title: Cerebral ischemia complicating intracranial aneurysm: a warning sign of imminent rupture?
abstract: OBJECTIVE
  Patients harboring nongiant cerebral aneurysms may rarely present with an ischemic infarct distal to the aneurysm. The aim of this case series was to report clinical and radiologic characteristics of these patients, their management, and outcome.
  
  
  METHODS
  We undertook a single-center retrospective analysis of consecutive patients admitted during an 8-year period with an acute ischemic stroke revealing an unruptured nongiant (<25 mm) sacciform intracranial aneurysm. Clinical, radiologic, therapeutic, and follow-up data were analyzed.
  
  
  RESULTS
  Nine patients were included. The mean size of aneurysms was 9.6 ± 6 mm, and 5 were partially or totally thrombosed. Two patients had a fatal SAH within 3 days after stroke-symptom onset, whereas asymptomatic meningeal bleeding was diagnosed or suspected in 2 others. Most of the patients with unthrombosed aneurysms were successfully treated by endovascular coiling in the acute phase. Thrombosed aneurysms were usually treated with antithrombotics, and most recanalized secondarily, requiring endovascular treatment or surgical obliteration. No recurrence of an ischemic event or SAH was observed during the 31 ± 12 months of follow-up (from 4 to 53 months).
  
  
  CONCLUSIONS
  In this single-center series, the frequency of early SAH in patients with ischemic stroke distal to an unruptured intracranial aneurysm was high. Acute management should be undertaken with care regarding antithrombotic use, and early endovascular coiling should be considered.
authors.affiliation: Department of Neurology, University Hospital of Nantes, France. benoit.guillon@chu-nantes.fr
authors.forename: B
authors.initials: B
authors.lastname: Guillon
authors.forename: B
authors.initials: B
authors.lastname: Daumas-Duport
authors.forename: O
authors.initials: O
authors.lastname: Delaroche
authors.forename: K
authors.initials: K
authors.lastname: Warin-Fresse
authors.forename: M
authors.initials: M
authors.lastname: Sévin
authors.forename: F
authors.initials: F
authors.lastname: Hérisson
authors.forename: E
authors.initials: E
authors.lastname: Auffray-Calvier
authors.forename: H
authors.initials: H
authors.lastname: Desal
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000209:etiology*; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors