This Article Full Text Full Text (PDF) All Versions of this Article: 34/8/1857    most recent 01.STR.0000085566.16190.EDv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Findlay, J. M. Search for Related Content PubMed PubMed Citation Articles by Findlay, J. M.

(Stroke. 2003;34:1857.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Prehemorrhage Risk Factors for Fatal Intracranial Aneurysm Rupture

Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In another important contribution from the Department of Neurosurgery at the University of Helsinki, where careful records and follow-up on patients with diagnosed intracranial aneurysms have been maintained for decades, evidence is presented that preexisting hypertension is associated with a higher fatality rate when unruptured cerebral aneurysms rupture. When dealing with the issue of unruptured cerebral aneurysms in the clinic, risk factors that may predict a higher risk of future bleeding (death notwithstanding) are assessed, factors that might justify the risk involved in prophylactic aneurysm repair. Previous study of this same captive Finnish population¹ and other reports have suggested that the risk of future hemorrhage increases with aneurysm size,^2,3 the presence of a local mass effect and symptoms resulting from the aneurysm,^3,4 previous bleeding from another intracranial aneurysm,^2,3 an aneurysm location in the posterior circulation,^2,3 a multilobulated⁵ or long⁶ aneurysm shape, female sex,³ younger age at diagnosis,⁷ a familial history of aneurysm rupture,⁸ cigarette smoking,^9,10 and heavy alcohol use.¹¹ Arterial hypertension is another but perhaps less powerful predictor of rupture, as the authors discuss in this report.

Still, even in the presence of several of the aforementioned risk factors, the annual risk of an unruptured saccular aneurysm rupturing on an annual basis might be only 1% to 3%,¹² a reassuringly low figure especially for older patients. Balancing this low annual bleeding rate, and especially for younger patients who bear a far greater cumulative lifetime risk of rupture, is the very high mortality and morbidity attached to each and every aneurysm . . . [Full Text of this Article]