-888799-97-2|page=[https://archive.org/details/clinicalneuropat00habe_423/page/n81 70]|edition=Online-Ausg.}}</ref><ref>{{DorlandsDict|one/000004838|berry aneurysm}}</ref> in order of frequency affecting the following arteries:<ref>{{cite book|first1=David|last1=Howlett|first2=Brian|last2=Ayers|title=The hands-on guide to imaging|url=https://archive.org/details/handsonguidetoim00howl|url-access=limited|year=2004|publisher=Blackwell|location=Oxford|isbn=978-1-4051-1551-3|page=[https://archive.org/details/handsonguidetoim00howl/page/n216 204]}}</ref>
* [[Anterior communicating artery]]
* [[Posterior communicating artery]]
* [[Middle cerebral artery]]
* [[Internal carotid artery]]
* Tip of [[basilar artery]]
Saccular aneurysms tend to have a lack of [[tunica media]] and elastic lamina around their dilated locations (congenital), with a wall of sac made up of thickened hyalinized intima and adventitia.<ref name=autopsy /> In addition, some parts of the brain vasculature are inherently weak—particularly areas along the circle of Willis, where small communicating vessels link the main cerebral vessels. These areas are particularly susceptible to saccular aneurysms.<ref name=Goljan2006 /> Approximately 25% of patients have multiple aneurysms, predominantly when there is a familial pattern.<ref name=stroke />
==Diagnosis==
[[File:CT angiography showing aneurysm at the ACOM.jpg|thumb|CT angiography showing aneurysm measuring 2.6 mm in diameter at the ACOM (anterior communicating artery).]]
Once suspected, intracranial aneurysms can be diagnosed radiologically using [[Magnetic resonance angiography|magnetic resonance]] or [[Computed tomography angiography|CT]] angiography.<ref name=":0">{{Cite journal|last1=White|first1=Philip M.|last2=Teasdale|first2=Evelyn M. |last3=Wardlaw |first3=Joanna M. |author3-link=Joanna Wardlaw |last4=Easton |first4=Valerie|date=2001-06-01|title=Intracranial Aneurysms: CT Angiography and MR Angiography for Detection – Prospective Blinded Comparison in a Large Patient Cohort |journal=Radiology |volume=219 |issue=3 |pages=739–49 |doi=10.1148/radiology.219.3.r01ma16739 |pmid=11376263|issn=0033-8419}}</ref> But these methods have limited sensitivity for diagnosis of small aneurysms, and often cannot be used to specifically distinguish them from infundibular dilations without performing a formal [[Angiography|angiogram]].<ref name=":0" /><ref>{{Cite book|title=Handbook of neurosurgery|last=Greenberg|first=Mark|date=2010|publisher=Greenberg Graphics|isbn=978-1-60406-326-4|oclc=892183792}}{{page needed|date=July 2020}}</ref> The determination of whether an aneurysm is ruptured is critical to diagnosis. [[Lumbar puncture]] (LP) is the gold standard technique for determining aneurysm rupture ([[subarachnoid hemorrhage]]). Once an LP is performed, the [[Cerebrospinal fluid|CSF]] is evaluated for [[Erythrocyte count|RBC count]], and presence or absence of [[xanthochromia]].<ref>{{Cite journal|last1=Mark|first1=Dustin G.|last2=Kene|first2=Mamata V.|last3=Offerman|first3=Steven R.|last4=Vinson|first4=David R.|last5=Ballard|first5=Dustin W.|title=Validation of cerebrospinal fluid findings in aneurysmal subarachnoid hemorrhage|journal=The American Journal of Emergency Medicine|volume=33|issue=9|pages=1249–52|doi=10.1016/j.ajem.2015.05.012|pmid=26022754|year=2015}}</ref>
== Treatment ==
[[File:AneurysmClips.jpg|thumb|A selection of [[Frank Henderson Mayfield|Mayfield]] and [[Charles George Drake|Drake]] aneurysm clips ready for implantation.]]
[[Emergency medicine|Emergency treatment]] for individuals with a ruptured cerebral aneurysm generally includes restoring deteriorating [[Respiration (physiology)|respiration]] and reducing [[intracranial pressure]]. Currently there are two treatment options for securing intracranial aneurysms: [[Clipping (medicine)|surgical clipping]] or [[endovascular coiling]]. If possible, either surgical clipping or endovascular coiling is typically performed within the first 24 hours after bleeding to occlude the ruptured aneurysm and reduce the risk of recurrent hemorrhage.<ref>{{Cite journal|last1=Park|first1=Jaechan|last2=Woo|first2=Hyunjin|last3=Kang|first3=Dong-Hun|last4=Kim|first4=Yong-Sun|last5=Kim|first5=Min Young|last6=Shin|first6=Im Hee|last7=Kwak|first7=Sang Gyu|date=2015-02-01|title=Formal protocol for emergency treatment of ruptured intracranial aneurysms to reduce in-hospital rebleeding and improve clinical outcomes|url=https://thejns.org/view/journals/j-neurosurg/122/2/article-p383.xml|journal=Journal of Neurosurgery|language=en-US|volume=122|issue=2|pages=383–91|doi=10.3171/2014.9.JNS131784|pmid=25403841|issn=1933-0693|doi-access=free}}</ref>
While a large [[meta-analysis]] found the outcomes and risks of surgical clipping and endovascular coiling to be statistically similar, no consensus has been reached.<ref>{{cite journal|last=Raja|first=PV|author2=Huang, J |author3=Germanwala, AV |author4=Gailloud, P |author5=Murphy, KP |author6= Tamargo, RJ |title=Microsurgical clipping and endovascular coiling of intracranial aneurysms: a critical review of the literature.|journal=Neurosurgery|date=June 2008|volume=62|issue=6|pages=1187–202; discussion 1202–03|pmid=18824986|doi=10.1227/01.neu.0000333291.67362.0b}}</ref> In particular, the large [[randomised control trial]] [[International Subarachnoid Aneurysm Trial]] appears to indicate a higher rate of recurrence when intracerebral aneurysms are treated using endovascular coiling. Analysis of data from this trial has indicated a 7% lower eight-year mortality rate with coiling,<ref>Mitchell P, Kerr R, Mendelow AD, Molyneux A. "Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in ISAT?" ''Journal of Neurosurgery'' 108: 437–42, March 2008</ref> a high rate of aneurysm recurrence in aneurysms treated with coiling—from 28.6 to 33.6% within a year,<ref name="Piotin et al. 2007">{{cite journal |last=Piotin |first=M |author2=Spelle, L |author3=Mounayer, C |author4=Salles-Rezende, MT |author5=Giansante-Abud, D |author6=Vanzin-Santos, R |author7=Moret, J |date=May 2007 |title=Intracranial aneurysms: treatment with bare platinum coils – aneurysm packing, complex coils, and angiographic recurrence |journal=Radiology |volume=243 |issue=2 |pages=500–08 |pmid=17293572 |doi=10.1148/radiol.2431060006 }}</ref><ref name="Raymond et al. 2003">{{cite journal |last=Raymond |first=J |author2=Guilbert, F |author3=Weill, A |author4=Georganos, SA |author5=Juravsky, L |author6=Lambert, A |author7=Lamoureux, J |author8=Chagnon, M |author9=Roy, D |date=June 2003 |title= Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils |journal=Stroke |volume=34 |issue=6 |pages=1398–1403 |pmid=12775880 |doi= 10.1161/01.STR.0000073841.88563.E9 |doi-access=free }}</ref> a 6.9 times greater rate of late retreatment for coiled aneurysms,<ref name="Campi et al. 2007">{{cite journal | vauthors = Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV | title = Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT) | journal = Stroke | volume = 38 | issue = 5 | pages = 1538–44 | date = May 2007 | pmid = 17395870 | doi = 10.1161/STROKEAHA.106.466987 | doi-access = free }}</ref> and a rate of rebleeding 8 times higher than surgically clipped aneurysms.<ref name="pmid18312088">{{cite journal | vauthors = Mitchell P, Kerr R, Mendelow AD, Molyneux A | s2cid = 24304414 | title = Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the International Subarachnoid Aneurysm Trial? | journal = J. Neurosurg. | volume = 108 | issue = 3 | pages = 437–42 | date = March 2008 | pmid = 18312088 | doi = 10.3171/JNS/2008/108/3/0437}}</ref>
=== Surgical clipping ===
{{main|Surgical clipping}}
Aneurysms can be treated by clipping the base of the aneurysm with a specially-designed clip. Whilst this is typically carried out by [[craniotomy]], a new endoscopic endonasal approach is being trialled.<ref>{{cite web |url=https://www.med.unc.edu/surgery/germanwala-presents-first-aneurysm-patient-treated-through-nose/ |title= Germanwala Presents First Aneurysm Patient Treated Through Nose|author=<!--Not stated--> |date=June 25, 2009 |website=UNC }}</ref> Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937.<ref>{{cite journal|url=http://www.neurologyindia.com/text.asp?2015/63/1/96/152666|title=Aneurysm clips: What every resident should know|first1=Gopalakrishnan Madhavan|last1=Sasidharan|first2=Savitr B V|last2=Sastri|first3=Paritosh|last3=Pandey|date=1 January 2015|via=www.neurologyindia.com|journal=Neurology India|volume=63|issue=1}}</ref>
After clipping, a catheter angiogram or CTA can be performed to confirm complete clipping.<ref>Bharatha A, Yeung R, Durant D, Fox AJ, Aviv RI, Howard P, Thompson AL, Bartlett ES, Symons SP. "Comparison of computed tomography angiography with digital subtraction angiography in the assessment of clipped intracranial aneurysms". ''Journal of Computer Assisted Tomography''. 2010 May–June; 34(3): 440–45.</ref>
===Endovascular coiling===
{{main|Endovascular coiling}}
Endovascular coiling refers to the insertion of [[platinum]] coils into the aneurysm. A [[catheter]] is inserted into a blood vessel, typically the [[femoral artery]], and passed through blood vessels into the cerebral circulation and the aneurysm. Coils are pushed into the aneurysm, or released into the blood stream ahead of the aneurysm. Upon depositing within the aneurysm, the coils expand and initiate a thrombotic reaction within the aneurysm. If successful, this prevents further bleeding from the aneurysm.<ref name="pmid9933290">{{cite journal | vauthors = Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A | title = Treatment of intracranial aneurysms by embolization with coils: a systematic review | journal = Stroke | volume = 30 | issue = 2 | pages = 470–76 | date = February 1999 | pmid = 9933290 | doi = 10.1161/01.STR.30.2.470 | doi-access = free }}</ref> In the case of broad-based aneurysms, a stent may be passed first into the parent artery to serve as a scaffold for the coils.<ref>{{Cite journal|last1=Oushy|first1=Soliman|last2=Rinaldo|first2=Lorenzo|last3=Brinjikji|first3=Waleed|last4=Cloft|first4=Harry|last5=Lanzino|first5=Giuseppe|date=June 2020|title=Recent advances in stent-assisted coiling of cerebral aneurysms|journal=Expert Review of Medical Devices|volume=17|issue=6|pages=519–32|doi=10.1080/17434440.2020.1778463|issn=1745-2422|pmid=32500761|s2cid=219328499}}</ref>
===Cerebral bypass surgery===
Cerebral bypass surgery was developed in the 1960s in Switzerland by [[Gazi Yaşargil]]. When a patient has an aneurysm involving a blood vessel or a tumor at the base of the skull wrapping around a blood vessel, surgeons eliminate the problem vessel by replacing it with an artery from another part of the body.<ref>{{cite journal|title=Microvascular bypass surgery|first1=Robert|last1=Spetzler|first2=Norman|last2=Chater|date=1 November 1976|journal=Journal of Neurosurgery|volume=45|issue=5|pages=508–13|doi=10.3171/jns.1976.45.5.0508|pmid=972334}}</ref>
== Prognosis ==
Outcomes depend on the size of the aneurysm.<ref name=Mal2017/> Small aneurysms (less than 7 mm) have a low risk of rupture and increase in size slowly.<ref name=Mal2017/> The risk of rupture is less than one percent for aneurysms of this size.<ref name=Mal2017>{{cite journal | vauthors = Malhotra A, Wu X, Forman HP, Grossetta Nardini HK, Matouk CC, Gandhi D, Moore C, Sanelli P | title = Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms: A Systematic Review | journal = Ann. Intern. Med. | volume = 167 | issue = 1 | pages = 26–33 | date = July 2017 | pmid = 28586893 | doi = 10.7326/M17-0246 }}</ref>
The [[prognosis]] for a ruptured cerebral aneurysm depends on the extent and location of the aneurysm, the person's age, general health, and neurological condition. Some individuals with a ruptured cerebral aneurysm die from the initial bleeding. Other individuals with cerebral aneurysm recover with little or no neurological deficit. The most significant factors in determining outcome are the [[Hunt and Hess scale|Hunt and Hess grade]], and age. Generally patients with Hunt and Hess grade I and II hemorrhage on admission to the emergency room and patients who are younger within the typical age range of vulnerability can anticipate a good outcome, without death or permanent disability. Older patients and those with poorer Hunt and Hess grades on admission have a poor prognosis. Generally, about two-thirds of patients have a poor outcome, death, or permanent disability.<ref name=Haberfield2007 /><ref>{{cite journal|last=Hop|first=J. W.|author2=Rinkel, G. J.E. |author3=Algra, A. |author4= van Gijn, J. |title=Case-Fatality Rates and Functional Outcome After Subarachnoid Hemorrhage : A Systematic Review|journal=Stroke|date=1 March 1997|volume=28|issue=3|pages=660–64|doi=10.1161/01.STR.28.3.660|pmid=9056628}}</ref><ref>{{cite journal|last=Ljunggren|first=B|author2=Sonesson, B |author3=Säveland, H |author4= Brandt, L |s2cid=26649695|title=Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation.|journal=Journal of Neurosurgery|date=May 1985|volume=62|issue=5|pages=673–79|pmid=3989590|doi=10.3171/jns.1985.62.5.0673}}</ref>
Increased availability and greater access to [[medical imaging]] has caused a rising number of asymptomatic, unruptured cerebral aneurysms to be [[Incidental imaging finding|discovered incidentally]] during medical imaging investigations.<ref>{{cite journal|last=Vernooij |first=MW|author2=Ikram, MA |author3=Tanghe, HL|title=Incidental findings on brain MRI in the general population.Incidental findings on brain MRI in the general population.|journal=N Engl J Med|date=2007|volume=357|issue=5|pages=1821–28|pmid=17978290|doi=10.1056/NEJMoa070972|doi-access=free}}</ref> Unruptured aneurysms may be managed by [[endovascular]] clipping or stenting. For those subjects that underwent follow-up for the unruptured aneurysm, [[computed tomography angiography]] (CTA) or [[magnetic resonance angiography]] (MRA) of the brain can be done yearly.<ref>{{Cite journal |last1=Thompson |first1=B. Gregory |last2=Brown |first2=Robert D. |last3=Amin-Hanjani |first3=Sepideh |last4=Broderick |first4=Joseph P. |last5=Cockroft |first5=Kevin M. |last6=Connolly |first6=E. Sander |last7=Duckwiler |first7=Gary R. |last8=Harris |first8=Catherine C. |last9=Howard |first9=Virginia J. |last10=Johnston |first10=S. Claiborne (Clay) |last11=Meyers |first11=Philip M. |last12=Molyneux |first12=Andrew |last13=Ogilvy |first13=Christopher S. |last14=Ringer |first14=Andrew J. |last15=Torner |first15=James |date=August 2015 |title=Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association |journal=Stroke |language=en |volume=46 |issue=8 |pages=2368–2400 |doi=10.1161/STR.0000000000000070 |issn=0039-2499|doi-access=free |pmid=26089327 }}</ref> Recently, an increasing number of aneurysm features have been evaluated in their ability to predict aneurysm rupture status, including aneurysm height, aspect ratio, height-to-width ratio, inflow angle, deviations from ideal spherical or elliptical forms, and [[radiomics]] morphological features.<ref>{{cite journal|last=Ludwig |first=CG|author2=Lauric, A |author3=Malek, JA|author4=Mulligan, R|author5=Malek, AM|title=Performance of Radiomics derived morphological features for prediction of aneurysm rupture status.|journal=Journal of NeuroInterventional Surgery|date=2020|volume=13|issue=8|pages=<!-- -->|pmid=33158993 |doi=10.1136/neurintsurg-2020-016808|s2cid=226274492}}</ref>
==Epidemiology==
The [[prevalence]] of intracranial aneurysm is about 1–5% (10 million to 12 million persons in the United States) and the [[Incidence (epidemiology)|incidence]] is 1 per 10,000 persons per year in the United States (approximately 27,000), with 30- to 60-year-olds being the age group most affected.<ref name=BRISMAN2006 /><ref name=Haberfield2007 /> Intracranial aneurysms occur more in women, by a ratio of 3 to 2, and are rarely seen in pediatric populations.<ref name=BRISMAN2006>{{cite journal|last=Brisman|first=JL|author2=Song, JK |author3=Newell, DW |title=Cerebral aneurysms.|journal=The New England Journal of Medicine|date=Aug 31, 2006|volume=355|issue=9|pages=928–39|pmid=16943405|doi=10.1056/nejmra052760}}</ref><ref name=Kemp2008 />
==See also==
* [[Interventional neuroradiology]]
* [[Intradural pseudoaneurysm]]
==References==
{{Reflist}}
== External links ==
{{commons category|Cerebral aneurysms}}
* [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke]
{{Medical resources
| DiseasesDB =
| ICD11 = {{ICD11|8B22.5}}
| ICD10 = {{ICD10|I|67|1|i|60}}
| ICD9 = {{ICD9|437.3}}
| ICDO =
| OMIM =
| MedlinePlus = 001414
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D002532
| SNOMED CT = 128609009
}}
{{Cerebrovascular diseases}}
{{Vascular diseases}}
{{Authority control}}
{{DEFAULTSORT:Cerebral Aneurysm}}
[[Category:Cerebrovascular diseases]]
[[Category:Neurosurgery]]' |
New page wikitext, after the edit (new_wikitext) | '{{short description|Cerebrovascular disorder}}
{{cs1 config|name-list-style=vanc}}
{{Shortlead|date=December 2023}}
{{Infobox medical condition (new)
| name = Intracranial aneurysm
| synonyms = Cerebral aneurysm, brain aneurysm
| image = Cerebellar aneurysm.png
| caption = [[Aneurysm]] of the [[basilar artery]] and the [[vertebral arteries]]
| pronounce =
| field =
| symptoms = None, severe [[headache]], visual problems, [[nausea]] and [[vomiting]], [[confusion]]<ref name="mayoclinic.org">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/brain-aneurysm/symptoms-causes/syc-20361483|title=Brain aneurysm - Symptoms and causes|website=[[Mayo Clinic]] }}</ref>
| complications =
| onset = 30–60 years old
| duration =
| types =
| causes = [[Hypertension]], [[infection]], [[head trauma]]<ref>{{Cite web|url=https://www.webmd.com/heart-disease/understanding-aneurysm-basics|title = What is an Aneurysm?}}</ref>
| risks = old age, [[family history]], smoking, alcoholism, [[cocaine]] use<ref name="mayoclinic.org">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/brain-aneurysm/symptoms-causes/syc-20361483|title=Brain aneurysm - Symptoms and causes|website=[[Mayo Clinic]] }}</ref>
| diagnosis = [[Angiography]], [[CT scan]]
| differential =
| prevention =
| treatment = [[Endovascular coiling]], [[surgical clipping]], cerebral bypass surgery, pipeline embolization
| medication =
| prognosis =
| frequency =
| deaths =
}}
An '''intracranial aneurysm''', also known as a '''cerebral aneurysm''', go fuck yourself so hard that you get yourself pregnant imagina being a nerd so much to as you read about brain aneurysms like bro who does this like go play Fortnite or something bro
[[Aneurysm]]s in the [[Cerebral circulation#Arterial cerebral circulation|posterior circulation]] ([[basilar artery]], [[vertebral arteries]] and [[posterior communicating artery]]) have a higher risk of rupture. Basilar artery aneurysms represent only 3–5% of all intracranial aneurysms but are the most common aneurysms in the posterior circulation.
==Classification==
{{See also|Aneurysm#Classification}}
[[Image:Cerebral aneurysm NIH.jpg|thumb|right|Diagram of cerebral aneurysm.]]
Cerebral aneurysms are classified both by size and shape. Small aneurysms have a diameter of less than 15 mm. Larger aneurysms include those classified as large (15 to 25 mm), giant (25 to 50 mm) (0.98 inches to 1.97 inches), and super-giant (over 50 mm).<ref name=HOPKINS8772>{{cite web|url=http://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/cerebral_aneurysm_85,P08772/|title=What You Should Know About Cerebral Aneurysms|website=www.hopkinsmedicine.org|date=8 August 2021 }}</ref>
===Berry (saccular) aneurysms===
Saccular aneurysms, also known as berry aneurysms, appear as a round outpouching and are the most common form of cerebral aneurysm.<ref name=HOPKINS8772 /><ref name=ROONGROJ2005>{{cite book|first1=Roongroj|last1=Bhidayasiri|first2=Michael F.|last2=Waters|first3=Christopher C.|last3=Giza|title=Neurological differential diagnosis : a prioritized approach|url=https://archive.org/details/neurologicaldiff00bhid|url-access=limited|year=2005|publisher=Blackwell Publishing|location=Oxford|isbn=978-1-4051-2039-5|page=[https://archive.org/details/neurologicaldiff00bhid/page/n147 133]|edition=3. Dr.}}</ref> Causes include connective tissue disorders, [[polycystic kidney disease]], arteriovenous malformations, untreated [[hypertension]], tobacco smoking, cocaine and amphetamines, intravenous drug abuse (can cause infectious mycotic aneurysms), alcoholism, heavy caffeine intake, head trauma, and infection in the arterial wall from [[bacteremia]] (mycotic aneurysms).<ref>Koutsothanasis G.A.; Sampath R., Berry Aneurysm (update: October 2, 2020). Link https://www.ncbi.nlm.nih.gov/books/NBK557480/</ref>
===Fusiform aneurysms===
Fusiform [[intracranial dolichoectasias|dolichoectatic]] aneurysms represent a widening of a segment of an artery around the entire blood vessel, rather than just arising from a side of an artery's wall. They have an estimated annual risk of rupture between 1.6 and 1.9 percent.<ref>{{Cite journal|last1=Xu|first1=David S.|last2=Levitt|first2=Michael R.|last3=Kalani|first3=M. Yashar S.|last4=Rangel-Castilla|first4=Leonardo|last5=Mulholland|first5=Celene B.|last6=Abecassis|first6=Isaac J.|last7=Morton|first7=Ryan P.|last8=Nerva|first8=John D.|last9=Siddiqui|first9=Adnan H.|last10=Levy|first10=Elad I.|last11=Spetzler|first11=Robert F.|date=2017-04-07|title=Dolichoectatic aneurysms of the vertebrobasilar system: clinical and radiographic factors that predict poor outcomes|url=https://thejns.org/view/journals/j-neurosurg/128/2/article-p560.xml|journal=Journal of Neurosurgery|language=en-US|volume=128|issue=2|pages=560–66|doi=10.3171/2016.10.JNS161041|pmid=28387624|issn=1933-0693|doi-access=free}}</ref><ref>Fusiform and dolichoectatic aneurysms By James R Brorson MD (Dr. Brorson of the University of Chicago received consultation fees from CVS-Caremark, National Peer Review Corporation, and Medico-legal Consulting.) Originally released October 28, 1997; last updated January 29, 2017; expires January 29, 2020
https://tcapp.org/wp-content/uploads/2017/09/Fusiform-and-Dolichoectatic-Aneurysms.pdf</ref>
===Microaneurysms===
{{Main|Charcot–Bouchard aneurysm}}
Microaneurysms, also known as [[Charcot–Bouchard aneurysm]]s, typically occur in small [[blood vessel]]s (less than 300 [[micrometre]] diameter), most often the [[Anterolateral central arteries|lenticulostriate]] vessels of the [[basal ganglia]], and are associated with [[chronic (medicine)|chronic]] [[hypertension]].<ref name = robbins>{{cite book | editor1-last = Kumar | editor2-last = Abbas | editor3-last = Fausto | title = Robbins and Cotran Pathologic Basis of Disease | edition = 7th | year = 2005 | location = China | publisher = Elsevier | isbn = 978-0-7216-0187-8}}{{page needed|date=July 2020}}</ref> Charcot–Bouchard aneurysms are a common cause of [[intracranial hemorrhage]].<ref>{{Citation|last1=Gupta|first1=Kashvi|title=Charcot Bouchard Aneurysm|date=2021|url=http://www.ncbi.nlm.nih.gov/books/NBK553028/|work=|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=31971704|access-date=2021-05-06|last2=M Das|first2=Joe}}</ref>
==Signs and symptoms==
A small, unchanging aneurysm will produce few, if any, symptoms. Before a larger aneurysm ruptures, the individual may experience such symptoms as a sudden and unusually severe headache, [[nausea]], vision impairment, [[vomiting]], and [[unconsciousness|loss of consciousness]], or no symptoms at all.<ref name=BRISMAN2006 />
=== Subarachnoid bleed ===
{{Main|Subarachnoid hemorrhage#Signs and symptoms}}
If an aneurysm ruptures, blood leaks into the space around the brain. This is called a [[subarachnoid hemorrhage]]. Onset is usually sudden without [[prodrome]], classically presenting as a "[[thunderclap headache]]" worse than previous headaches.<ref name=Goljan2006/><ref name=stroke /> Symptoms of a subarachnoid hemorrhage differ depending on the site and size of the aneurysm.<ref name=stroke /> Symptoms of a ruptured aneurysm can include:<ref>{{Cite web|last=Publishing|first=Harvard Health|title=Subarachnoid Hemorrhage|url=https://www.health.harvard.edu/a_to_z/subarachnoid-hemorrhage-a-to-z|access-date=2021-05-06|website=Harvard Health|date=18 December 2018}}</ref>
* a sudden severe headache that can last from several hours to days
* nausea and vomiting
* drowsiness, confusion and/or loss of consciousness
* visual abnormalities
* [[meningism]]
* dizziness
Almost all aneurysms rupture at their apex. This leads to hemorrhage in the subarachnoid space and sometimes in brain [[parenchyma]]. Minor leakage from aneurysm may precede rupture, causing warning headaches. About 60% of patients die immediately after rupture.<ref name=autopsy /> Larger aneurysms have a greater tendency to rupture, though most ruptured aneurysms are less than 10 mm in diameter.<ref name=stroke />
===Microaneurysms===
A ruptured microaneurysm may cause an [[intracerebral hemorrhage]], presenting as a focal neurological deficit.<ref name=stroke />
Rebleeding, [[hydrocephalus]] (the excessive accumulation of [[cerebrospinal fluid]]), [[vasospasm]] (spasm, or narrowing, of the blood vessels), or multiple aneurysms may also occur. The risk of rupture from a cerebral aneurysm varies according to the size of an aneurysm, with the risk rising as the aneurysm size increases.<ref>{{Cite journal|last1=Korja Miikka|last2=Lehto Hanna|last3=Juvela Seppo|date=2014-07-01|title=Lifelong Rupture Risk of Intracranial Aneurysms Depends on Risk Factors|journal=Stroke|volume=45|issue=7|pages=1958–63|doi=10.1161/STROKEAHA.114.005318|pmid=24851875|doi-access=free}}</ref>
=== Vasospasm ===
{{see also|Subarachnoid hemorrhage#Vasospasm}}
[[Vasospasm]], referring to blood vessel constriction, can occur secondary to subarachnoid hemorrhage following a ruptured aneurysm. This is most likely to occur within 21 days and is seen radiologically within 60% of such patients. The vasospasm is thought to be secondary to the [[apoptosis]] of [[Inflammation|inflammatory]] cells such as [[macrophage]]s and [[neutrophil]]s that become trapped in the subarachnoid space. These cells initially invade the subarachnoid space from the circulation in order to [[phagocytose]] the hemorrhaged red blood cells. Following apoptosis, it is thought there is a massive degranulation of vasoconstrictors, including [[endothelin]]s and [[free radical]]s, that cause the vasospasm.<ref>{{cite journal|last=Gallia|first=Gary L.|author2=Tamargo, Rafael J.|s2cid=27713975|title=Leukocyte-endothelial cell interactions in chronic vasospasm after subarachnoid hemorrhage|journal=Neurological Research|date=1 October 2006|volume=28|issue=7|pages=750–58|doi=10.1179/016164106X152025|pmid=17164038}}</ref>
==Risk factors==
Intracranial aneurysms may result from diseases acquired during life, or from genetic conditions. [[Hypertension]], [[smoking]], [[alcoholism]], and [[obesity]] are associated with the development of brain aneurysms.<ref name=Goljan2006/><ref name=stroke>{{cite book|editor-first1=David |editor-last1=Alway |editor-first2=John Walden |editor-last2=Cole|title=Stroke Essentials for Primary Care: A Practical Guide|url=https://archive.org/details/strokeessentials00alwa_561 |url-access=limited |year=2009|publisher=Humana Press|location=New York|isbn=978-1-934115-01-5|pages=[https://archive.org/details/strokeessentials00alwa_561/page/n95 86]–88, 153}}</ref><ref name=Kemp2008>{{cite book|last=Brown|first=Walter L. Kemp, Dennis K. Burns, Travis G.|title=Pathology the big picture|year=2008|publisher=McGraw-Hill Medical|location=New York|isbn=978-0-07-159379-3|page=148}}</ref> [[Cocaine]] use has also been associated with the development of intracranial aneurysms.<ref name = stroke/>
Other acquired associations with intracranial aneurysms include head trauma and infections.<ref name = Goljan2006 />
===Genetic associations===
Coarctation of the aorta is also a known risk factor,<ref name=Goljan2006>{{cite book |author=Goljan, Edward F. |title=Rapid Review Pathology |publisher=Mosby |location=St. Louis |year=2006 |edition=2nd |isbn=978-0-323-04414-1|page=158}}</ref> as is [[arteriovenous malformation]].<ref name=autopsy>{{cite book|first1=Vincent J.|last1=DiMaio|first2=Dominick|last2=DiMaio|title=Forensic pathology|year=2001|publisher=CRC Press|location=Boca Raton, FL |isbn=978-0-8493-0072-1|page=[https://archive.org/details/forensicpatholog0000dima/page/61 61]|edition=2nd|url-access=registration|url=https://archive.org/details/forensicpatholog0000dima/page/61}}</ref> Genetic conditions associated with [[connective tissue disease]] may also be associated with the development of aneurysms.<ref name=Goljan2006 /> This includes:<ref>{{cite journal|last=Caranci|first=F.|author2=Briganti, F. |author3=Cirillo, L. |author4=Leonardi, M. |author5= Muto, M. |title=Epidemiology and genetics of intracranial aneurysms|journal=European Journal of Radiology|volume=82|issue=10|pages=1598–605|year=2012|doi=10.1016/j.ejrad.2012.12.026|pmid=23399038}}</ref>
* [[autosomal dominant polycystic kidney disease]],
* [[neurofibromatosis type I]],
* [[Marfan syndrome]],
* [[multiple endocrine neoplasia]] type I,
* [[pseudoxanthoma elasticum]],
* [[hereditary hemorrhagic telangiectasia]] and
* [[Ehlers-Danlos syndrome]] types II and IV.
Specific genes have also had reported association with the development of intracranial aneurysms, including [[perlecan]], [[elastin]], [[collagen]] type 1 A2, endothelial [[nitric oxide synthase]], [[endothelin]] receptor A and [[cyclin dependent kinase inhibitor]]. Recently, several [[genetic loci]] have been identified as relevant to the development of intracranial aneurysms. These include 1p34–36, 2p14–15, 7q11, 11q25, and 19q13.1–13.3.<ref>{{cite journal|last=van der Voet|first=M|author2=Olson, J |author3=Kuivaniemi, H |author4=Dudek, D |author5=Skunca, M |author6=Ronkainen, A |author7=Niemelä, M |author8=Jääskeläinen, J |author9=Hernesniemi, J |author10= Helin, K |title=Intracranial Aneurysms in Finnish Families: Confirmation of Linkage and Refinement of the Interval to Chromosome 19q13.3|journal=The American Journal of Human Genetics|date=1 March 2004|volume=74|issue=3|pages=564–71|doi=10.1086/382285 |pmid=14872410 |pmc=1182270}}</ref>
==Pathophysiology==
{{See also|Aneurysm#Pathophysiology}}
[[Aneurysm]] means an outpouching of a [[blood vessel]] wall that is filled with blood. Aneurysms occur at a point of weakness in the vessel wall. This can be because of acquired disease or hereditary factors. The repeated trauma of blood flow against the vessel wall presses against the point of weakness and causes the aneurysm to enlarge.<ref name=Haberfield2007 /> As described by the [[law of Young-Laplace]], the increasing area increases tension against the aneurysmal walls, leading to enlargement.<ref>{{Cite journal|last1=Humphrey|first1=J. D.|last2=Kyriacou|first2=S. K.|date=June 1996|title=The use of Laplace's equation in aneurysm mechanics|url=https://pubmed.ncbi.nlm.nih.gov/8837052/|journal=Neurological Research|volume=18|issue=3|pages=204–08|doi=10.1080/01616412.1996.11740404|issn=0161-6412|pmid=8837052}}</ref><ref>{{Cite web|title=Laplace's Law and Aneurysms|url=https://sciencedemonstrations.fas.harvard.edu/presentations/laplaces-law-and-aneurysms|access-date=2021-05-06|website=sciencedemonstrations.fas.harvard.edu|language=en}}</ref><ref>{{Cite journal|last=Hademenos|first=George J.|date=2008-01-11|title=The Physics of Cerebral Aneurysms|url=https://physicstoday.scitation.org/doi/abs/10.1063/1.881442|journal=Physics Today|language=en|volume=48|issue=2|page=24|doi=10.1063/1.881442|issn=0031-9228}}</ref> In addition, a combination of computational fluid dynamics and morphological indices have been proposed as reliable predictors of cerebral aneurysm rupture.<ref>{{Cite journal|last1=Amigo|first1=Nicolás|last2=Valencia|first2=Alvaro|last3=Wu|first3=Wei|last4=Patnaik|first4=Sourav|last5=Finol|first5=Ender|date=2021-03-08|title=Cerebral aneurysm rupture status classification using statistical and machine learning methods|url=https://pubmed.ncbi.nlm.nih.gov/33685288|journal=Proceedings of the Institution of Mechanical Engineers, Part H|volume=235|issue=6|pages= 655–662|doi=10.1177/09544119211000477|issn=2041-3033|pmid=33685288|s2cid=232161029}}</ref>
Both high and low wall [[shear stress]] of flowing blood can cause aneurysm and rupture. However, the mechanism of action is still unknown. It is speculated that low shear stress causes growth and rupture of large aneurysms through inflammatory response while high shear stress causes growth and rupture of small aneurysm through mural response (response from the blood vessel wall). Other risk factors that contributes to the formation of aneurysm are: cigarette smoking, hypertension, female gender, family history of cerebral aneurysm, infection, and trauma. Damage to structural integrity of the arterial wall by shear stress causes an inflammatory response with the recruitment of [[T cell]]s, [[macrophage]]s, and [[mast cell]]s. The inflammatory mediators are: [[interleukin 1 beta]], [[interleukin 6]], [[tumor necrosis factor alpha]] (TNF alpha), [[MMP1]], [[MMP2]], [[MMP9]], [[prostaglandin E2]], [[complement system]], [[reactive oxygen species]] (ROS), and [[angiotensin II]]. However, [[smooth muscle cell]]s from the [[tunica media]] layer of the artery moved into the [[tunica intima]], where the function of the smooth muscle cells changed from contractile function into pro-inflammatory function. This causes the fibrosis of the arterial wall, with reduction of number of smooth muscle cells, abnormal collagen synthesis, resulting in a thinning of the arterial wall and the formation of aneurysm and rupture. No specific gene loci has been identified to be associated with cerebral aneurysms.<ref name="AHA journal">{{cite journal|last1=Chalouhi|first1=Nohra|last2=Loh|first2=Brian L|last3=Hasan|first3=David|title=Review of Cerebral Aneurysm Formation, Growth, and Rupture|journal= Stroke|date=25 November 2013|volume=44|issue=12|pages=3613–22|doi=10.1161/STROKEAHA.113.002390|pmid=24130141|doi-access=free}}</ref>
Generally, aneurysms larger than 7 mm in diameter should be treated because they are prone for rupture. Meanwhile, aneurysms less than 7 mm arise from the [[anterior communicating artery|anterior]] and [[posterior communicating artery]] and are more easily ruptured when compared to aneurysms arising from other locations.<ref name="AHA journal"/>
===Saccular aneurysms===
[[File:Wikipedia intracranial aneurysms - inferior view - heat map.jpg|thumb|right|The most common sites of intracranial saccular aneurysms]]
Saccular aneurysms are almost always the result of hereditary weaknesses in blood vessels and typically occur within the arteries of the [[circle of Willis]],<ref name=Haberfield2007>{{cite book|last=Haberland|first=Catherine|title=Clinical neuropathology : text and color atlas|url=https://archive.org/details/clinicalneuropat00habe_423|url-access=limited|year=2007|publisher=Demos|location=New York|isbn=978-1-888799-97-2|page=[https://archive.org/details/clinicalneuropat00habe_423/page/n81 70]|edition=Online-Ausg.}}</ref><ref>{{DorlandsDict|one/000004838|berry aneurysm}}</ref> in order of frequency affecting the following arteries:<ref>{{cite book|first1=David|last1=Howlett|first2=Brian|last2=Ayers|title=The hands-on guide to imaging|url=https://archive.org/details/handsonguidetoim00howl|url-access=limited|year=2004|publisher=Blackwell|location=Oxford|isbn=978-1-4051-1551-3|page=[https://archive.org/details/handsonguidetoim00howl/page/n216 204]}}</ref>
* [[Anterior communicating artery]]
* [[Posterior communicating artery]]
* [[Middle cerebral artery]]
* [[Internal carotid artery]]
* Tip of [[basilar artery]]
Saccular aneurysms tend to have a lack of [[tunica media]] and elastic lamina around their dilated locations (congenital), with a wall of sac made up of thickened hyalinized intima and adventitia.<ref name=autopsy /> In addition, some parts of the brain vasculature are inherently weak—particularly areas along the circle of Willis, where small communicating vessels link the main cerebral vessels. These areas are particularly susceptible to saccular aneurysms.<ref name=Goljan2006 /> Approximately 25% of patients have multiple aneurysms, predominantly when there is a familial pattern.<ref name=stroke />
==Diagnosis==
[[File:CT angiography showing aneurysm at the ACOM.jpg|thumb|CT angiography showing aneurysm measuring 2.6 mm in diameter at the ACOM (anterior communicating artery).]]
Once suspected, intracranial aneurysms can be diagnosed radiologically using [[Magnetic resonance angiography|magnetic resonance]] or [[Computed tomography angiography|CT]] angiography.<ref name=":0">{{Cite journal|last1=White|first1=Philip M.|last2=Teasdale|first2=Evelyn M. |last3=Wardlaw |first3=Joanna M. |author3-link=Joanna Wardlaw |last4=Easton |first4=Valerie|date=2001-06-01|title=Intracranial Aneurysms: CT Angiography and MR Angiography for Detection – Prospective Blinded Comparison in a Large Patient Cohort |journal=Radiology |volume=219 |issue=3 |pages=739–49 |doi=10.1148/radiology.219.3.r01ma16739 |pmid=11376263|issn=0033-8419}}</ref> But these methods have limited sensitivity for diagnosis of small aneurysms, and often cannot be used to specifically distinguish them from infundibular dilations without performing a formal [[Angiography|angiogram]].<ref name=":0" /><ref>{{Cite book|title=Handbook of neurosurgery|last=Greenberg|first=Mark|date=2010|publisher=Greenberg Graphics|isbn=978-1-60406-326-4|oclc=892183792}}{{page needed|date=July 2020}}</ref> The determination of whether an aneurysm is ruptured is critical to diagnosis. [[Lumbar puncture]] (LP) is the gold standard technique for determining aneurysm rupture ([[subarachnoid hemorrhage]]). Once an LP is performed, the [[Cerebrospinal fluid|CSF]] is evaluated for [[Erythrocyte count|RBC count]], and presence or absence of [[xanthochromia]].<ref>{{Cite journal|last1=Mark|first1=Dustin G.|last2=Kene|first2=Mamata V.|last3=Offerman|first3=Steven R.|last4=Vinson|first4=David R.|last5=Ballard|first5=Dustin W.|title=Validation of cerebrospinal fluid findings in aneurysmal subarachnoid hemorrhage|journal=The American Journal of Emergency Medicine|volume=33|issue=9|pages=1249–52|doi=10.1016/j.ajem.2015.05.012|pmid=26022754|year=2015}}</ref>
== Treatment ==
[[File:AneurysmClips.jpg|thumb|A selection of [[Frank Henderson Mayfield|Mayfield]] and [[Charles George Drake|Drake]] aneurysm clips ready for implantation.]]
[[Emergency medicine|Emergency treatment]] for individuals with a ruptured cerebral aneurysm generally includes restoring deteriorating [[Respiration (physiology)|respiration]] and reducing [[intracranial pressure]]. Currently there are two treatment options for securing intracranial aneurysms: [[Clipping (medicine)|surgical clipping]] or [[endovascular coiling]]. If possible, either surgical clipping or endovascular coiling is typically performed within the first 24 hours after bleeding to occlude the ruptured aneurysm and reduce the risk of recurrent hemorrhage.<ref>{{Cite journal|last1=Park|first1=Jaechan|last2=Woo|first2=Hyunjin|last3=Kang|first3=Dong-Hun|last4=Kim|first4=Yong-Sun|last5=Kim|first5=Min Young|last6=Shin|first6=Im Hee|last7=Kwak|first7=Sang Gyu|date=2015-02-01|title=Formal protocol for emergency treatment of ruptured intracranial aneurysms to reduce in-hospital rebleeding and improve clinical outcomes|url=https://thejns.org/view/journals/j-neurosurg/122/2/article-p383.xml|journal=Journal of Neurosurgery|language=en-US|volume=122|issue=2|pages=383–91|doi=10.3171/2014.9.JNS131784|pmid=25403841|issn=1933-0693|doi-access=free}}</ref>
While a large [[meta-analysis]] found the outcomes and risks of surgical clipping and endovascular coiling to be statistically similar, no consensus has been reached.<ref>{{cite journal|last=Raja|first=PV|author2=Huang, J |author3=Germanwala, AV |author4=Gailloud, P |author5=Murphy, KP |author6= Tamargo, RJ |title=Microsurgical clipping and endovascular coiling of intracranial aneurysms: a critical review of the literature.|journal=Neurosurgery|date=June 2008|volume=62|issue=6|pages=1187–202; discussion 1202–03|pmid=18824986|doi=10.1227/01.neu.0000333291.67362.0b}}</ref> In particular, the large [[randomised control trial]] [[International Subarachnoid Aneurysm Trial]] appears to indicate a higher rate of recurrence when intracerebral aneurysms are treated using endovascular coiling. Analysis of data from this trial has indicated a 7% lower eight-year mortality rate with coiling,<ref>Mitchell P, Kerr R, Mendelow AD, Molyneux A. "Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in ISAT?" ''Journal of Neurosurgery'' 108: 437–42, March 2008</ref> a high rate of aneurysm recurrence in aneurysms treated with coiling—from 28.6 to 33.6% within a year,<ref name="Piotin et al. 2007">{{cite journal |last=Piotin |first=M |author2=Spelle, L |author3=Mounayer, C |author4=Salles-Rezende, MT |author5=Giansante-Abud, D |author6=Vanzin-Santos, R |author7=Moret, J |date=May 2007 |title=Intracranial aneurysms: treatment with bare platinum coils – aneurysm packing, complex coils, and angiographic recurrence |journal=Radiology |volume=243 |issue=2 |pages=500–08 |pmid=17293572 |doi=10.1148/radiol.2431060006 }}</ref><ref name="Raymond et al. 2003">{{cite journal |last=Raymond |first=J |author2=Guilbert, F |author3=Weill, A |author4=Georganos, SA |author5=Juravsky, L |author6=Lambert, A |author7=Lamoureux, J |author8=Chagnon, M |author9=Roy, D |date=June 2003 |title= Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils |journal=Stroke |volume=34 |issue=6 |pages=1398–1403 |pmid=12775880 |doi= 10.1161/01.STR.0000073841.88563.E9 |doi-access=free }}</ref> a 6.9 times greater rate of late retreatment for coiled aneurysms,<ref name="Campi et al. 2007">{{cite journal | vauthors = Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV | title = Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT) | journal = Stroke | volume = 38 | issue = 5 | pages = 1538–44 | date = May 2007 | pmid = 17395870 | doi = 10.1161/STROKEAHA.106.466987 | doi-access = free }}</ref> and a rate of rebleeding 8 times higher than surgically clipped aneurysms.<ref name="pmid18312088">{{cite journal | vauthors = Mitchell P, Kerr R, Mendelow AD, Molyneux A | s2cid = 24304414 | title = Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the International Subarachnoid Aneurysm Trial? | journal = J. Neurosurg. | volume = 108 | issue = 3 | pages = 437–42 | date = March 2008 | pmid = 18312088 | doi = 10.3171/JNS/2008/108/3/0437}}</ref>
=== Surgical clipping ===
{{main|Surgical clipping}}
Aneurysms can be treated by clipping the base of the aneurysm with a specially-designed clip. Whilst this is typically carried out by [[craniotomy]], a new endoscopic endonasal approach is being trialled.<ref>{{cite web |url=https://www.med.unc.edu/surgery/germanwala-presents-first-aneurysm-patient-treated-through-nose/ |title= Germanwala Presents First Aneurysm Patient Treated Through Nose|author=<!--Not stated--> |date=June 25, 2009 |website=UNC }}</ref> Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937.<ref>{{cite journal|url=http://www.neurologyindia.com/text.asp?2015/63/1/96/152666|title=Aneurysm clips: What every resident should know|first1=Gopalakrishnan Madhavan|last1=Sasidharan|first2=Savitr B V|last2=Sastri|first3=Paritosh|last3=Pandey|date=1 January 2015|via=www.neurologyindia.com|journal=Neurology India|volume=63|issue=1}}</ref>
After clipping, a catheter angiogram or CTA can be performed to confirm complete clipping.<ref>Bharatha A, Yeung R, Durant D, Fox AJ, Aviv RI, Howard P, Thompson AL, Bartlett ES, Symons SP. "Comparison of computed tomography angiography with digital subtraction angiography in the assessment of clipped intracranial aneurysms". ''Journal of Computer Assisted Tomography''. 2010 May–June; 34(3): 440–45.</ref>
===Endovascular coiling===
{{main|Endovascular coiling}}
Endovascular coiling refers to the insertion of [[platinum]] coils into the aneurysm. A [[catheter]] is inserted into a blood vessel, typically the [[femoral artery]], and passed through blood vessels into the cerebral circulation and the aneurysm. Coils are pushed into the aneurysm, or released into the blood stream ahead of the aneurysm. Upon depositing within the aneurysm, the coils expand and initiate a thrombotic reaction within the aneurysm. If successful, this prevents further bleeding from the aneurysm.<ref name="pmid9933290">{{cite journal | vauthors = Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A | title = Treatment of intracranial aneurysms by embolization with coils: a systematic review | journal = Stroke | volume = 30 | issue = 2 | pages = 470–76 | date = February 1999 | pmid = 9933290 | doi = 10.1161/01.STR.30.2.470 | doi-access = free }}</ref> In the case of broad-based aneurysms, a stent may be passed first into the parent artery to serve as a scaffold for the coils.<ref>{{Cite journal|last1=Oushy|first1=Soliman|last2=Rinaldo|first2=Lorenzo|last3=Brinjikji|first3=Waleed|last4=Cloft|first4=Harry|last5=Lanzino|first5=Giuseppe|date=June 2020|title=Recent advances in stent-assisted coiling of cerebral aneurysms|journal=Expert Review of Medical Devices|volume=17|issue=6|pages=519–32|doi=10.1080/17434440.2020.1778463|issn=1745-2422|pmid=32500761|s2cid=219328499}}</ref>
===Cerebral bypass surgery===
Cerebral bypass surgery was developed in the 1960s in Switzerland by [[Gazi Yaşargil]]. When a patient has an aneurysm involving a blood vessel or a tumor at the base of the skull wrapping around a blood vessel, surgeons eliminate the problem vessel by replacing it with an artery from another part of the body.<ref>{{cite journal|title=Microvascular bypass surgery|first1=Robert|last1=Spetzler|first2=Norman|last2=Chater|date=1 November 1976|journal=Journal of Neurosurgery|volume=45|issue=5|pages=508–13|doi=10.3171/jns.1976.45.5.0508|pmid=972334}}</ref>
== Prognosis ==
Outcomes depend on the size of the aneurysm.<ref name=Mal2017/> Small aneurysms (less than 7 mm) have a low risk of rupture and increase in size slowly.<ref name=Mal2017/> The risk of rupture is less than one percent for aneurysms of this size.<ref name=Mal2017>{{cite journal | vauthors = Malhotra A, Wu X, Forman HP, Grossetta Nardini HK, Matouk CC, Gandhi D, Moore C, Sanelli P | title = Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms: A Systematic Review | journal = Ann. Intern. Med. | volume = 167 | issue = 1 | pages = 26–33 | date = July 2017 | pmid = 28586893 | doi = 10.7326/M17-0246 }}</ref>
The [[prognosis]] for a ruptured cerebral aneurysm depends on the extent and location of the aneurysm, the person's age, general health, and neurological condition. Some individuals with a ruptured cerebral aneurysm die from the initial bleeding. Other individuals with cerebral aneurysm recover with little or no neurological deficit. The most significant factors in determining outcome are the [[Hunt and Hess scale|Hunt and Hess grade]], and age. Generally patients with Hunt and Hess grade I and II hemorrhage on admission to the emergency room and patients who are younger within the typical age range of vulnerability can anticipate a good outcome, without death or permanent disability. Older patients and those with poorer Hunt and Hess grades on admission have a poor prognosis. Generally, about two-thirds of patients have a poor outcome, death, or permanent disability.<ref name=Haberfield2007 /><ref>{{cite journal|last=Hop|first=J. W.|author2=Rinkel, G. J.E. |author3=Algra, A. |author4= van Gijn, J. |title=Case-Fatality Rates and Functional Outcome After Subarachnoid Hemorrhage : A Systematic Review|journal=Stroke|date=1 March 1997|volume=28|issue=3|pages=660–64|doi=10.1161/01.STR.28.3.660|pmid=9056628}}</ref><ref>{{cite journal|last=Ljunggren|first=B|author2=Sonesson, B |author3=Säveland, H |author4= Brandt, L |s2cid=26649695|title=Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation.|journal=Journal of Neurosurgery|date=May 1985|volume=62|issue=5|pages=673–79|pmid=3989590|doi=10.3171/jns.1985.62.5.0673}}</ref>
Increased availability and greater access to [[medical imaging]] has caused a rising number of asymptomatic, unruptured cerebral aneurysms to be [[Incidental imaging finding|discovered incidentally]] during medical imaging investigations.<ref>{{cite journal|last=Vernooij |first=MW|author2=Ikram, MA |author3=Tanghe, HL|title=Incidental findings on brain MRI in the general population.Incidental findings on brain MRI in the general population.|journal=N Engl J Med|date=2007|volume=357|issue=5|pages=1821–28|pmid=17978290|doi=10.1056/NEJMoa070972|doi-access=free}}</ref> Unruptured aneurysms may be managed by [[endovascular]] clipping or stenting. For those subjects that underwent follow-up for the unruptured aneurysm, [[computed tomography angiography]] (CTA) or [[magnetic resonance angiography]] (MRA) of the brain can be done yearly.<ref>{{Cite journal |last1=Thompson |first1=B. Gregory |last2=Brown |first2=Robert D. |last3=Amin-Hanjani |first3=Sepideh |last4=Broderick |first4=Joseph P. |last5=Cockroft |first5=Kevin M. |last6=Connolly |first6=E. Sander |last7=Duckwiler |first7=Gary R. |last8=Harris |first8=Catherine C. |last9=Howard |first9=Virginia J. |last10=Johnston |first10=S. Claiborne (Clay) |last11=Meyers |first11=Philip M. |last12=Molyneux |first12=Andrew |last13=Ogilvy |first13=Christopher S. |last14=Ringer |first14=Andrew J. |last15=Torner |first15=James |date=August 2015 |title=Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association |journal=Stroke |language=en |volume=46 |issue=8 |pages=2368–2400 |doi=10.1161/STR.0000000000000070 |issn=0039-2499|doi-access=free |pmid=26089327 }}</ref> Recently, an increasing number of aneurysm features have been evaluated in their ability to predict aneurysm rupture status, including aneurysm height, aspect ratio, height-to-width ratio, inflow angle, deviations from ideal spherical or elliptical forms, and [[radiomics]] morphological features.<ref>{{cite journal|last=Ludwig |first=CG|author2=Lauric, A |author3=Malek, JA|author4=Mulligan, R|author5=Malek, AM|title=Performance of Radiomics derived morphological features for prediction of aneurysm rupture status.|journal=Journal of NeuroInterventional Surgery|date=2020|volume=13|issue=8|pages=<!-- -->|pmid=33158993 |doi=10.1136/neurintsurg-2020-016808|s2cid=226274492}}</ref>
==Epidemiology==
The [[prevalence]] of intracranial aneurysm is about 1–5% (10 million to 12 million persons in the United States) and the [[Incidence (epidemiology)|incidence]] is 1 per 10,000 persons per year in the United States (approximately 27,000), with 30- to 60-year-olds being the age group most affected.<ref name=BRISMAN2006 /><ref name=Haberfield2007 /> Intracranial aneurysms occur more in women, by a ratio of 3 to 2, and are rarely seen in pediatric populations.<ref name=BRISMAN2006>{{cite journal|last=Brisman|first=JL|author2=Song, JK |author3=Newell, DW |title=Cerebral aneurysms.|journal=The New England Journal of Medicine|date=Aug 31, 2006|volume=355|issue=9|pages=928–39|pmid=16943405|doi=10.1056/nejmra052760}}</ref><ref name=Kemp2008 />
==See also==
* [[Interventional neuroradiology]]
* [[Intradural pseudoaneurysm]]
==References==
{{Reflist}}
== External links ==
{{commons category|Cerebral aneurysms}}
* [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke]
{{Medical resources
| DiseasesDB =
| ICD11 = {{ICD11|8B22.5}}
| ICD10 = {{ICD10|I|67|1|i|60}}
| ICD9 = {{ICD9|437.3}}
| ICDO =
| OMIM =
| MedlinePlus = 001414
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D002532
| SNOMED CT = 128609009
}}
{{Cerebrovascular diseases}}
{{Vascular diseases}}
{{Authority control}}
{{DEFAULTSORT:Cerebral Aneurysm}}
[[Category:Cerebrovascular diseases]]
[[Category:Neurosurgery]]' |
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Parsed HTML source of the new revision (new_html) | '<div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Cerebrovascular disorder</div>
<style data-mw-deduplicate="TemplateStyles:r1097763485">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}html.client-js body.skin-minerva .mw-parser-output .mbox-text-span{margin-left:23px!important}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}</style><table class="box-Lead_too_short plainlinks metadata ambox ambox-content ambox-lead_too_short" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><a href="/wiki/File:Wiki_letter_w.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/en/thumb/6/6c/Wiki_letter_w.svg/40px-Wiki_letter_w.svg.png" decoding="async" width="40" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/6/6c/Wiki_letter_w.svg/60px-Wiki_letter_w.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/6/6c/Wiki_letter_w.svg/80px-Wiki_letter_w.svg.png 2x" data-file-width="44" data-file-height="44" /></a></span></div></td><td class="mbox-text"><div class="mbox-text-span">This article's <a href="/wiki/Wikipedia:Manual_of_Style/Lead_section#Length" title="Wikipedia:Manual of Style/Lead section">lead section</a> <b>may be too short to adequately <a href="/wiki/Wikipedia:Summary_style" title="Wikipedia:Summary style">summarize</a> the key points</b>.<span class="hide-when-compact"> Please consider expanding the lead to <a href="/wiki/Wikipedia:Manual_of_Style/Lead_section#Provide_an_accessible_overview" title="Wikipedia:Manual of Style/Lead section">provide an accessible overview</a> of all important aspects of the article.</span> <span class="date-container"><i>(<span class="date">December 2023</span>)</i></span></div></td></tr></tbody></table>
<div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1218072481">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}body.skin-minerva .mw-parser-output .infobox-header,body.skin-minerva .mw-parser-output .infobox-subheader,body.skin-minerva .mw-parser-output .infobox-above,body.skin-minerva .mw-parser-output .infobox-title,body.skin-minerva .mw-parser-output .infobox-image,body.skin-minerva .mw-parser-output .infobox-full-data,body.skin-minerva .mw-parser-output .infobox-below{text-align:center}html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data div{background:#1f1f23!important;color:#f8f9fa}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data div{background:#1f1f23!important;color:#f8f9fa}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Intracranial aneurysm</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Cerebral aneurysm, brain aneurysm</td></tr><tr><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Cerebellar_aneurysm.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Cerebellar_aneurysm.png/220px-Cerebellar_aneurysm.png" decoding="async" width="220" height="286" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Cerebellar_aneurysm.png/330px-Cerebellar_aneurysm.png 1.5x, //upload.wikimedia.org/wikipedia/commons/e/e5/Cerebellar_aneurysm.png 2x" data-file-width="414" data-file-height="539" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/Aneurysm" title="Aneurysm">Aneurysm</a> of the <a href="/wiki/Basilar_artery" title="Basilar artery">basilar artery</a> and the <a href="/wiki/Vertebral_arteries" class="mw-redirect" title="Vertebral arteries">vertebral arteries</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Interventional_neuroradiology" title="Interventional neuroradiology">Interventional neuroradiology</a>, <a href="/wiki/Neurosurgery" title="Neurosurgery">neurosurgery</a>, <a href="/wiki/Neurology" title="Neurology">neurology</a> <span class="penicon autoconfirmed-show"><span class="mw-valign-text-top" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q1198391?uselang=en#P1995" title="Edit this on Wikidata"><img alt="Edit this on Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></span></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">None, severe <a href="/wiki/Headache" title="Headache">headache</a>, visual problems, <a href="/wiki/Nausea" title="Nausea">nausea</a> and <a href="/wiki/Vomiting" title="Vomiting">vomiting</a>, <a href="/wiki/Confusion" title="Confusion">confusion</a><sup id="cite_ref-mayoclinic.org_1-0" class="reference"><a href="#cite_note-mayoclinic.org-1">[1]</a></sup></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">30–60 years old</td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><a href="/wiki/Hypertension" title="Hypertension">Hypertension</a>, <a href="/wiki/Infection" title="Infection">infection</a>, <a href="/wiki/Head_trauma" class="mw-redirect" title="Head trauma">head trauma</a><sup id="cite_ref-2" class="reference"><a href="#cite_note-2">[2]</a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">old age, <a href="/wiki/Family_history" class="mw-redirect" title="Family history">family history</a>, smoking, alcoholism, <a href="/wiki/Cocaine" title="Cocaine">cocaine</a> use<sup id="cite_ref-mayoclinic.org_1-1" class="reference"><a href="#cite_note-mayoclinic.org-1">[1]</a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data"><a href="/wiki/Angiography" title="Angiography">Angiography</a>, <a href="/wiki/CT_scan" title="CT scan">CT scan</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Endovascular_coiling" title="Endovascular coiling">Endovascular coiling</a>, <a href="/wiki/Surgical_clipping" class="mw-redirect" title="Surgical clipping">surgical clipping</a>, cerebral bypass surgery, pipeline embolization</td></tr></tbody></table>
<p>An <b>intracranial aneurysm</b>, also known as a <b>cerebral aneurysm</b>, go fuck yourself so hard that you get yourself pregnant imagina being a nerd so much to as you read about brain aneurysms like bro who does this like go play Fortnite or something bro
</p><p><a href="/wiki/Aneurysm" title="Aneurysm">Aneurysms</a> in the <a href="/wiki/Cerebral_circulation#Arterial_cerebral_circulation" title="Cerebral circulation">posterior circulation</a> (<a href="/wiki/Basilar_artery" title="Basilar artery">basilar artery</a>, <a href="/wiki/Vertebral_arteries" class="mw-redirect" title="Vertebral arteries">vertebral arteries</a> and <a href="/wiki/Posterior_communicating_artery" title="Posterior communicating artery">posterior communicating artery</a>) have a higher risk of rupture. Basilar artery aneurysms represent only 3–5% of all intracranial aneurysms but are the most common aneurysms in the posterior circulation.
