Thrombosis of non-giant unruptured aneurysms causing ischemic stroke.
OBJECTIVE
To describe a series of patients with stroke secondary to thrombosis in unruptured non-giant aneurysms and to classify them.


METHODS
Patients with saccular non-giant aneurysm thrombosis presenting with ischemic events were identified. The clinical and imaging attributes were then used to build a novel classification scheme for aneurysm-related stroke.


RESULTS
Six patients were included representing 0.15% of all strokes. The proposed mechanisms for stroke were classified as dislodgement of aneurysm thrombi to distal vessels, extension of aneurysm clot into the parent vessel and parent vessel occlusion due to extrinsic compression by the thrombosed aneurysm. Stroke severity was minor and outcome was excellent in all patients.


CONCLUSIONS
Strokes caused by unruptured aneurysms are rare and can be caused by several mechanisms. Clinicians should be aware of this rare form of stroke as it may represent a contraindication to systemic thrombolysis due to increased risk of aneurysm recanalization and rupture.
Cohen
José E
JE
Department of Neurosurgery, Hadassah Hebrew University Hospital, Jerusalem, Israel. cohenns@yahoo.com
Gomori
John M
JM
Leker
Ronen R
RR
D000328:Adult; D000368:Aged; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013927:Thrombosis / Q000150:complications* / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods