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Perianeurysmal edema as a predictive sign of aneurysmal rupture

2014; American Association of Neurological Surgeons; Volume: 121; Issue: 5 Linguagem: Inglês

10.3171/2014.6.jns132558

1933-0693

Félix Hendrik Pahl, Matheus Fernandes de Oliveira, Nelson Paes Fortes Diniz Ferreira, Leonardo Lopes de Macedo, Roger Schmidt Brock, Valéria Cardoso de Souza,

Neurosurgical Procedures and Complications

Subarachnoid hemorrhage following intracranial aneurysmal rupture is a major cause of morbidity and mortality. Several factors may affect the probability of rupture, such as tobacco and alcohol use; size, shape, and location of the aneurysm; presence of intraluminal thrombus; and even the sex of the patient. However, few data correlate such findings with the timing of aneurysmal rupture. The authors report 2 cases of middle-age women with headache and MRI findings of incidental aneurysms. Magnetic resonance imaging showed evidence of surrounding parenchymal edema, and in one case there was a clear increase in edema during follow-up, suggesting a progressive inflammatory process that culminated with rupture. These findings raise the possibility that bleb formation and an enlargement of a cerebral aneurysm might be associated with an inflammatory reaction of the aneurysm wall resulting in perianeurysmal edema and subsequent aneurysmal rupture. There may be a temporal link between higher degree of edema and higher risk for rupture, including risk for immediate rupture.