</p>
<div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"><input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none" /><div class="toctitle" lang="en" dir="ltr"><h2 id="mw-toc-heading">Contents</h2><span class="toctogglespan"><label class="toctogglelabel" for="toctogglecheckbox"></label></span></div>
<ul>
<li class="toclevel-1 tocsection-1"><a href="#Classification"><span class="tocnumber">1</span> <span class="toctext">Classification</span></a>
<ul>
<li class="toclevel-2 tocsection-2"><a href="#Berry_(saccular)_aneurysms"><span class="tocnumber">1.1</span> <span class="toctext">Berry (saccular) aneurysms</span></a></li>
<li class="toclevel-2 tocsection-3"><a href="#Fusiform_aneurysms"><span class="tocnumber">1.2</span> <span class="toctext">Fusiform aneurysms</span></a></li>
<li class="toclevel-2 tocsection-4"><a href="#Microaneurysms"><span class="tocnumber">1.3</span> <span class="toctext">Microaneurysms</span></a></li>
</ul>
</li>
<li class="toclevel-1 tocsection-5"><a href="#Signs_and_symptoms"><span class="tocnumber">2</span> <span class="toctext">Signs and symptoms</span></a>
<ul>
<li class="toclevel-2 tocsection-6"><a href="#Subarachnoid_bleed"><span class="tocnumber">2.1</span> <span class="toctext">Subarachnoid bleed</span></a></li>
<li class="toclevel-2 tocsection-7"><a href="#Microaneurysms_2"><span class="tocnumber">2.2</span> <span class="toctext">Microaneurysms</span></a></li>
<li class="toclevel-2 tocsection-8"><a href="#Vasospasm"><span class="tocnumber">2.3</span> <span class="toctext">Vasospasm</span></a></li>
</ul>
</li>
<li class="toclevel-1 tocsection-9"><a href="#Risk_factors"><span class="tocnumber">3</span> <span class="toctext">Risk factors</span></a>
<ul>
<li class="toclevel-2 tocsection-10"><a href="#Genetic_associations"><span class="tocnumber">3.1</span> <span class="toctext">Genetic associations</span></a></li>
</ul>
</li>
<li class="toclevel-1 tocsection-11"><a href="#Pathophysiology"><span class="tocnumber">4</span> <span class="toctext">Pathophysiology</span></a>
<ul>
<li class="toclevel-2 tocsection-12"><a href="#Saccular_aneurysms"><span class="tocnumber">4.1</span> <span class="toctext">Saccular aneurysms</span></a></li>
</ul>
</li>
<li class="toclevel-1 tocsection-13"><a href="#Diagnosis"><span class="tocnumber">5</span> <span class="toctext">Diagnosis</span></a></li>
<li class="toclevel-1 tocsection-14"><a href="#Treatment"><span class="tocnumber">6</span> <span class="toctext">Treatment</span></a>
<ul>
<li class="toclevel-2 tocsection-15"><a href="#Surgical_clipping"><span class="tocnumber">6.1</span> <span class="toctext">Surgical clipping</span></a></li>
<li class="toclevel-2 tocsection-16"><a href="#Endovascular_coiling"><span class="tocnumber">6.2</span> <span class="toctext">Endovascular coiling</span></a></li>
<li class="toclevel-2 tocsection-17"><a href="#Cerebral_bypass_surgery"><span class="tocnumber">6.3</span> <span class="toctext">Cerebral bypass surgery</span></a></li>
</ul>
</li>
<li class="toclevel-1 tocsection-18"><a href="#Prognosis"><span class="tocnumber">7</span> <span class="toctext">Prognosis</span></a></li>
<li class="toclevel-1 tocsection-19"><a href="#Epidemiology"><span class="tocnumber">8</span> <span class="toctext">Epidemiology</span></a></li>
<li class="toclevel-1 tocsection-20"><a href="#See_also"><span class="tocnumber">9</span> <span class="toctext">See also</span></a></li>
<li class="toclevel-1 tocsection-21"><a href="#References"><span class="tocnumber">10</span> <span class="toctext">References</span></a></li>
<li class="toclevel-1 tocsection-22"><a href="#External_links"><span class="tocnumber">11</span> <span class="toctext">External links</span></a></li>
</ul>
</div>
<h2><span class="mw-headline" id="Classification">Classification</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=1" title="Edit section: Classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<style data-mw-deduplicate="TemplateStyles:r1033289096">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}</style><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Aneurysm#Classification" title="Aneurysm">Aneurysm § Classification</a></div>
<figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Cerebral_aneurysm_NIH.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/80/Cerebral_aneurysm_NIH.jpg/220px-Cerebral_aneurysm_NIH.jpg" decoding="async" width="220" height="238" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/80/Cerebral_aneurysm_NIH.jpg/330px-Cerebral_aneurysm_NIH.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/8/80/Cerebral_aneurysm_NIH.jpg 2x" data-file-width="334" data-file-height="361" /></a><figcaption>Diagram of cerebral aneurysm.</figcaption></figure>
<p>Cerebral aneurysms are classified both by size and shape. Small aneurysms have a diameter of less than 15 mm. Larger aneurysms include those classified as large (15 to 25 mm), giant (25 to 50 mm) (0.98 inches to 1.97 inches), and super-giant (over 50 mm).<sup id="cite_ref-HOPKINS8772_3-0" class="reference"><a href="#cite_note-HOPKINS8772-3">[3]</a></sup>
</p>
<h3><span id="Berry_.28saccular.29_aneurysms"></span><span class="mw-headline" id="Berry_(saccular)_aneurysms">Berry (saccular) aneurysms</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=2" title="Edit section: Berry (saccular) aneurysms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<p>Saccular aneurysms, also known as berry aneurysms, appear as a round outpouching and are the most common form of cerebral aneurysm.<sup id="cite_ref-HOPKINS8772_3-1" class="reference"><a href="#cite_note-HOPKINS8772-3">[3]</a></sup><sup id="cite_ref-ROONGROJ2005_4-0" class="reference"><a href="#cite_note-ROONGROJ2005-4">[4]</a></sup> Causes include connective tissue disorders, <a href="/wiki/Polycystic_kidney_disease" title="Polycystic kidney disease">polycystic kidney disease</a>, arteriovenous malformations, untreated <a href="/wiki/Hypertension" title="Hypertension">hypertension</a>, tobacco smoking, cocaine and amphetamines, intravenous drug abuse (can cause infectious mycotic aneurysms), alcoholism, heavy caffeine intake, head trauma, and infection in the arterial wall from <a href="/wiki/Bacteremia" class="mw-redirect" title="Bacteremia">bacteremia</a> (mycotic aneurysms).<sup id="cite_ref-5" class="reference"><a href="#cite_note-5">[5]</a></sup>
</p>
<h3><span class="mw-headline" id="Fusiform_aneurysms">Fusiform aneurysms</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=3" title="Edit section: Fusiform aneurysms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<p>Fusiform <a href="/wiki/Intracranial_dolichoectasias" title="Intracranial dolichoectasias">dolichoectatic</a> aneurysms represent a widening of a segment of an artery around the entire blood vessel, rather than just arising from a side of an artery's wall. They have an estimated annual risk of rupture between 1.6 and 1.9 percent.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6">[6]</a></sup><sup id="cite_ref-7" class="reference"><a href="#cite_note-7">[7]</a></sup>
</p>
<h3><span class="mw-headline" id="Microaneurysms">Microaneurysms</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=4" title="Edit section: Microaneurysms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1033289096"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Charcot%E2%80%93Bouchard_aneurysm" title="Charcot–Bouchard aneurysm">Charcot–Bouchard aneurysm</a></div>
<p>Microaneurysms, also known as <a href="/wiki/Charcot%E2%80%93Bouchard_aneurysm" title="Charcot–Bouchard aneurysm">Charcot–Bouchard aneurysms</a>, typically occur in small <a href="/wiki/Blood_vessel" title="Blood vessel">blood vessels</a> (less than 300 <a href="/wiki/Micrometre" title="Micrometre">micrometre</a> diameter), most often the <a href="/wiki/Anterolateral_central_arteries" class="mw-redirect" title="Anterolateral central arteries">lenticulostriate</a> vessels of the <a href="/wiki/Basal_ganglia" title="Basal ganglia">basal ganglia</a>, and are associated with <a href="/wiki/Chronic_(medicine)" class="mw-redirect" title="Chronic (medicine)">chronic</a> <a href="/wiki/Hypertension" title="Hypertension">hypertension</a>.<sup id="cite_ref-robbins_8-0" class="reference"><a href="#cite_note-robbins-8">[8]</a></sup> Charcot–Bouchard aneurysms are a common cause of <a href="/wiki/Intracranial_hemorrhage" title="Intracranial hemorrhage">intracranial hemorrhage</a>.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9">[9]</a></sup>
</p>
<h2><span class="mw-headline" id="Signs_and_symptoms">Signs and symptoms</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=5" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<p>A small, unchanging aneurysm will produce few, if any, symptoms. Before a larger aneurysm ruptures, the individual may experience such symptoms as a sudden and unusually severe headache, <a href="/wiki/Nausea" title="Nausea">nausea</a>, vision impairment, <a href="/wiki/Vomiting" title="Vomiting">vomiting</a>, and <a href="/wiki/Unconsciousness" title="Unconsciousness">loss of consciousness</a>, or no symptoms at all.<sup id="cite_ref-BRISMAN2006_10-0" class="reference"><a href="#cite_note-BRISMAN2006-10">[10]</a></sup>
</p>
<h3><span class="mw-headline" id="Subarachnoid_bleed">Subarachnoid bleed</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=6" title="Edit section: Subarachnoid bleed"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1033289096"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Subarachnoid_hemorrhage#Signs_and_symptoms" title="Subarachnoid hemorrhage">Subarachnoid hemorrhage § Signs and symptoms</a></div>
<p>If an aneurysm ruptures, blood leaks into the space around the brain. This is called a <a href="/wiki/Subarachnoid_hemorrhage" title="Subarachnoid hemorrhage">subarachnoid hemorrhage</a>. Onset is usually sudden without <a href="/wiki/Prodrome" title="Prodrome">prodrome</a>, classically presenting as a "<a href="/wiki/Thunderclap_headache" title="Thunderclap headache">thunderclap headache</a>" worse than previous headaches.<sup id="cite_ref-Goljan2006_11-0" class="reference"><a href="#cite_note-Goljan2006-11">[11]</a></sup><sup id="cite_ref-stroke_12-0" class="reference"><a href="#cite_note-stroke-12">[12]</a></sup> Symptoms of a subarachnoid hemorrhage differ depending on the site and size of the aneurysm.<sup id="cite_ref-stroke_12-1" class="reference"><a href="#cite_note-stroke-12">[12]</a></sup> Symptoms of a ruptured aneurysm can include:<sup id="cite_ref-13" class="reference"><a href="#cite_note-13">[13]</a></sup>
</p>
<ul><li>a sudden severe headache that can last from several hours to days</li>
<li>nausea and vomiting</li>
<li>drowsiness, confusion and/or loss of consciousness</li>
<li>visual abnormalities</li>
<li><a href="/wiki/Meningism" title="Meningism">meningism</a></li>
<li>dizziness</li></ul>
<p>Almost all aneurysms rupture at their apex. This leads to hemorrhage in the subarachnoid space and sometimes in brain <a href="/wiki/Parenchyma" title="Parenchyma">parenchyma</a>. Minor leakage from aneurysm may precede rupture, causing warning headaches. About 60% of patients die immediately after rupture.<sup id="cite_ref-autopsy_14-0" class="reference"><a href="#cite_note-autopsy-14">[14]</a></sup> Larger aneurysms have a greater tendency to rupture, though most ruptured aneurysms are less than 10 mm in diameter.<sup id="cite_ref-stroke_12-2" class="reference"><a href="#cite_note-stroke-12">[12]</a></sup>
</p>
<h3><span class="mw-headline" id="Microaneurysms_2">Microaneurysms</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=7" title="Edit section: Microaneurysms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<p>A ruptured microaneurysm may cause an <a href="/wiki/Intracerebral_hemorrhage" title="Intracerebral hemorrhage">intracerebral hemorrhage</a>, presenting as a focal neurological deficit.<sup id="cite_ref-stroke_12-3" class="reference"><a href="#cite_note-stroke-12">[12]</a></sup>
</p><p>Rebleeding, <a href="/wiki/Hydrocephalus" title="Hydrocephalus">hydrocephalus</a> (the excessive accumulation of <a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">cerebrospinal fluid</a>), <a href="/wiki/Vasospasm" title="Vasospasm">vasospasm</a> (spasm, or narrowing, of the blood vessels), or multiple aneurysms may also occur. The risk of rupture from a cerebral aneurysm varies according to the size of an aneurysm, with the risk rising as the aneurysm size increases.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15">[15]</a></sup>
</p>
<h3><span class="mw-headline" id="Vasospasm">Vasospasm</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=8" title="Edit section: Vasospasm"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1033289096"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Subarachnoid_hemorrhage#Vasospasm" title="Subarachnoid hemorrhage">Subarachnoid hemorrhage § Vasospasm</a></div>
<p><a href="/wiki/Vasospasm" title="Vasospasm">Vasospasm</a>, referring to blood vessel constriction, can occur secondary to subarachnoid hemorrhage following a ruptured aneurysm. This is most likely to occur within 21 days and is seen radiologically within 60% of such patients. The vasospasm is thought to be secondary to the <a href="/wiki/Apoptosis" title="Apoptosis">apoptosis</a> of <a href="/wiki/Inflammation" title="Inflammation">inflammatory</a> cells such as <a href="/wiki/Macrophage" title="Macrophage">macrophages</a> and <a href="/wiki/Neutrophil" title="Neutrophil">neutrophils</a> that become trapped in the subarachnoid space. These cells initially invade the subarachnoid space from the circulation in order to <a href="/wiki/Phagocytose" class="mw-redirect" title="Phagocytose">phagocytose</a> the hemorrhaged red blood cells. Following apoptosis, it is thought there is a massive degranulation of vasoconstrictors, including <a href="/wiki/Endothelin" title="Endothelin">endothelins</a> and <a href="/wiki/Free_radical" class="mw-redirect" title="Free radical">free radicals</a>, that cause the vasospasm.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16">[16]</a></sup>
</p>
<h2><span class="mw-headline" id="Risk_factors">Risk factors</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=9" title="Edit section: Risk factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<p>Intracranial aneurysms may result from diseases acquired during life, or from genetic conditions. <a href="/wiki/Hypertension" title="Hypertension">Hypertension</a>, <a href="/wiki/Smoking" title="Smoking">smoking</a>, <a href="/wiki/Alcoholism" title="Alcoholism">alcoholism</a>, and <a href="/wiki/Obesity" title="Obesity">obesity</a> are associated with the development of brain aneurysms.<sup id="cite_ref-Goljan2006_11-1" class="reference"><a href="#cite_note-Goljan2006-11">[11]</a></sup><sup id="cite_ref-stroke_12-4" class="reference"><a href="#cite_note-stroke-12">[12]</a></sup><sup id="cite_ref-Kemp2008_17-0" class="reference"><a href="#cite_note-Kemp2008-17">[17]</a></sup> <a href="/wiki/Cocaine" title="Cocaine">Cocaine</a> use has also been associated with the development of intracranial aneurysms.<sup id="cite_ref-stroke_12-5" class="reference"><a href="#cite_note-stroke-12">[12]</a></sup>
</p><p>Other acquired associations with intracranial aneurysms include head trauma and infections.<sup id="cite_ref-Goljan2006_11-2" class="reference"><a href="#cite_note-Goljan2006-11">[11]</a></sup>
</p>
<h3><span class="mw-headline" id="Genetic_associations">Genetic associations</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=10" title="Edit section: Genetic associations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<p>Coarctation of the aorta is also a known risk factor,<sup id="cite_ref-Goljan2006_11-3" class="reference"><a href="#cite_note-Goljan2006-11">[11]</a></sup> as is <a href="/wiki/Arteriovenous_malformation" title="Arteriovenous malformation">arteriovenous malformation</a>.<sup id="cite_ref-autopsy_14-1" class="reference"><a href="#cite_note-autopsy-14">[14]</a></sup> Genetic conditions associated with <a href="/wiki/Connective_tissue_disease" title="Connective tissue disease">connective tissue disease</a> may also be associated with the development of aneurysms.<sup id="cite_ref-Goljan2006_11-4" class="reference"><a href="#cite_note-Goljan2006-11">[11]</a></sup> This includes:<sup id="cite_ref-18" class="reference"><a href="#cite_note-18">[18]</a></sup>
</p>
<ul><li><a href="/wiki/Autosomal_dominant_polycystic_kidney_disease" title="Autosomal dominant polycystic kidney disease">autosomal dominant polycystic kidney disease</a>,</li>
<li><a href="/wiki/Neurofibromatosis_type_I" title="Neurofibromatosis type I">neurofibromatosis type I</a>,</li>
<li><a href="/wiki/Marfan_syndrome" title="Marfan syndrome">Marfan syndrome</a>,</li>
<li><a href="/wiki/Multiple_endocrine_neoplasia" title="Multiple endocrine neoplasia">multiple endocrine neoplasia</a> type I,</li>
<li><a href="/wiki/Pseudoxanthoma_elasticum" title="Pseudoxanthoma elasticum">pseudoxanthoma elasticum</a>,</li>
<li><a href="/wiki/Hereditary_hemorrhagic_telangiectasia" title="Hereditary hemorrhagic telangiectasia">hereditary hemorrhagic telangiectasia</a> and</li>
<li><a href="/wiki/Ehlers-Danlos_syndrome" class="mw-redirect" title="Ehlers-Danlos syndrome">Ehlers-Danlos syndrome</a> types II and IV.</li></ul>
<p>Specific genes have also had reported association with the development of intracranial aneurysms, including <a href="/wiki/Perlecan" title="Perlecan">perlecan</a>, <a href="/wiki/Elastin" title="Elastin">elastin</a>, <a href="/wiki/Collagen" title="Collagen">collagen</a> type 1 A2, endothelial <a href="/wiki/Nitric_oxide_synthase" title="Nitric oxide synthase">nitric oxide synthase</a>, <a href="/wiki/Endothelin" title="Endothelin">endothelin</a> receptor A and <a href="/wiki/Cyclin_dependent_kinase_inhibitor" class="mw-redirect" title="Cyclin dependent kinase inhibitor">cyclin dependent kinase inhibitor</a>. Recently, several <a href="/wiki/Genetic_loci" class="mw-redirect" title="Genetic loci">genetic loci</a> have been identified as relevant to the development of intracranial aneurysms. These include 1p34–36, 2p14–15, 7q11, 11q25, and 19q13.1–13.3.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19">[19]</a></sup>
</p>
<h2><span class="mw-headline" id="Pathophysiology">Pathophysiology</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=11" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1033289096"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Aneurysm#Pathophysiology" title="Aneurysm">Aneurysm § Pathophysiology</a></div>
<p><a href="/wiki/Aneurysm" title="Aneurysm">Aneurysm</a> means an outpouching of a <a href="/wiki/Blood_vessel" title="Blood vessel">blood vessel</a> wall that is filled with blood. Aneurysms occur at a point of weakness in the vessel wall. This can be because of acquired disease or hereditary factors. The repeated trauma of blood flow against the vessel wall presses against the point of weakness and causes the aneurysm to enlarge.<sup id="cite_ref-Haberfield2007_20-0" class="reference"><a href="#cite_note-Haberfield2007-20">[20]</a></sup> As described by the <a href="/wiki/Law_of_Young-Laplace" class="mw-redirect" title="Law of Young-Laplace">law of Young-Laplace</a>, the increasing area increases tension against the aneurysmal walls, leading to enlargement.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21">[21]</a></sup><sup id="cite_ref-22" class="reference"><a href="#cite_note-22">[22]</a></sup><sup id="cite_ref-23" class="reference"><a href="#cite_note-23">[23]</a></sup> In addition, a combination of computational fluid dynamics and morphological indices have been proposed as reliable predictors of cerebral aneurysm rupture.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24">[24]</a></sup>
</p><p>Both high and low wall <a href="/wiki/Shear_stress" title="Shear stress">shear stress</a> of flowing blood can cause aneurysm and rupture. However, the mechanism of action is still unknown. It is speculated that low shear stress causes growth and rupture of large aneurysms through inflammatory response while high shear stress causes growth and rupture of small aneurysm through mural response (response from the blood vessel wall). Other risk factors that contributes to the formation of aneurysm are: cigarette smoking, hypertension, female gender, family history of cerebral aneurysm, infection, and trauma. Damage to structural integrity of the arterial wall by shear stress causes an inflammatory response with the recruitment of <a href="/wiki/T_cell" title="T cell">T cells</a>, <a href="/wiki/Macrophage" title="Macrophage">macrophages</a>, and <a href="/wiki/Mast_cell" title="Mast cell">mast cells</a>. The inflammatory mediators are: <a href="/wiki/Interleukin_1_beta" title="Interleukin 1 beta">interleukin 1 beta</a>, <a href="/wiki/Interleukin_6" title="Interleukin 6">interleukin 6</a>, <a href="/wiki/Tumor_necrosis_factor_alpha" class="mw-redirect" title="Tumor necrosis factor alpha">tumor necrosis factor alpha</a> (TNF alpha), <a href="/wiki/MMP1" class="mw-redirect" title="MMP1">MMP1</a>, <a href="/wiki/MMP2" title="MMP2">MMP2</a>, <a href="/wiki/MMP9" title="MMP9">MMP9</a>, <a href="/wiki/Prostaglandin_E2" title="Prostaglandin E2">prostaglandin E2</a>, <a href="/wiki/Complement_system" title="Complement system">complement system</a>, <a href="/wiki/Reactive_oxygen_species" title="Reactive oxygen species">reactive oxygen species</a> (ROS), and <a href="/wiki/Angiotensin_II" class="mw-redirect" title="Angiotensin II">angiotensin II</a>. However, <a href="/wiki/Smooth_muscle_cell" class="mw-redirect" title="Smooth muscle cell">smooth muscle cells</a> from the <a href="/wiki/Tunica_media" title="Tunica media">tunica media</a> layer of the artery moved into the <a href="/wiki/Tunica_intima" title="Tunica intima">tunica intima</a>, where the function of the smooth muscle cells changed from contractile function into pro-inflammatory function. This causes the fibrosis of the arterial wall, with reduction of number of smooth muscle cells, abnormal collagen synthesis, resulting in a thinning of the arterial wall and the formation of aneurysm and rupture. No specific gene loci has been identified to be associated with cerebral aneurysms.<sup id="cite_ref-AHA_journal_25-0" class="reference"><a href="#cite_note-AHA_journal-25">[25]</a></sup>
</p><p>Generally, aneurysms larger than 7 mm in diameter should be treated because they are prone for rupture. Meanwhile, aneurysms less than 7 mm arise from the <a href="/wiki/Anterior_communicating_artery" title="Anterior communicating artery">anterior</a> and <a href="/wiki/Posterior_communicating_artery" title="Posterior communicating artery">posterior communicating artery</a> and are more easily ruptured when compared to aneurysms arising from other locations.<sup id="cite_ref-AHA_journal_25-1" class="reference"><a href="#cite_note-AHA_journal-25">[25]</a></sup>
</p>
<h3><span class="mw-headline" id="Saccular_aneurysms">Saccular aneurysms</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=12" title="Edit section: Saccular aneurysms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Wikipedia_intracranial_aneurysms_-_inferior_view_-_heat_map.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/83/Wikipedia_intracranial_aneurysms_-_inferior_view_-_heat_map.jpg/220px-Wikipedia_intracranial_aneurysms_-_inferior_view_-_heat_map.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/83/Wikipedia_intracranial_aneurysms_-_inferior_view_-_heat_map.jpg/330px-Wikipedia_intracranial_aneurysms_-_inferior_view_-_heat_map.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/83/Wikipedia_intracranial_aneurysms_-_inferior_view_-_heat_map.jpg/440px-Wikipedia_intracranial_aneurysms_-_inferior_view_-_heat_map.jpg 2x" data-file-width="2400" data-file-height="1800" /></a><figcaption>The most common sites of intracranial saccular aneurysms</figcaption></figure>
<p>Saccular aneurysms are almost always the result of hereditary weaknesses in blood vessels and typically occur within the arteries of the <a href="/wiki/Circle_of_Willis" title="Circle of Willis">circle of Willis</a>,<sup id="cite_ref-Haberfield2007_20-1" class="reference"><a href="#cite_note-Haberfield2007-20">[20]</a></sup><sup id="cite_ref-26" class="reference"><a href="#cite_note-26">[26]</a></sup> in order of frequency affecting the following arteries:<sup id="cite_ref-27" class="reference"><a href="#cite_note-27">[27]</a></sup>
</p>
<ul><li><a href="/wiki/Anterior_communicating_artery" title="Anterior communicating artery">Anterior communicating artery</a></li>
<li><a href="/wiki/Posterior_communicating_artery" title="Posterior communicating artery">Posterior communicating artery</a></li>
<li><a href="/wiki/Middle_cerebral_artery" title="Middle cerebral artery">Middle cerebral artery</a></li>
<li><a href="/wiki/Internal_carotid_artery" title="Internal carotid artery">Internal carotid artery</a></li>
<li>Tip of <a href="/wiki/Basilar_artery" title="Basilar artery">basilar artery</a></li></ul>
<p>Saccular aneurysms tend to have a lack of <a href="/wiki/Tunica_media" title="Tunica media">tunica media</a> and elastic lamina around their dilated locations (congenital), with a wall of sac made up of thickened hyalinized intima and adventitia.<sup id="cite_ref-autopsy_14-2" class="reference"><a href="#cite_note-autopsy-14">[14]</a></sup> In addition, some parts of the brain vasculature are inherently weak—particularly areas along the circle of Willis, where small communicating vessels link the main cerebral vessels. These areas are particularly susceptible to saccular aneurysms.<sup id="cite_ref-Goljan2006_11-5" class="reference"><a href="#cite_note-Goljan2006-11">[11]</a></sup> Approximately 25% of patients have multiple aneurysms, predominantly when there is a familial pattern.<sup id="cite_ref-stroke_12-6" class="reference"><a href="#cite_note-stroke-12">[12]</a></sup>
</p>
<h2><span class="mw-headline" id="Diagnosis">Diagnosis</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=13" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:CT_angiography_showing_aneurysm_at_the_ACOM.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/90/CT_angiography_showing_aneurysm_at_the_ACOM.jpg/220px-CT_angiography_showing_aneurysm_at_the_ACOM.jpg" decoding="async" width="220" height="181" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/90/CT_angiography_showing_aneurysm_at_the_ACOM.jpg/330px-CT_angiography_showing_aneurysm_at_the_ACOM.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/90/CT_angiography_showing_aneurysm_at_the_ACOM.jpg/440px-CT_angiography_showing_aneurysm_at_the_ACOM.jpg 2x" data-file-width="3344" data-file-height="2756" /></a><figcaption>CT angiography showing aneurysm measuring 2.6 mm in diameter at the ACOM (anterior communicating artery).</figcaption></figure>
<p>Once suspected, intracranial aneurysms can be diagnosed radiologically using <a href="/wiki/Magnetic_resonance_angiography" title="Magnetic resonance angiography">magnetic resonance</a> or <a href="/wiki/Computed_tomography_angiography" title="Computed tomography angiography">CT</a> angiography.<sup id="cite_ref-:0_28-0" class="reference"><a href="#cite_note-:0-28">[28]</a></sup> But these methods have limited sensitivity for diagnosis of small aneurysms, and often cannot be used to specifically distinguish them from infundibular dilations without performing a formal <a href="/wiki/Angiography" title="Angiography">angiogram</a>.<sup id="cite_ref-:0_28-1" class="reference"><a href="#cite_note-:0-28">[28]</a></sup><sup id="cite_ref-29" class="reference"><a href="#cite_note-29">[29]</a></sup> The determination of whether an aneurysm is ruptured is critical to diagnosis. <a href="/wiki/Lumbar_puncture" title="Lumbar puncture">Lumbar puncture</a> (LP) is the gold standard technique for determining aneurysm rupture (<a href="/wiki/Subarachnoid_hemorrhage" title="Subarachnoid hemorrhage">subarachnoid hemorrhage</a>). Once an LP is performed, the <a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">CSF</a> is evaluated for <a href="/wiki/Erythrocyte_count" class="mw-redirect" title="Erythrocyte count">RBC count</a>, and presence or absence of <a href="/wiki/Xanthochromia" title="Xanthochromia">xanthochromia</a>.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30">[30]</a></sup>
</p>
<h2><span class="mw-headline" id="Treatment">Treatment</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=14" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:AneurysmClips.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fa/AneurysmClips.jpg/220px-AneurysmClips.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fa/AneurysmClips.jpg/330px-AneurysmClips.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fa/AneurysmClips.jpg/440px-AneurysmClips.jpg 2x" data-file-width="3648" data-file-height="2736" /></a><figcaption>A selection of <a href="/wiki/Frank_Henderson_Mayfield" title="Frank Henderson Mayfield">Mayfield</a> and <a href="/wiki/Charles_George_Drake" title="Charles George Drake">Drake</a> aneurysm clips ready for implantation.</figcaption></figure>
<p><a href="/wiki/Emergency_medicine" title="Emergency medicine">Emergency treatment</a> for individuals with a ruptured cerebral aneurysm generally includes restoring deteriorating <a href="/wiki/Respiration_(physiology)" title="Respiration (physiology)">respiration</a> and reducing <a href="/wiki/Intracranial_pressure" title="Intracranial pressure">intracranial pressure</a>. Currently there are two treatment options for securing intracranial aneurysms: <a href="/wiki/Clipping_(medicine)" title="Clipping (medicine)">surgical clipping</a> or <a href="/wiki/Endovascular_coiling" title="Endovascular coiling">endovascular coiling</a>. If possible, either surgical clipping or endovascular coiling is typically performed within the first 24 hours after bleeding to occlude the ruptured aneurysm and reduce the risk of recurrent hemorrhage.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31">[31]</a></sup>
</p><p>While a large <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> found the outcomes and risks of surgical clipping and endovascular coiling to be statistically similar, no consensus has been reached.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32">[32]</a></sup> In particular, the large <a href="/wiki/Randomised_control_trial" class="mw-redirect" title="Randomised control trial">randomised control trial</a> <a href="/wiki/International_Subarachnoid_Aneurysm_Trial" title="International Subarachnoid Aneurysm Trial">International Subarachnoid Aneurysm Trial</a> appears to indicate a higher rate of recurrence when intracerebral aneurysms are treated using endovascular coiling. Analysis of data from this trial has indicated a 7% lower eight-year mortality rate with coiling,<sup id="cite_ref-33" class="reference"><a href="#cite_note-33">[33]</a></sup> a high rate of aneurysm recurrence in aneurysms treated with coiling—from 28.6 to 33.6% within a year,<sup id="cite_ref-Piotin_et_al._2007_34-0" class="reference"><a href="#cite_note-Piotin_et_al._2007-34">[34]</a></sup><sup id="cite_ref-Raymond_et_al._2003_35-0" class="reference"><a href="#cite_note-Raymond_et_al._2003-35">[35]</a></sup> a 6.9 times greater rate of late retreatment for coiled aneurysms,<sup id="cite_ref-Campi_et_al._2007_36-0" class="reference"><a href="#cite_note-Campi_et_al._2007-36">[36]</a></sup> and a rate of rebleeding 8 times higher than surgically clipped aneurysms.<sup id="cite_ref-pmid18312088_37-0" class="reference"><a href="#cite_note-pmid18312088-37">[37]</a></sup>
</p>
<h3><span class="mw-headline" id="Surgical_clipping">Surgical clipping</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=15" title="Edit section: Surgical clipping"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1033289096"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Surgical_clipping" class="mw-redirect" title="Surgical clipping">Surgical clipping</a></div>
<p>Aneurysms can be treated by clipping the base of the aneurysm with a specially-designed clip. Whilst this is typically carried out by <a href="/wiki/Craniotomy" title="Craniotomy">craniotomy</a>, a new endoscopic endonasal approach is being trialled.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38">[38]</a></sup> Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39">[39]</a></sup>
After clipping, a catheter angiogram or CTA can be performed to confirm complete clipping.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40">[40]</a></sup>
</p>
<h3><span class="mw-headline" id="Endovascular_coiling">Endovascular coiling</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=16" title="Edit section: Endovascular coiling"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1033289096"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Endovascular_coiling" title="Endovascular coiling">Endovascular coiling</a></div>
<p>Endovascular coiling refers to the insertion of <a href="/wiki/Platinum" title="Platinum">platinum</a> coils into the aneurysm. A <a href="/wiki/Catheter" title="Catheter">catheter</a> is inserted into a blood vessel, typically the <a href="/wiki/Femoral_artery" title="Femoral artery">femoral artery</a>, and passed through blood vessels into the cerebral circulation and the aneurysm. Coils are pushed into the aneurysm, or released into the blood stream ahead of the aneurysm. Upon depositing within the aneurysm, the coils expand and initiate a thrombotic reaction within the aneurysm. If successful, this prevents further bleeding from the aneurysm.<sup id="cite_ref-pmid9933290_41-0" class="reference"><a href="#cite_note-pmid9933290-41">[41]</a></sup> In the case of broad-based aneurysms, a stent may be passed first into the parent artery to serve as a scaffold for the coils.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42">[42]</a></sup>
</p>
<h3><span class="mw-headline" id="Cerebral_bypass_surgery">Cerebral bypass surgery</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=17" title="Edit section: Cerebral bypass surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<p>Cerebral bypass surgery was developed in the 1960s in Switzerland by <a href="/wiki/Gazi_Ya%C5%9Fargil" title="Gazi Yaşargil">Gazi Yaşargil</a>. When a patient has an aneurysm involving a blood vessel or a tumor at the base of the skull wrapping around a blood vessel, surgeons eliminate the problem vessel by replacing it with an artery from another part of the body.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43">[43]</a></sup>
</p>
<h2><span class="mw-headline" id="Prognosis">Prognosis</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=18" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<p>Outcomes depend on the size of the aneurysm.<sup id="cite_ref-Mal2017_44-0" class="reference"><a href="#cite_note-Mal2017-44">[44]</a></sup> Small aneurysms (less than 7 mm) have a low risk of rupture and increase in size slowly.<sup id="cite_ref-Mal2017_44-1" class="reference"><a href="#cite_note-Mal2017-44">[44]</a></sup> The risk of rupture is less than one percent for aneurysms of this size.<sup id="cite_ref-Mal2017_44-2" class="reference"><a href="#cite_note-Mal2017-44">[44]</a></sup>
</p><p>The <a href="/wiki/Prognosis" title="Prognosis">prognosis</a> for a ruptured cerebral aneurysm depends on the extent and location of the aneurysm, the person's age, general health, and neurological condition. Some individuals with a ruptured cerebral aneurysm die from the initial bleeding. Other individuals with cerebral aneurysm recover with little or no neurological deficit. The most significant factors in determining outcome are the <a href="/wiki/Hunt_and_Hess_scale" title="Hunt and Hess scale">Hunt and Hess grade</a>, and age. Generally patients with Hunt and Hess grade I and II hemorrhage on admission to the emergency room and patients who are younger within the typical age range of vulnerability can anticipate a good outcome, without death or permanent disability. Older patients and those with poorer Hunt and Hess grades on admission have a poor prognosis. Generally, about two-thirds of patients have a poor outcome, death, or permanent disability.<sup id="cite_ref-Haberfield2007_20-2" class="reference"><a href="#cite_note-Haberfield2007-20">[20]</a></sup><sup id="cite_ref-45" class="reference"><a href="#cite_note-45">[45]</a></sup><sup id="cite_ref-46" class="reference"><a href="#cite_note-46">[46]</a></sup>
</p><p>Increased availability and greater access to <a href="/wiki/Medical_imaging" title="Medical imaging">medical imaging</a> has caused a rising number of asymptomatic, unruptured cerebral aneurysms to be <a href="/wiki/Incidental_imaging_finding" title="Incidental imaging finding">discovered incidentally</a> during medical imaging investigations.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47">[47]</a></sup> Unruptured aneurysms may be managed by <a href="/wiki/Endovascular" class="mw-redirect" title="Endovascular">endovascular</a> clipping or stenting. For those subjects that underwent follow-up for the unruptured aneurysm, <a href="/wiki/Computed_tomography_angiography" title="Computed tomography angiography">computed tomography angiography</a> (CTA) or <a href="/wiki/Magnetic_resonance_angiography" title="Magnetic resonance angiography">magnetic resonance angiography</a> (MRA) of the brain can be done yearly.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48">[48]</a></sup> Recently, an increasing number of aneurysm features have been evaluated in their ability to predict aneurysm rupture status, including aneurysm height, aspect ratio, height-to-width ratio, inflow angle, deviations from ideal spherical or elliptical forms, and <a href="/wiki/Radiomics" title="Radiomics">radiomics</a> morphological features.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49">[49]</a></sup>
</p>
