Critical Care Medicine-Neurologic Disorders>>>>>Cerebrovascular Diseases
Question 4#

A 67-year-old female has had progressive tinnitus over the last 4 years. Initial laboratory workup has been unrevealing, so additional workup with brain imaging was completed. The CT angiogram is shown in the figure that follows:

Which of the following is MOST true regarding incidentally discovered aneurysms?

a. Saccular aneurysms are most amenable to treatment with intraarterial coiling
b. Incidentally discovered aneurysms without any symptoms do not warrant further evaluation or intervention
c. Aneurysms located in the posterior circulation have a higher risk of rupture than the anterior circulation
d. The average annual rupture rate of all incidentally discovered aneurysm is around 10%

Correct Answer is C

Comment:

Correct Answer: C

The tinnitus is likely an unrelated symptom, but there is CT angiogram evidence of an incidentally discovered broad-based unruptured aneurysm arising from the left vertebral artery. The overall annual incidence of aneurysm rupture is 1.1% to 1.4%. Patient factors that increase the risk of aneurysmal rupture include smoking, female sex, and posterior circulation, and patient age inversely (younger patients at higher risk) increased the risk of rupture. Aneurysm factors that increase the risk of rupture include larger size in anterior circulation >7 and >6 mm in posterior circulation, multilobulated aneurysm, posterior circulation, and aneurysm growth in serial imaging are associated with increased risk of rupture. The different approaches to management of unruptured, and ruptured, aneurysm are open surgery with ligation or wrapping of the aneurysm and endovascular therapy with coiling of the aneurysm with or without stent assistance.

References:

  1. Juvela S, Poussa K, Lehto H, et al. Natural history of unruptured intracranial aneurysms: a long-term follow-up study. Stroke. 2013;44:2414-2421.
  2. Wermer MJH, van der Schaff IC, Algra A, et al. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics. Stroke. 2007;38:1404-1410.