What is a cerebral aneurysm? A localized dilation (outpouching) of a cerebral artery caused by weakening of the vessel wall.
What is the most common type of cerebral aneurysm? Saccular (berry) aneurysm
At arterial branch points of the Circle of Willis, especially:
- Anterior communicating artery (most common)
Where do berry aneurysms most commonly occur?
- Posterior communicating artery
- Middle cerebral artery bifurcation
These locations experience high hemodynamic stress, leading to progressive weakening of
Why do aneurysms most commonly form at arterial bifurcations?
the vessel wall.
- Hypertension
- Cigarette smoking
- Family history
What are the major risk factors for cerebral aneurysms? - Female sex
- Increasing age
- Polycystic kidney disease
- Connective tissue disorders (e.g., Ehlers-Danlos)
What is the greatest danger of a cerebral aneurysm? Rupture, causing a subarachnoid hemorrhage (SAH).
Most are asymptomatic, but large aneurysms may compress nearby structures causing:
Headache
What symptoms may occur before an aneurysm ruptures?
Cranial nerve palsies
Visual disturbances
Which cranial nerve is classically compressed by a posterior communicating artery aneurysm? CN III (oculomotor nerve)
- Ptosis
- Dilated pupil ("blown pupil")
What symptoms suggest a CN III palsy from a PCom aneurysm? - Eye deviated "down and out"
- Diplopia
- Ruptured Aneurysm
Sudden thunderclap headache ("worst headache of my life") due to subarachnoid hemor-
What is the classic presentation of a ruptured cerebral aneurysm?
rhage.
- Nausea/vomiting
- Neck stittness
Besides headache, what symptoms commonly accompany aneurysmal rupture? - Photophobia
- Altered mental status
- Loss of consciousness
What is the initial imaging study for suspected ruptured aneurysm? Non-contrast CT head
CT angiography (CTA)
What imaging identifies the aneurysm itself?
Cerebral angiography (gold standard)
Surgical clipping
What are the two definitive treatments for cerebral aneurysms?
Endovascular coiling
How does surgical clipping work? A clip is placed across the aneurysm neck to exclude it from circulation.
Platinum coils are inserted into the aneurysm, promoting thrombosis and preventing rupture
How does endovascular coiling work? or rebleeding.
- Arteriovenous - Malformations (AVMs)
A congenital tangle of abnormal arteries and veins connected without an intervening capillary
What is an arteriovenous malformation (AVM)?
bed.
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What is the most common type of cerebral aneurysm? Saccular (berry) aneurysm
At arterial branch points of the Circle of Willis, especially:
- Anterior communicating artery (most common)
Where do berry aneurysms most commonly occur?
- Posterior communicating artery
- Middle cerebral artery bifurcation
These locations experience high hemodynamic stress, leading to progressive weakening of
Why do aneurysms most commonly form at arterial bifurcations?
the vessel wall.
- Hypertension
- Cigarette smoking
- Family history
What are the major risk factors for cerebral aneurysms? - Female sex
- Increasing age
- Polycystic kidney disease
- Connective tissue disorders (e.g., Ehlers-Danlos)
What is the greatest danger of a cerebral aneurysm? Rupture, causing a subarachnoid hemorrhage (SAH).
Most are asymptomatic, but large aneurysms may compress nearby structures causing:
Headache
What symptoms may occur before an aneurysm ruptures?
Cranial nerve palsies
Visual disturbances
Which cranial nerve is classically compressed by a posterior communicating artery aneurysm? CN III (oculomotor nerve)
- Ptosis
- Dilated pupil ("blown pupil")
What symptoms suggest a CN III palsy from a PCom aneurysm? - Eye deviated "down and out"
- Diplopia
- Ruptured Aneurysm
Sudden thunderclap headache ("worst headache of my life") due to subarachnoid hemor-
What is the classic presentation of a ruptured cerebral aneurysm?
rhage.
- Nausea/vomiting
- Neck stittness
Besides headache, what symptoms commonly accompany aneurysmal rupture? - Photophobia
- Altered mental status
- Loss of consciousness
What is the initial imaging study for suspected ruptured aneurysm? Non-contrast CT head
CT angiography (CTA)
What imaging identifies the aneurysm itself?
Cerebral angiography (gold standard)
Surgical clipping
What are the two definitive treatments for cerebral aneurysms?
Endovascular coiling
How does surgical clipping work? A clip is placed across the aneurysm neck to exclude it from circulation.
Platinum coils are inserted into the aneurysm, promoting thrombosis and preventing rupture
How does endovascular coiling work? or rebleeding.
- Arteriovenous - Malformations (AVMs)
A congenital tangle of abnormal arteries and veins connected without an intervening capillary
What is an arteriovenous malformation (AVM)?
bed.
1/2