<h2><span class="mw-headline" id="Epidemiology">Epidemiology</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=19" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<p>The <a href="/wiki/Prevalence" title="Prevalence">prevalence</a> of intracranial aneurysm is about 1–5% (10 million to 12 million persons in the United States) and the <a href="/wiki/Incidence_(epidemiology)" title="Incidence (epidemiology)">incidence</a> is 1 per 10,000 persons per year in the United States (approximately 27,000), with 30- to 60-year-olds being the age group most affected.<sup id="cite_ref-BRISMAN2006_10-1" class="reference"><a href="#cite_note-BRISMAN2006-10">[10]</a></sup><sup id="cite_ref-Haberfield2007_20-3" class="reference"><a href="#cite_note-Haberfield2007-20">[20]</a></sup> Intracranial aneurysms occur more in women, by a ratio of 3 to 2, and are rarely seen in pediatric populations.<sup id="cite_ref-BRISMAN2006_10-2" class="reference"><a href="#cite_note-BRISMAN2006-10">[10]</a></sup><sup id="cite_ref-Kemp2008_17-1" class="reference"><a href="#cite_note-Kemp2008-17">[17]</a></sup>
</p>
<h2><span class="mw-headline" id="See_also">See also</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=20" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<ul><li><a href="/wiki/Interventional_neuroradiology" title="Interventional neuroradiology">Interventional neuroradiology</a></li>
<li><a href="/wiki/Intradural_pseudoaneurysm" title="Intradural pseudoaneurysm">Intradural pseudoaneurysm</a></li></ul>
<h2><span class="mw-headline" id="References">References</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=21" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<style data-mw-deduplicate="TemplateStyles:r1217336898">.mw-parser-output .reflist{font-size:90%;margin-bottom:0.5em;list-style-type:decimal}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist">
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<li id="cite_note-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-6">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFXuLevittKalaniRangel-Castilla2017" class="citation journal cs1">Xu DS, Levitt MR, Kalani MY, Rangel-Castilla L, Mulholland CB, Abecassis IJ, Morton RP, Nerva JD, Siddiqui AH, Levy EI, Spetzler RF (2017-04-07). <a rel="nofollow" class="external text" href="https://thejns.org/view/journals/j-neurosurg/128/2/article-p560.xml">"Dolichoectatic aneurysms of the vertebrobasilar system: clinical and radiographic factors that predict poor outcomes"</a>. <i>Journal of Neurosurgery</i>. <b>128</b> (2): 560–66. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.3171%2F2016.10.JNS161041">10.3171/2016.10.JNS161041</a></span>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://www.worldcat.org/issn/1933-0693">1933-0693</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/28387624">28387624</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neurosurgery&rft.atitle=Dolichoectatic+aneurysms+of+the+vertebrobasilar+system%3A+clinical+and+radiographic+factors+that+predict+poor+outcomes&rft.volume=128&rft.issue=2&rft.pages=560-66&rft.date=2017-04-07&rft.issn=1933-0693&rft_id=info%3Apmid%2F28387624&rft_id=info%3Adoi%2F10.3171%2F2016.10.JNS161041&rft.aulast=Xu&rft.aufirst=David+S.&rft.au=Levitt%2C+Michael+R.&rft.au=Kalani%2C+M.+Yashar+S.&rft.au=Rangel-Castilla%2C+Leonardo&rft.au=Mulholland%2C+Celene+B.&rft.au=Abecassis%2C+Isaac+J.&rft.au=Morton%2C+Ryan+P.&rft.au=Nerva%2C+John+D.&rft.au=Siddiqui%2C+Adnan+H.&rft.au=Levy%2C+Elad+I.&rft.au=Spetzler%2C+Robert+F.&rft_id=https%3A%2F%2Fthejns.org%2Fview%2Fjournals%2Fj-neurosurg%2F128%2F2%2Farticle-p560.xml&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-7"><span class="mw-cite-backlink"><b><a href="#cite_ref-7">^</a></b></span> <span class="reference-text">Fusiform and dolichoectatic aneurysms By James R Brorson MD (Dr. Brorson of the University of Chicago received consultation fees from CVS-Caremark, National Peer Review Corporation, and Medico-legal Consulting.) Originally released October 28, 1997; last updated January 29, 2017; expires January 29, 2020
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<li id="cite_note-robbins-8"><span class="mw-cite-backlink"><b><a href="#cite_ref-robbins_8-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFKumarAbbasFausto2005" class="citation book cs1">Kumar, Abbas, Fausto, eds. (2005). <i>Robbins and Cotran Pathologic Basis of Disease</i> (7th ed.). China: Elsevier. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7216-0187-8" title="Special:BookSources/978-0-7216-0187-8"><bdi>978-0-7216-0187-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Robbins+and+Cotran+Pathologic+Basis+of+Disease&rft.place=China&rft.edition=7th&rft.pub=Elsevier&rft.date=2005&rft.isbn=978-0-7216-0187-8&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span><sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citing_sources" title="Wikipedia:Citing sources"><span title="This citation requires a reference to the specific page or range of pages in which the material appears. (July 2020)">page needed</span></a></i>]</sup></span>
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<li id="cite_note-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-9">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFGuptaM_Das2021" class="citation cs2">Gupta K, M Das J (2021), <a rel="nofollow" class="external text" href="http://www.ncbi.nlm.nih.gov/books/NBK553028/"><i>Charcot Bouchard Aneurysm</i></a>, Treasure Island (FL): StatPearls Publishing, <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/31971704">31971704</a><span class="reference-accessdate">, retrieved <span class="nowrap">2021-05-06</span></span></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Charcot+Bouchard+Aneurysm&rft.place=Treasure+Island+%28FL%29&rft.pub=StatPearls+Publishing&rft.date=2021&rft_id=info%3Apmid%2F31971704&rft.aulast=Gupta&rft.aufirst=Kashvi&rft.au=M+Das%2C+Joe&rft_id=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK553028%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-BRISMAN2006-10"><span class="mw-cite-backlink">^ <a href="#cite_ref-BRISMAN2006_10-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-BRISMAN2006_10-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-BRISMAN2006_10-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFBrismanSong,_JKNewell,_DW2006" class="citation journal cs1">Brisman JL, Song, JK, Newell, DW (Aug 31, 2006). "Cerebral aneurysms". <i>The New England Journal of Medicine</i>. <b>355</b> (9): 928–39. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1056%2Fnejmra052760">10.1056/nejmra052760</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16943405">16943405</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+England+Journal+of+Medicine&rft.atitle=Cerebral+aneurysms.&rft.volume=355&rft.issue=9&rft.pages=928-39&rft.date=2006-08-31&rft_id=info%3Adoi%2F10.1056%2Fnejmra052760&rft_id=info%3Apmid%2F16943405&rft.aulast=Brisman&rft.aufirst=JL&rft.au=Song%2C+JK&rft.au=Newell%2C+DW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-Goljan2006-11"><span class="mw-cite-backlink">^ <a href="#cite_ref-Goljan2006_11-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Goljan2006_11-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Goljan2006_11-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Goljan2006_11-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Goljan2006_11-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Goljan2006_11-5"><sup><i><b>f</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFGoljan,_Edward_F.2006" class="citation book cs1">Goljan, Edward F. (2006). <i>Rapid Review Pathology</i> (2nd ed.). St. Louis: Mosby. p. 158. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-323-04414-1" title="Special:BookSources/978-0-323-04414-1"><bdi>978-0-323-04414-1</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Rapid+Review+Pathology&rft.place=St.+Louis&rft.pages=158&rft.edition=2nd&rft.pub=Mosby&rft.date=2006&rft.isbn=978-0-323-04414-1&rft.au=Goljan%2C+Edward+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-stroke-12"><span class="mw-cite-backlink">^ <a href="#cite_ref-stroke_12-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-stroke_12-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-stroke_12-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-stroke_12-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-stroke_12-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-stroke_12-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-stroke_12-6"><sup><i><b>g</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFAlwayCole2009" class="citation book cs1">Alway D, Cole JW, eds. (2009). <span class="id-lock-limited" title="Free access subject to limited trial, subscription normally required"><a rel="nofollow" class="external text" href="https://archive.org/details/strokeessentials00alwa_561"><i>Stroke Essentials for Primary Care: A Practical Guide</i></a></span>. New York: Humana Press. pp. <a rel="nofollow" class="external text" href="https://archive.org/details/strokeessentials00alwa_561/page/n95">86</a>–88, 153. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-934115-01-5" title="Special:BookSources/978-1-934115-01-5"><bdi>978-1-934115-01-5</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Stroke+Essentials+for+Primary+Care%3A+A+Practical+Guide&rft.place=New+York&rft.pages=86-88%2C+153&rft.pub=Humana+Press&rft.date=2009&rft.isbn=978-1-934115-01-5&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fstrokeessentials00alwa_561&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-13">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFPublishing2018" class="citation web cs1">Publishing HH (18 December 2018). <a rel="nofollow" class="external text" href="https://www.health.harvard.edu/a_to_z/subarachnoid-hemorrhage-a-to-z">"Subarachnoid Hemorrhage"</a>. <i>Harvard Health</i><span class="reference-accessdate">. Retrieved <span class="nowrap">2021-05-06</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Harvard+Health&rft.atitle=Subarachnoid+Hemorrhage&rft.date=2018-12-18&rft.aulast=Publishing&rft.aufirst=Harvard+Health&rft_id=https%3A%2F%2Fwww.health.harvard.edu%2Fa_to_z%2Fsubarachnoid-hemorrhage-a-to-z&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-autopsy-14"><span class="mw-cite-backlink">^ <a href="#cite_ref-autopsy_14-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-autopsy_14-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-autopsy_14-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFDiMaioDiMaio2001" class="citation book cs1">DiMaio VJ, DiMaio D (2001). <span class="id-lock-registration" title="Free registration required"><a rel="nofollow" class="external text" href="https://archive.org/details/forensicpatholog0000dima/page/61"><i>Forensic pathology</i></a></span> (2nd ed.). Boca Raton, FL: CRC Press. p. <a rel="nofollow" class="external text" href="https://archive.org/details/forensicpatholog0000dima/page/61">61</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-8493-0072-1" title="Special:BookSources/978-0-8493-0072-1"><bdi>978-0-8493-0072-1</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Forensic+pathology&rft.place=Boca+Raton%2C+FL&rft.pages=61&rft.edition=2nd&rft.pub=CRC+Press&rft.date=2001&rft.isbn=978-0-8493-0072-1&rft.aulast=DiMaio&rft.aufirst=Vincent+J.&rft.au=DiMaio%2C+Dominick&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fforensicpatholog0000dima%2Fpage%2F61&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-15"><span class="mw-cite-backlink"><b><a href="#cite_ref-15">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFKorja_MiikkaLehto_HannaJuvela_Seppo2014" class="citation journal cs1">Korja Miikka, Lehto Hanna, Juvela Seppo (2014-07-01). <a rel="nofollow" class="external text" href="https://doi.org/10.1161%2FSTROKEAHA.114.005318">"Lifelong Rupture Risk of Intracranial Aneurysms Depends on Risk Factors"</a>. <i>Stroke</i>. <b>45</b> (7): 1958–63. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1161%2FSTROKEAHA.114.005318">10.1161/STROKEAHA.114.005318</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24851875">24851875</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Stroke&rft.atitle=Lifelong+Rupture+Risk+of+Intracranial+Aneurysms+Depends+on+Risk+Factors&rft.volume=45&rft.issue=7&rft.pages=1958-63&rft.date=2014-07-01&rft_id=info%3Adoi%2F10.1161%2FSTROKEAHA.114.005318&rft_id=info%3Apmid%2F24851875&rft.au=Korja+Miikka&rft.au=Lehto+Hanna&rft.au=Juvela+Seppo&rft_id=https%3A%2F%2Fdoi.org%2F10.1161%252FSTROKEAHA.114.005318&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-16"><span class="mw-cite-backlink"><b><a href="#cite_ref-16">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFGalliaTamargo,_Rafael_J.2006" class="citation journal cs1">Gallia GL, Tamargo, Rafael J. (1 October 2006). "Leukocyte-endothelial cell interactions in chronic vasospasm after subarachnoid hemorrhage". <i>Neurological Research</i>. <b>28</b> (7): 750–58. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1179%2F016164106X152025">10.1179/016164106X152025</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17164038">17164038</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:27713975">27713975</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurological+Research&rft.atitle=Leukocyte-endothelial+cell+interactions+in+chronic+vasospasm+after+subarachnoid+hemorrhage&rft.volume=28&rft.issue=7&rft.pages=750-58&rft.date=2006-10-01&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A27713975%23id-name%3DS2CID&rft_id=info%3Apmid%2F17164038&rft_id=info%3Adoi%2F10.1179%2F016164106X152025&rft.aulast=Gallia&rft.aufirst=Gary+L.&rft.au=Tamargo%2C+Rafael+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-Kemp2008-17"><span class="mw-cite-backlink">^ <a href="#cite_ref-Kemp2008_17-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Kemp2008_17-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFBrown2008" class="citation book cs1">Brown Walter L. Kemp, Dennis K. Burns, Travis G. (2008). <i>Pathology the big picture</i>. New York: McGraw-Hill Medical. p. 148. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-07-159379-3" title="Special:BookSources/978-0-07-159379-3"><bdi>978-0-07-159379-3</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pathology+the+big+picture&rft.place=New+York&rft.pages=148&rft.pub=McGraw-Hill+Medical&rft.date=2008&rft.isbn=978-0-07-159379-3&rft.aulast=Brown&rft.aufirst=Walter+L.+Kemp%2C+Dennis+K.+Burns%2C+Travis+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span><span class="cs1-maint citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_book" title="Template:Cite book">cite book</a>}}</code>: CS1 maint: multiple names: authors list (<a href="/wiki/Category:CS1_maint:_multiple_names:_authors_list" title="Category:CS1 maint: multiple names: authors list">link</a>)</span></span>
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<li id="cite_note-18"><span class="mw-cite-backlink"><b><a href="#cite_ref-18">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFCaranciBriganti,_F.Cirillo,_L.Leonardi,_M.2012" class="citation journal cs1">Caranci F, Briganti, F., Cirillo, L., Leonardi, M., Muto, M. (2012). "Epidemiology and genetics of intracranial aneurysms". <i>European Journal of Radiology</i>. <b>82</b> (10): 1598–605. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.ejrad.2012.12.026">10.1016/j.ejrad.2012.12.026</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23399038">23399038</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Radiology&rft.atitle=Epidemiology+and+genetics+of+intracranial+aneurysms&rft.volume=82&rft.issue=10&rft.pages=1598-605&rft.date=2012&rft_id=info%3Adoi%2F10.1016%2Fj.ejrad.2012.12.026&rft_id=info%3Apmid%2F23399038&rft.aulast=Caranci&rft.aufirst=F.&rft.au=Briganti%2C+F.&rft.au=Cirillo%2C+L.&rft.au=Leonardi%2C+M.&rft.au=Muto%2C+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-19"><span class="mw-cite-backlink"><b><a href="#cite_ref-19">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFvan_der_VoetOlson,_JKuivaniemi,_HDudek,_D2004" class="citation journal cs1">van der Voet M, Olson, J, Kuivaniemi, H, Dudek, D, Skunca, M, Ronkainen, A, Niemelä, M, Jääskeläinen, J, Hernesniemi, J, Helin, K (1 March 2004). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182270">"Intracranial Aneurysms in Finnish Families: Confirmation of Linkage and Refinement of the Interval to Chromosome 19q13.3"</a>. <i>The American Journal of Human Genetics</i>. <b>74</b> (3): 564–71. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1086%2F382285">10.1086/382285</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182270">1182270</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/14872410">14872410</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Journal+of+Human+Genetics&rft.atitle=Intracranial+Aneurysms+in+Finnish+Families%3A+Confirmation+of+Linkage+and+Refinement+of+the+Interval+to+Chromosome+19q13.3&rft.volume=74&rft.issue=3&rft.pages=564-71&rft.date=2004-03-01&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1182270%23id-name%3DPMC&rft_id=info%3Apmid%2F14872410&rft_id=info%3Adoi%2F10.1086%2F382285&rft.aulast=van+der+Voet&rft.aufirst=M&rft.au=Olson%2C+J&rft.au=Kuivaniemi%2C+H&rft.au=Dudek%2C+D&rft.au=Skunca%2C+M&rft.au=Ronkainen%2C+A&rft.au=Niemel%C3%A4%2C+M&rft.au=J%C3%A4%C3%A4skel%C3%A4inen%2C+J&rft.au=Hernesniemi%2C+J&rft.au=Helin%2C+K&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1182270&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-Haberfield2007-20"><span class="mw-cite-backlink">^ <a href="#cite_ref-Haberfield2007_20-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Haberfield2007_20-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Haberfield2007_20-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Haberfield2007_20-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFHaberland2007" class="citation book cs1">Haberland C (2007). <span class="id-lock-limited" title="Free access subject to limited trial, subscription normally required"><a rel="nofollow" class="external text" href="https://archive.org/details/clinicalneuropat00habe_423"><i>Clinical neuropathology : text and color atlas</i></a></span> (Online-Ausg. ed.). New York: Demos. p. <a rel="nofollow" class="external text" href="https://archive.org/details/clinicalneuropat00habe_423/page/n81">70</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-888799-97-2" title="Special:BookSources/978-1-888799-97-2"><bdi>978-1-888799-97-2</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Clinical+neuropathology+%3A+text+and+color+atlas&rft.place=New+York&rft.pages=70&rft.edition=Online-Ausg.&rft.pub=Demos&rft.date=2007&rft.isbn=978-1-888799-97-2&rft.aulast=Haberland&rft.aufirst=Catherine&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fclinicalneuropat00habe_423&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-21"><span class="mw-cite-backlink"><b><a href="#cite_ref-21">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFHumphreyKyriacou1996" class="citation journal cs1">Humphrey JD, Kyriacou SK (June 1996). <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8837052/">"The use of Laplace's equation in aneurysm mechanics"</a>. <i>Neurological Research</i>. <b>18</b> (3): 204–08. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1080%2F01616412.1996.11740404">10.1080/01616412.1996.11740404</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://www.worldcat.org/issn/0161-6412">0161-6412</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8837052">8837052</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurological+Research&rft.atitle=The+use+of+Laplace%27s+equation+in+aneurysm+mechanics&rft.volume=18&rft.issue=3&rft.pages=204-08&rft.date=1996-06&rft.issn=0161-6412&rft_id=info%3Apmid%2F8837052&rft_id=info%3Adoi%2F10.1080%2F01616412.1996.11740404&rft.aulast=Humphrey&rft.aufirst=J.+D.&rft.au=Kyriacou%2C+S.+K.&rft_id=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F8837052%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-22"><span class="mw-cite-backlink"><b><a href="#cite_ref-22">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://sciencedemonstrations.fas.harvard.edu/presentations/laplaces-law-and-aneurysms">"Laplace's Law and Aneurysms"</a>. <i>sciencedemonstrations.fas.harvard.edu</i><span class="reference-accessdate">. Retrieved <span class="nowrap">2021-05-06</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=sciencedemonstrations.fas.harvard.edu&rft.atitle=Laplace%27s+Law+and+Aneurysms&rft_id=https%3A%2F%2Fsciencedemonstrations.fas.harvard.edu%2Fpresentations%2Flaplaces-law-and-aneurysms&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-23"><span class="mw-cite-backlink"><b><a href="#cite_ref-23">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFHademenos2008" class="citation journal cs1">Hademenos GJ (2008-01-11). <a rel="nofollow" class="external text" href="https://physicstoday.scitation.org/doi/abs/10.1063/1.881442">"The Physics of Cerebral Aneurysms"</a>. <i>Physics Today</i>. <b>48</b> (2): 24. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1063%2F1.881442">10.1063/1.881442</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://www.worldcat.org/issn/0031-9228">0031-9228</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physics+Today&rft.atitle=The+Physics+of+Cerebral+Aneurysms&rft.volume=48&rft.issue=2&rft.pages=24&rft.date=2008-01-11&rft_id=info%3Adoi%2F10.1063%2F1.881442&rft.issn=0031-9228&rft.aulast=Hademenos&rft.aufirst=George+J.&rft_id=https%3A%2F%2Fphysicstoday.scitation.org%2Fdoi%2Fabs%2F10.1063%2F1.881442&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-24"><span class="mw-cite-backlink"><b><a href="#cite_ref-24">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFAmigoValenciaWuPatnaik2021" class="citation journal cs1">Amigo N, Valencia A, Wu W, Patnaik S, Finol E (2021-03-08). <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/33685288">"Cerebral aneurysm rupture status classification using statistical and machine learning methods"</a>. <i>Proceedings of the Institution of Mechanical Engineers, Part H</i>. <b>235</b> (6): 655–662. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1177%2F09544119211000477">10.1177/09544119211000477</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://www.worldcat.org/issn/2041-3033">2041-3033</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/33685288">33685288</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:232161029">232161029</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+Institution+of+Mechanical+Engineers%2C+Part+H&rft.atitle=Cerebral+aneurysm+rupture+status+classification+using+statistical+and+machine+learning+methods&rft.volume=235&rft.issue=6&rft.pages=655-662&rft.date=2021-03-08&rft.issn=2041-3033&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A232161029%23id-name%3DS2CID&rft_id=info%3Apmid%2F33685288&rft_id=info%3Adoi%2F10.1177%2F09544119211000477&rft.aulast=Amigo&rft.aufirst=Nicol%C3%A1s&rft.au=Valencia%2C+Alvaro&rft.au=Wu%2C+Wei&rft.au=Patnaik%2C+Sourav&rft.au=Finol%2C+Ender&rft_id=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F33685288&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-AHA_journal-25"><span class="mw-cite-backlink">^ <a href="#cite_ref-AHA_journal_25-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-AHA_journal_25-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFChalouhiLohHasan2013" class="citation journal cs1">Chalouhi N, Loh BL, Hasan D (25 November 2013). <a rel="nofollow" class="external text" href="https://doi.org/10.1161%2FSTROKEAHA.113.002390">"Review of Cerebral Aneurysm Formation, Growth, and Rupture"</a>. <i>Stroke</i>. <b>44</b> (12): 3613–22. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1161%2FSTROKEAHA.113.002390">10.1161/STROKEAHA.113.002390</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24130141">24130141</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Stroke&rft.atitle=Review+of+Cerebral+Aneurysm+Formation%2C+Growth%2C+and+Rupture&rft.volume=44&rft.issue=12&rft.pages=3613-22&rft.date=2013-11-25&rft_id=info%3Adoi%2F10.1161%2FSTROKEAHA.113.002390&rft_id=info%3Apmid%2F24130141&rft.aulast=Chalouhi&rft.aufirst=Nohra&rft.au=Loh%2C+Brian+L&rft.au=Hasan%2C+David&rft_id=https%3A%2F%2Fdoi.org%2F10.1161%252FSTROKEAHA.113.002390&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-26"><span class="mw-cite-backlink"><b><a href="#cite_ref-26">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20090628224336/http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/one/000004838.htm">"berry aneurysm"</a> at <i><a href="/wiki/Dorland%27s_medical_reference_works" title="Dorland's medical reference works">Dorland's Medical Dictionary</a></i></span>
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<li id="cite_note-27"><span class="mw-cite-backlink"><b><a href="#cite_ref-27">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFHowlettAyers2004" class="citation book cs1">Howlett D, Ayers B (2004). <span class="id-lock-limited" title="Free access subject to limited trial, subscription normally required"><a rel="nofollow" class="external text" href="https://archive.org/details/handsonguidetoim00howl"><i>The hands-on guide to imaging</i></a></span>. Oxford: Blackwell. p. <a rel="nofollow" class="external text" href="https://archive.org/details/handsonguidetoim00howl/page/n216">204</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4051-1551-3" title="Special:BookSources/978-1-4051-1551-3"><bdi>978-1-4051-1551-3</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+hands-on+guide+to+imaging&rft.place=Oxford&rft.pages=204&rft.pub=Blackwell&rft.date=2004&rft.isbn=978-1-4051-1551-3&rft.aulast=Howlett&rft.aufirst=David&rft.au=Ayers%2C+Brian&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fhandsonguidetoim00howl&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-:0-28"><span class="mw-cite-backlink">^ <a href="#cite_ref-:0_28-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:0_28-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFWhiteTeasdaleWardlawEaston2001" class="citation journal cs1">White PM, Teasdale EM, <a href="/wiki/Joanna_Wardlaw" title="Joanna Wardlaw">Wardlaw JM</a>, Easton V (2001-06-01). "Intracranial Aneurysms: CT Angiography and MR Angiography for Detection – Prospective Blinded Comparison in a Large Patient Cohort". <i>Radiology</i>. <b>219</b> (3): 739–49. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1148%2Fradiology.219.3.r01ma16739">10.1148/radiology.219.3.r01ma16739</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://www.worldcat.org/issn/0033-8419">0033-8419</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11376263">11376263</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Radiology&rft.atitle=Intracranial+Aneurysms%3A+CT+Angiography+and+MR+Angiography+for+Detection+%E2%80%93+Prospective+Blinded+Comparison+in+a+Large+Patient+Cohort&rft.volume=219&rft.issue=3&rft.pages=739-49&rft.date=2001-06-01&rft.issn=0033-8419&rft_id=info%3Apmid%2F11376263&rft_id=info%3Adoi%2F10.1148%2Fradiology.219.3.r01ma16739&rft.aulast=White&rft.aufirst=Philip+M.&rft.au=Teasdale%2C+Evelyn+M.&rft.au=Wardlaw%2C+Joanna+M.&rft.au=Easton%2C+Valerie&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-42"><span class="mw-cite-backlink"><b><a href="#cite_ref-42">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFOushyRinaldoBrinjikjiCloft2020" class="citation journal cs1">Oushy S, Rinaldo L, Brinjikji W, Cloft H, Lanzino G (June 2020). "Recent advances in stent-assisted coiling of cerebral aneurysms". <i>Expert Review of Medical Devices</i>. <b>17</b> (6): 519–32. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1080%2F17434440.2020.1778463">10.1080/17434440.2020.1778463</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://www.worldcat.org/issn/1745-2422">1745-2422</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/32500761">32500761</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:219328499">219328499</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Expert+Review+of+Medical+Devices&rft.atitle=Recent+advances+in+stent-assisted+coiling+of+cerebral+aneurysms&rft.volume=17&rft.issue=6&rft.pages=519-32&rft.date=2020-06&rft.issn=1745-2422&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A219328499%23id-name%3DS2CID&rft_id=info%3Apmid%2F32500761&rft_id=info%3Adoi%2F10.1080%2F17434440.2020.1778463&rft.aulast=Oushy&rft.aufirst=Soliman&rft.au=Rinaldo%2C+Lorenzo&rft.au=Brinjikji%2C+Waleed&rft.au=Cloft%2C+Harry&rft.au=Lanzino%2C+Giuseppe&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-43"><span class="mw-cite-backlink"><b><a href="#cite_ref-43">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFSpetzlerChater1976" class="citation journal cs1">Spetzler R, Chater N (1 November 1976). "Microvascular bypass surgery". <i>Journal of Neurosurgery</i>. <b>45</b> (5): 508–13. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.3171%2Fjns.1976.45.5.0508">10.3171/jns.1976.45.5.0508</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/972334">972334</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neurosurgery&rft.atitle=Microvascular+bypass+surgery&rft.volume=45&rft.issue=5&rft.pages=508-13&rft.date=1976-11-01&rft_id=info%3Adoi%2F10.3171%2Fjns.1976.45.5.0508&rft_id=info%3Apmid%2F972334&rft.aulast=Spetzler&rft.aufirst=Robert&rft.au=Chater%2C+Norman&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-Mal2017-44"><span class="mw-cite-backlink">^ <a href="#cite_ref-Mal2017_44-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Mal2017_44-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Mal2017_44-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFMalhotraWuFormanGrossetta_Nardini2017" class="citation journal cs1">Malhotra A, Wu X, Forman HP, Grossetta Nardini HK, Matouk CC, Gandhi D, Moore C, Sanelli P (July 2017). "Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms: A Systematic Review". <i>Ann. Intern. Med</i>. <b>167</b> (1): 26–33. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.7326%2FM17-0246">10.7326/M17-0246</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/28586893">28586893</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann.+Intern.+Med.&rft.atitle=Growth+and+Rupture+Risk+of+Small+Unruptured+Intracranial+Aneurysms%3A+A+Systematic+Review&rft.volume=167&rft.issue=1&rft.pages=26-33&rft.date=2017-07&rft_id=info%3Adoi%2F10.7326%2FM17-0246&rft_id=info%3Apmid%2F28586893&rft.aulast=Malhotra&rft.aufirst=A&rft.au=Wu%2C+X&rft.au=Forman%2C+HP&rft.au=Grossetta+Nardini%2C+HK&rft.au=Matouk%2C+CC&rft.au=Gandhi%2C+D&rft.au=Moore%2C+C&rft.au=Sanelli%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-47"><span class="mw-cite-backlink"><b><a href="#cite_ref-47">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFVernooijIkram,_MATanghe,_HL2007" class="citation journal cs1">Vernooij MW, Ikram, MA, Tanghe, HL (2007). <a rel="nofollow" class="external text" href="https://doi.org/10.1056%2FNEJMoa070972">"Incidental findings on brain MRI in the general population.Incidental findings on brain MRI in the general population"</a>. <i>N Engl J Med</i>. <b>357</b> (5): 1821–28. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1056%2FNEJMoa070972">10.1056/NEJMoa070972</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17978290">17978290</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=N+Engl+J+Med&rft.atitle=Incidental+findings+on+brain+MRI+in+the+general+population.Incidental+findings+on+brain+MRI+in+the+general+population.&rft.volume=357&rft.issue=5&rft.pages=1821-28&rft.date=2007&rft_id=info%3Adoi%2F10.1056%2FNEJMoa070972&rft_id=info%3Apmid%2F17978290&rft.aulast=Vernooij&rft.aufirst=MW&rft.au=Ikram%2C+MA&rft.au=Tanghe%2C+HL&rft_id=https%3A%2F%2Fdoi.org%2F10.1056%252FNEJMoa070972&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-48"><span class="mw-cite-backlink"><b><a href="#cite_ref-48">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFThompsonBrownAmin-HanjaniBroderick2015" class="citation journal cs1">Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, Duckwiler GR, Harris CC, Howard VJ, Johnston SC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J (August 2015). <a rel="nofollow" class="external text" href="https://doi.org/10.1161%2FSTR.0000000000000070">"Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association"</a>. <i>Stroke</i>. <b>46</b> (8): 2368–2400. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1161%2FSTR.0000000000000070">10.1161/STR.0000000000000070</a></span>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://www.worldcat.org/issn/0039-2499">0039-2499</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26089327">26089327</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Stroke&rft.atitle=Guidelines+for+the+Management+of+Patients+With+Unruptured+Intracranial+Aneurysms%3A+A+Guideline+for+Healthcare+Professionals+From+the+American+Heart+Association%2FAmerican+Stroke+Association&rft.volume=46&rft.issue=8&rft.pages=2368-2400&rft.date=2015-08&rft.issn=0039-2499&rft_id=info%3Apmid%2F26089327&rft_id=info%3Adoi%2F10.1161%2FSTR.0000000000000070&rft.aulast=Thompson&rft.aufirst=B.+Gregory&rft.au=Brown%2C+Robert+D.&rft.au=Amin-Hanjani%2C+Sepideh&rft.au=Broderick%2C+Joseph+P.&rft.au=Cockroft%2C+Kevin+M.&rft.au=Connolly%2C+E.+Sander&rft.au=Duckwiler%2C+Gary+R.&rft.au=Harris%2C+Catherine+C.&rft.au=Howard%2C+Virginia+J.&rft.au=Johnston%2C+S.+Claiborne+%28Clay%29&rft.au=Meyers%2C+Philip+M.&rft.au=Molyneux%2C+Andrew&rft.au=Ogilvy%2C+Christopher+S.&rft.au=Ringer%2C+Andrew+J.&rft.au=Torner%2C+James&rft_id=https%3A%2F%2Fdoi.org%2F10.1161%252FSTR.0000000000000070&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<li id="cite_note-49"><span class="mw-cite-backlink"><b><a href="#cite_ref-49">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFLudwigLauric,_AMalek,_JAMulligan,_R2020" class="citation journal cs1">Ludwig CG, Lauric, A, Malek, JA, Mulligan, R, Malek, AM (2020). "Performance of Radiomics derived morphological features for prediction of aneurysm rupture status". <i>Journal of NeuroInterventional Surgery</i>. <b>13</b> (8). <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1136%2Fneurintsurg-2020-016808">10.1136/neurintsurg-2020-016808</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/33158993">33158993</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:226274492">226274492</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+NeuroInterventional+Surgery&rft.atitle=Performance+of+Radiomics+derived+morphological+features+for+prediction+of+aneurysm+rupture+status.&rft.volume=13&rft.issue=8&rft.date=2020&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A226274492%23id-name%3DS2CID&rft_id=info%3Apmid%2F33158993&rft_id=info%3Adoi%2F10.1136%2Fneurintsurg-2020-016808&rft.aulast=Ludwig&rft.aufirst=CG&rft.au=Lauric%2C+A&rft.au=Malek%2C+JA&rft.au=Mulligan%2C+R&rft.au=Malek%2C+AM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntracranial+aneurysm" class="Z3988"></span></span>
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<h2><span class="mw-headline" id="External_links">External links</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Intracranial_aneurysm&action=edit&section=22" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
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<ul><li><a rel="nofollow" class="external text" href="http://www.ninds.nih.gov">National Institute of Neurological Disorders and Stroke</a></li></ul>
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margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q1198391" class="extiw" title="d:Q1198391">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#289522729">8B22.5</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/I67.1">I67.1</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=437.3">437.3</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D002532">D002532</a></li><li><b><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a></b>: <a rel="nofollow" class="external text" href="http://snomed.info/id/128609009">128609009</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/001414.htm">001414</a></li></ul></div></div></td></tr></tbody></table></div>
<div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1061467846"></div><div role="navigation" class="navbox" aria-labelledby="Cerebrovascular_diseases_including_stroke" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1063604349">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Cerebrovascular_diseases" title="Template:Cerebrovascular diseases"><abbr title="View this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Cerebrovascular_diseases" title="Template talk:Cerebrovascular diseases"><abbr title="Discuss this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Cerebrovascular_diseases" title="Special:EditPage/Template:Cerebrovascular diseases"><abbr title="Edit this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">e</abbr></a></li></ul></div><div id="Cerebrovascular_diseases_including_stroke" style="font-size:114%;margin:0 4em"><a href="/wiki/Cerebrovascular_disease" title="Cerebrovascular disease">Cerebrovascular diseases</a> including <a href="/wiki/Stroke" title="Stroke">stroke</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Ischaemic_stroke" class="mw-redirect" title="Ischaemic stroke">Ischaemic stroke</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Brain" title="Brain">Brain</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Anterior_cerebral_artery_syndrome" title="Anterior cerebral artery syndrome">Anterior cerebral artery syndrome</a></li>
<li><a href="/wiki/Middle_cerebral_artery_syndrome" title="Middle cerebral artery syndrome">Middle cerebral artery syndrome</a></li>
<li><a href="/wiki/Posterior_cerebral_artery_syndrome" title="Posterior cerebral artery syndrome">Posterior cerebral artery syndrome</a></li>
<li><a href="/wiki/Amaurosis_fugax" title="Amaurosis fugax">Amaurosis fugax</a></li>
<li><a href="/wiki/Moyamoya_disease" title="Moyamoya disease">Moyamoya disease</a></li>
<li><a href="/wiki/Dejerine%E2%80%93Roussy_syndrome" title="Dejerine–Roussy syndrome">Dejerine–Roussy syndrome</a></li>
<li><a href="/wiki/Watershed_stroke" title="Watershed stroke">Watershed stroke</a></li>
