title: Perianeurysmal edema as a predictive sign of aneurysmal rupture.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo;
authors.forename: Felix Hendrik
authors.initials: FH
authors.lastname: Pahl
authors.forename: Matheus Fernandes
authors.initials: MF
authors.lastname: de Oliveira
authors.forename: Nelson Paes Fortes Diniz
authors.initials: NP
authors.lastname: Ferreira
authors.forename: Leonardo Lopes
authors.initials: LL
authors.lastname: de Macedo
authors.forename: Roger Schmidt
authors.initials: RS
authors.lastname: Brock
authors.forename: Valéria Cardoso
authors.initials: VC
authors.lastname: de Souza
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000209:etiology*; D001929:Brain Edema / Q000150:complications*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011237:Predictive Value of Tests; D013345:Subarachnoid Hemorrhage / Q000150:complications*
keywords: IPH = intraparenchymal hemorrhage; SAH = subarachnoid hemorrhage; aneurysm; subarachnoid hemorrhage; treatment; vascular disorders