Intracranial Aneurysms Associated with Other Lesions, Disorders or Anatomic Variations
Section snippets
Flow-related aneurysms
Hemodynamic stress has a predominant role in the formation of spontaneous saccular aneurysms at branching sites and trunkal aneurysms arising at nonbranching sites [3], [4], [5]. Consequently, almost all aneurysms are flow-related. Nevertheless, the term flow-related aneurysm describes the lesions in which manifest flow changes and increased hemodynamic stress caused by high-flow pathologic conditions appear to be very likely responsible for aneurysm development. Aneurysms associated with
Infectious aneurysms
Infectious aneurysms are rare, accounting for 2.5% to 6% of all IAs according to autopsy studies [47]. They also are defined as septic or mycotic aneurysms. Most of them, however, are bacterial in origin; thus the term mycotic is a misnomer if not used in the appropriate etiologic context. Bacterial aneurysms are more common than fungal aneurysms. Infectious aneurysms are found frequently in patients, especially in children, infected with HIV or suffering from AIDS [47], [48].
Traumatic aneurysms
Traumatic IAs are rare complications of closed and penetrating head injuries, and they also may be related to surgical procedures. They constitute less than 1% of IAs. As also showed on histological studies [62], [63], traumatic aneurysms are false aneurysms. Depending on how deep in the vessel wall the trauma occurs, the aneurysm can be a pseudoaneurysm characterized by a lumen circumscribed by organized hematoma, or, more rarely, a dissecting aneurysm characterized by a lumen contained by a
Iatrogenic aneurysms
Most iatrogenic aneurysms are false/pseudoaneurysms.
Neoplastic aneurysms
Neoplastic aneurysms caused by actual tumor infiltration of the arterial wall are exceptional [72]. Most neoplastic aneurysms are metastatic lesions reported in association with cardiac myxoma, choriocarcinoma, and bronchogenic and undifferentiated carcinomas [60], [78], [79], [80], [81], [82]. Tumoral emboli, similar to infectious emboli, cause vessel wall damage, resulting in vessel occlusion, hemorrhage, or aneurysm formation. Neoplastic cells infiltrate the vessel wall, resulting in
Aneurysms associated with systemic disorders
IAs have been associated with numerous heritable or congenital systemic disorders [83]. Vasculitis/vasculopathies, responsible for or concurrent to the development of IAs, can be secondary, occurring in a systemic disease or primary, occurring in a pathologic condition with exclusive involvement of the vascular system. In certain conditions (ie, polycystic kidney disease), the association with IAs has been established, while in others conditions, this association only is suggested or could be
Aneurysms in drug abuse
Abuse of drugs like amphetamine, ecstasy and cocaine, especially in its base-form type (crack), may be complicated by cerebral ischemic or hemorrhagic events including aneurismal SAH [115], [116], [117], [118]. A strong temporal association between the use of alkaloidal cocaine (during or within 72 hours) and both ischemic and hemorrhagic complications has been reported [116], [119]. A history of severe headache immediately after the use of amphetamine, ecstasy, or cocaine should suggest the
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