<li><a href="/wiki/Lacunar_stroke" title="Lacunar stroke">Lacunar stroke</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Brain_stem" class="mw-redirect" title="Brain stem">Brain stem</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Brainstem_stroke_syndrome" title="Brainstem stroke syndrome">Brainstem stroke syndrome</a></li>
<li><a href="/wiki/Medulla_oblongata" title="Medulla oblongata">Medulla</a>
<ul><li><a href="/wiki/Medial_medullary_syndrome" title="Medial medullary syndrome">Medial medullary syndrome</a></li>
<li><a href="/wiki/Lateral_medullary_syndrome" title="Lateral medullary syndrome">Lateral medullary syndrome</a></li></ul></li>
<li><a href="/wiki/Pons" title="Pons">Pons</a>
<ul><li><a href="/wiki/Medial_pontine_syndrome" title="Medial pontine syndrome">Medial pontine syndrome</a> / <a href="/wiki/Foville%27s_syndrome" title="Foville's syndrome">Foville's</a></li>
<li><a href="/wiki/Lateral_pontine_syndrome" title="Lateral pontine syndrome">Lateral pontine syndrome</a> / <a href="/wiki/Millard%E2%80%93Gubler_syndrome" title="Millard–Gubler syndrome">Millard-Gubler</a></li></ul></li>
<li><a href="/wiki/Midbrain" title="Midbrain">Midbrain</a>
<ul><li><a href="/wiki/Weber%27s_syndrome" title="Weber's syndrome">Weber's syndrome</a></li>
<li><a href="/wiki/Benedikt_syndrome" title="Benedikt syndrome">Benedikt syndrome</a></li>
<li><a href="/wiki/Claude%27s_syndrome" title="Claude's syndrome">Claude's syndrome</a></li></ul></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cerebellum" title="Cerebellum">Cerebellum</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Cerebellar_stroke_syndrome" title="Cerebellar stroke syndrome">Cerebellar stroke syndrome</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Extracranial arteries</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Carotid_artery_stenosis" title="Carotid artery stenosis">Carotid artery stenosis</a></li>
<li><a href="/wiki/Precerebral_artery" title="Precerebral artery">precerebral</a></li>
<li><a href="/wiki/Anterior_spinal_artery_syndrome" title="Anterior spinal artery syndrome">Anterior spinal artery syndrome</a></li>
<li><a href="/wiki/Vertebrobasilar_insufficiency" title="Vertebrobasilar insufficiency">Vertebrobasilar insufficiency</a>
<ul><li><a href="/wiki/Subclavian_steal_syndrome" title="Subclavian steal syndrome">Subclavian steal syndrome</a></li></ul></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Brain_ischemia" title="Brain ischemia">Brain ischemia</a></li>
<li><a href="/wiki/Cerebral_infarction" title="Cerebral infarction">Cerebral infarction</a></li>
<li><a href="/wiki/Stroke#Classification" title="Stroke">Classification</a>
<ul><li><a href="/wiki/Transient_ischemic_attack" title="Transient ischemic attack">Transient ischemic attack</a></li>
<li><a href="/wiki/Total_anterior_circulation_infarct" title="Total anterior circulation infarct">Total anterior circulation infarct</a></li>
<li><a href="/wiki/Partial_anterior_circulation_infarct" title="Partial anterior circulation infarct">Partial anterior circulation infarct</a></li></ul></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/CADASIL" title="CADASIL">CADASIL</a></li>
<li><a href="/wiki/Binswanger%27s_disease" title="Binswanger's disease">Binswanger's disease</a></li>
<li><a href="/wiki/Transient_global_amnesia" title="Transient global amnesia">Transient global amnesia</a></li></ul>
</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Haemorrhagic_stroke" class="mw-redirect" title="Haemorrhagic stroke">Haemorrhagic stroke</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Extra-axial</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Epidural_hematoma" title="Epidural hematoma">Epidural</a></li>
<li><a href="/wiki/Subdural_hematoma" title="Subdural hematoma">Subdural</a></li>
<li><a href="/wiki/Subarachnoid_hemorrhage" title="Subarachnoid hemorrhage">Subarachnoid</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Intracerebral_hemorrhage" title="Intracerebral hemorrhage">Cerebral/Intra-axial</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Intraventricular_hemorrhage" title="Intraventricular hemorrhage">Intraventricular</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Brainstem" title="Brainstem">Brainstem</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Duret_haemorrhages" title="Duret haemorrhages">Duret haemorrhages</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Intracranial_hemorrhage" title="Intracranial hemorrhage">Intracranial hemorrhage</a></li></ul>
</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aneurysm" title="Aneurysm">Aneurysm</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a class="mw-selflink selflink">Intracranial aneurysm</a>
<ul><li><a href="/wiki/Charcot%E2%80%93Bouchard_aneurysm" title="Charcot–Bouchard aneurysm">Charcot–Bouchard aneurysm</a></li></ul></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Cerebral_vasculitis" title="Cerebral vasculitis">Cerebral vasculitis</a></li>
<li><a href="/wiki/Cerebral_venous_sinus_thrombosis" title="Cerebral venous sinus thrombosis">Cerebral venous sinus thrombosis</a></li></ul>
</div></td></tr></tbody></table></div>
<div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1061467846"></div><div role="navigation" class="navbox" aria-labelledby="Cardiovascular_disease_(vessels)" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1063604349"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Vascular_diseases" title="Template:Vascular diseases"><abbr title="View this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Vascular_diseases" title="Template talk:Vascular diseases"><abbr title="Discuss this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Vascular_diseases" title="Special:EditPage/Template:Vascular diseases"><abbr title="Edit this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">e</abbr></a></li></ul></div><div id="Cardiovascular_disease_(vessels)" style="font-size:114%;margin:0 4em"><a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">Cardiovascular disease</a> (vessels)</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Artery" title="Artery">Arteries</a>, <a href="/wiki/Arteriole" title="Arteriole">arterioles</a><br /> and <a href="/wiki/Capillary" title="Capillary">capillaries</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Arteritis" title="Arteritis">Arteritis</a>
<ul><li><a href="/wiki/Aortitis" title="Aortitis">Aortitis</a></li></ul></li>
<li><a href="/wiki/Thromboangiitis_obliterans" title="Thromboangiitis obliterans">Buerger's disease</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Peripheral_artery_disease" title="Peripheral artery disease">Peripheral artery disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Arteriosclerosis" title="Arteriosclerosis">Arteriosclerosis</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Atherosclerosis" title="Atherosclerosis">Atherosclerosis</a>
<ul><li><a href="/wiki/Foam_cell" title="Foam cell">Foam cell</a></li>
<li><a href="/wiki/Fatty_streak" title="Fatty streak">Fatty streak</a></li>
<li><a href="/wiki/Atheroma" title="Atheroma">Atheroma</a></li>
<li><a href="/wiki/Intermittent_claudication" title="Intermittent claudication">Intermittent claudication</a></li>
<li><a href="/wiki/Critical_limb_ischemia" class="mw-redirect" title="Critical limb ischemia">Critical limb ischemia</a></li></ul></li></ul>
<ul><li><a href="/wiki/Monckeberg%27s_arteriosclerosis" title="Monckeberg's arteriosclerosis">Monckeberg's arteriosclerosis</a></li>
<li><a href="/wiki/Arteriolosclerosis" title="Arteriolosclerosis">Arteriolosclerosis</a>
<ul><li><a href="/wiki/Hyaline_arteriolosclerosis" class="mw-redirect" title="Hyaline arteriolosclerosis">Hyaline</a></li>
<li><a href="/wiki/Hyperplastic_arteriolosclerosis" class="mw-redirect" title="Hyperplastic arteriolosclerosis">Hyperplastic</a></li>
<li><a href="/wiki/Cholesterol" title="Cholesterol">Cholesterol</a></li>
<li><a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">LDL</a></li>
<li><a href="/wiki/Oxycholesterol" title="Oxycholesterol">Oxycholesterol</a></li>
<li><a href="/wiki/Trans_fat" title="Trans fat">Trans fat</a></li></ul></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Stenosis" title="Stenosis">Stenosis</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Carotid_artery_stenosis" title="Carotid artery stenosis">Carotid artery stenosis</a></li>
<li><a href="/wiki/Renal_artery_stenosis" title="Renal artery stenosis">Renal artery stenosis</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Aortoiliac_occlusive_disease" title="Aortoiliac occlusive disease">Aortoiliac occlusive disease</a></li>
<li><a href="/wiki/Degos_disease" title="Degos disease">Degos disease</a></li>
<li><a href="/wiki/Erythromelalgia" title="Erythromelalgia">Erythromelalgia</a></li>
<li><a href="/wiki/Fibromuscular_dysplasia" title="Fibromuscular dysplasia">Fibromuscular dysplasia</a></li>
<li><a href="/wiki/Raynaud%27s_phenomenon" class="mw-redirect" title="Raynaud's phenomenon">Raynaud's phenomenon</a></li></ul>
</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aneurysm" title="Aneurysm">Aneurysm</a> / <a href="/wiki/Dissection_(medical)" class="mw-redirect" title="Dissection (medical)">dissection</a> /<br /> <a href="/wiki/Pseudoaneurysm" title="Pseudoaneurysm">pseudoaneurysm</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><i>torso</i>: <a href="/wiki/Aortic_aneurysm" title="Aortic aneurysm">Aortic aneurysm</a>
<ul><li><a href="/wiki/Abdominal_aortic_aneurysm" title="Abdominal aortic aneurysm">Abdominal aortic aneurysm</a></li>
<li><a href="/wiki/Thoracic_aortic_aneurysm" title="Thoracic aortic aneurysm">Thoracic aortic aneurysm</a></li>
<li><a href="/wiki/Aneurysm_of_sinus_of_Valsalva" title="Aneurysm of sinus of Valsalva">Aneurysm of sinus of Valsalva</a></li></ul></li>
<li><a href="/wiki/Aortic_dissection" title="Aortic dissection">Aortic dissection</a></li>
<li><a href="/wiki/Aortic_rupture" title="Aortic rupture">Aortic rupture</a></li>
<li><a href="/wiki/Coronary_artery_aneurysm" title="Coronary artery aneurysm">Coronary artery aneurysm</a></li>
<li><i>head / neck</i>
<ul><li><a class="mw-selflink selflink">Intracranial aneurysm</a></li>
<li><a href="/wiki/Intracranial_berry_aneurysm" class="mw-redirect" title="Intracranial berry aneurysm">Intracranial berry aneurysm</a></li>
<li><a href="/wiki/Carotid_artery_dissection" title="Carotid artery dissection">Carotid artery dissection</a></li>
<li><a href="/wiki/Vertebral_artery_dissection" title="Vertebral artery dissection">Vertebral artery dissection</a></li>
<li><a href="/wiki/Familial_aortic_dissection" title="Familial aortic dissection">Familial aortic dissection</a></li></ul></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vascular_malformation" title="Vascular malformation">Vascular malformation</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Arteriovenous_fistula" title="Arteriovenous fistula">Arteriovenous fistula</a></li>
<li><a href="/wiki/Arteriovenous_malformation" title="Arteriovenous malformation">Arteriovenous malformation</a></li>
<li><a href="/wiki/Telangiectasia" title="Telangiectasia">Telangiectasia</a>
<ul><li><a href="/wiki/Hereditary_hemorrhagic_telangiectasia" title="Hereditary hemorrhagic telangiectasia">Hereditary hemorrhagic telangiectasia</a></li>
<li><a href="/wiki/Generalized_essential_telangiectasia" title="Generalized essential telangiectasia">Generalized essential telangiectasia</a></li></ul></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nevus#Vascular_nevus" title="Nevus">Vascular nevus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Cherry_hemangioma" class="mw-redirect" title="Cherry hemangioma">Cherry hemangioma</a></li>
<li><a href="/wiki/Halo_nevus" title="Halo nevus">Halo nevus</a></li>
<li><a href="/wiki/Spider_angioma" title="Spider angioma">Spider angioma</a></li></ul>
</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vein" title="Vein">Veins</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Phlebitis" title="Phlebitis">Phlebitis</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Venous_thrombosis" title="Venous thrombosis">Venous thrombosis</a> /<br /> <a href="/wiki/Thrombophlebitis" title="Thrombophlebitis">Thrombophlebitis</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><i>primarily lower limb</i>
<ul><li><a href="/wiki/Deep_vein_thrombosis" title="Deep vein thrombosis">Deep vein thrombosis</a></li></ul></li>
<li><i>abdomen</i>
<ul><li><a href="/wiki/Hepatic_veno-occlusive_disease" title="Hepatic veno-occlusive disease">Hepatic veno-occlusive disease</a></li>
<li><a href="/wiki/Budd%E2%80%93Chiari_syndrome" title="Budd–Chiari syndrome">Budd–Chiari syndrome</a></li>
<li><a href="/wiki/May%E2%80%93Thurner_syndrome" title="May–Thurner syndrome">May–Thurner syndrome</a></li>
<li><a href="/wiki/Portal_vein_thrombosis" title="Portal vein thrombosis">Portal vein thrombosis</a></li>
<li><a href="/wiki/Renal_vein_thrombosis" title="Renal vein thrombosis">Renal vein thrombosis</a></li></ul></li>
<li><i>upper limb / torso</i>
<ul><li><a href="/wiki/Mondor%27s_disease" class="mw-redirect" title="Mondor's disease">Mondor's disease</a></li>
<li><a href="/wiki/Paget%E2%80%93Schroetter_disease" title="Paget–Schroetter disease">Paget–Schroetter disease</a></li></ul></li>
<li><i>head</i>
<ul><li><a href="/wiki/Cerebral_venous_sinus_thrombosis" title="Cerebral venous sinus thrombosis">Cerebral venous sinus thrombosis</a></li></ul></li>
<li><a href="/wiki/Post-thrombotic_syndrome" title="Post-thrombotic syndrome">Post-thrombotic syndrome</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Varicose_veins" title="Varicose veins">Varicose veins</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Gastric_varices" title="Gastric varices">Gastric varices</a></li>
<li><a href="/wiki/Portacaval_anastomosis" title="Portacaval anastomosis">Portacaval anastomosis</a>
<ul><li><a href="/wiki/Caput_medusae" title="Caput medusae">Caput medusae</a></li>
<li><a href="/wiki/Esophageal_varices" title="Esophageal varices">Esophageal varices</a></li>
<li><a href="/wiki/Hemorrhoid" title="Hemorrhoid">Hemorrhoid</a></li></ul></li>
<li><a href="/wiki/Varicocele" title="Varicocele">Varicocele</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Chronic_venous_insufficiency" title="Chronic venous insufficiency">Chronic venous insufficiency</a></li>
<li><a href="/wiki/Chronic_cerebrospinal_venous_insufficiency" class="mw-redirect" title="Chronic cerebrospinal venous insufficiency">Chronic cerebrospinal venous insufficiency</a></li>
<li><a href="/wiki/Superior_vena_cava_syndrome" title="Superior vena cava syndrome">Superior vena cava syndrome</a></li>
<li><a href="/wiki/Inferior_vena_cava_syndrome" title="Inferior vena cava syndrome">Inferior vena cava syndrome</a></li>
<li><a href="/wiki/Venous_ulcer" title="Venous ulcer">Venous ulcer</a></li></ul>
</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Arteries or veins</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Angiopathy" title="Angiopathy">Angiopathy</a>
<ul><li><a href="/wiki/Macroangiopathy" class="mw-redirect" title="Macroangiopathy">Macroangiopathy</a></li>
<li><a href="/wiki/Microangiopathy" title="Microangiopathy">Microangiopathy</a></li></ul></li>
<li><a href="/wiki/Embolism" title="Embolism">Embolism</a>
<ul><li><a href="/wiki/Pulmonary_embolism" title="Pulmonary embolism">Pulmonary embolism</a></li>
<li><a href="/wiki/Cholesterol_embolism" title="Cholesterol embolism">Cholesterol embolism</a></li>
<li><a href="/wiki/Paradoxical_embolism" title="Paradoxical embolism">Paradoxical embolism</a></li></ul></li>
<li><a href="/wiki/Thrombosis" title="Thrombosis">Thrombosis</a></li>
<li><a href="/wiki/Hepatic_artery_thrombosis" title="Hepatic artery thrombosis">Hepatic artery thrombosis</a></li>
<li><a href="/wiki/Vasculitis" title="Vasculitis">Vasculitis</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Blood_pressure" title="Blood pressure">Blood pressure</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hypertension" title="Hypertension">Hypertension</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Hypertensive_heart_disease" title="Hypertensive heart disease">Hypertensive heart disease</a></li>
<li><a href="/wiki/Hypertensive_emergency" title="Hypertensive emergency">Hypertensive emergency</a></li>
<li><a href="/wiki/Hypertensive_nephropathy" class="mw-redirect" title="Hypertensive nephropathy">Hypertensive nephropathy</a></li>
<li><a href="/wiki/Essential_hypertension" title="Essential hypertension">Essential hypertension</a></li>
<li><a href="/wiki/Secondary_hypertension" title="Secondary hypertension">Secondary hypertension</a>
<ul><li><a href="/wiki/Renovascular_hypertension" title="Renovascular hypertension">Renovascular hypertension</a></li></ul></li>
<li><a href="/wiki/Benign_hypertension" title="Benign hypertension">Benign hypertension</a></li>
<li><a href="/wiki/Pulmonary_hypertension" title="Pulmonary hypertension">Pulmonary hypertension</a></li>
<li><a href="/wiki/Systolic_hypertension" title="Systolic hypertension">Systolic hypertension</a></li>
<li><a href="/wiki/White_coat_hypertension" title="White coat hypertension">White coat hypertension</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hypotension" title="Hypotension">Hypotension</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Orthostatic_hypotension" title="Orthostatic hypotension">Orthostatic hypotension</a></li></ul>
</div></td></tr></tbody></table><div></div></td></tr></tbody></table></div>
<div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1061467846"><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319"></div><div role="navigation" class="navbox authority-control" aria-label="Navbox" style="padding:3px"><table class="nowraplinks hlist navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Help:Authority_control" title="Help:Authority control">Authority control databases</a>: National <span class="mw-valign-text-top noprint" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q1198391#identifiers" title="Edit this at Wikidata"><img alt="Edit this at Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><span class="uid"><span class="rt-commentedText tooltip tooltip-dotted" title="Anévrisme cérébral"><a rel="nofollow" class="external text" href="https://catalogue.bnf.fr/ark:/12148/cb121733160">France</a></span></span></li>
<li><span class="uid"><span class="rt-commentedText tooltip tooltip-dotted" title="Anévrisme cérébral"><a rel="nofollow" class="external text" href="https://data.bnf.fr/ark:/12148/cb121733160">BnF data</a></span></span></li>
<li><span class="uid"><a rel="nofollow" class="external text" href="http://olduli.nli.org.il/F/?func=find-b&local_base=NLX10&find_code=UID&request=987007558019005171">Israel</a></span></li>
<li><span class="uid"><span class="rt-commentedText tooltip tooltip-dotted" title="Intracranial aneurysms"><a rel="nofollow" class="external text" href="https://id.loc.gov/authorities/sh85067613">United States</a></span></span></li>
<li><span class="uid"><a rel="nofollow" class="external text" href="https://id.ndl.go.jp/auth/ndlna/01233175">Japan</a></span></li></ul>
</div></td></tr></tbody></table></div></div>' |
