Etiology of intracranial berry aneurysms

William E. Stehbens M.D., D.Phil.1
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  • 1 Department of Pathology, Wellington School of Medicine and the Malaghan Institute of Medical Research, Wellington, New Zealand
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✓ The congenital theory of the etiology of intracranial berry aneurysms has been widely accepted for manyyears. Review of the supporting evidence indicates that it is not based on sound scientific data but on unscientific and unsubstantiated allegations. There is no evidence of a congenital, developmental, or inherited weakness of the vessel wall. The most plausible explanation is that the aneurysms are acquired degenerative lesions — the effect of hemodynamic stress. The mural atrophy leading to aneurysmal dilatation is an acquired lesion which can be produced experimentally by hemodynamics alone. Hypertension and connective tissue disorders associated with acquired loss of tensile strength of the connective tissues are not essential: they appear to be aggravating rather than causal factors. Occlusion of one or more feeding vessels may enhance the possibility of aneurysm formation at large arterial forks subjected to the augmented hemodynamic stress associated with collateral flow.

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    Stehbens WE: Haemodynamics and the Blood Vessel Wall. Springfield, Ill: Charles C Thomas, 1979 Stehbens WE: Haemodynamics and the Blood Vessel Wall. Springfield, Ill: Charles C Thomas, 1979

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    Stehbens WE: Histopathology of cerebral aneurysms. Arch Neurol 8:272285, 1963 Stehbens WE: Histopathology of cerebral aneurysms. Arch Neurol 8:272–285, 1963

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    Stehbens WE: Hypertension and cerebral aneurysms. Med J Aust 2:810, 1962 Stehbens WE: Hypertension and cerebral aneurysms. Med J Aust 2:8–10, 1962

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    Stehbens WE: Intimal proliferation and spontaneous lipid deposition in the cerebral arteries of sheep and steer. J Atheroscler Res 5:556568, 1965 Stehbens WE: Intimal proliferation and spontaneous lipid deposition in the cerebral arteries of sheep and steer. J Atheroscler Res 5:556–568, 1965

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    Stehbens WE: Intracranial arterial aneurysms and atherosclerosis. University of Sydney, Sydney, Australia (Thesis) Stehbens WE: Intracranial arterial aneurysms and atherosclerosis. University of Sydney, Sydney, Australia (Thesis)

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    Stehbens WE: Intracranial berry aneurysms in infancy. Surg Neurol 18:5860, 1982 Stehbens WE: Intracranial berry aneurysms in infancy. Surg Neurol 18:58–60, 1982

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    Stehbens WE: Medial defects of the cerebral arteries of man. J Pathol Bacteriol 78:179185, 1959 Stehbens WE: Medial defects of the cerebral arteries of man. J Pathol Bacteriol 78:179–185, 1959

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    Stehbens WE: Medial defects of the cerebral arteries of some mammals. Nature 179:327328, 1957 Stehbens WE: Medial defects of the cerebral arteries of some mammals. Nature 179:327–328, 1957

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    Stehbens WE: Pathology of the Cerebral Blood Vessels. St Louis: CV Mosby, 1972 Stehbens WE: Pathology of the Cerebral Blood Vessels. St Louis: CV Mosby, 1972

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    Stehbens WE: The renal artery in normal and cholesterol-fed rabbits. Am J Pathol 43:969985, 1963 Stehbens WE: The renal artery in normal and cholesterol-fed rabbits. Am J Pathol 43:969–985, 1963

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    Stehbens WE, , Delahunt B, & Hilless A: Early berry aneurysm formation in Marfan's syndrome. Surg Neurol 31:200202, 1989 Stehbens WE, Delahunt B, Hilless A: Early berry aneurysm formation in Marfan's syndrome. Surg Neurol 31:200–202, 1989

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    Stehbens WE, & Silver MD: Arterial lesions induced by methyl cellulose. Am J Pathol 48:483501, 1966 Stehbens WE, Silver MD: Arterial lesions induced by methyl cellulose. Am J Pathol 48:483–501, 1966

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    Stern J, , Whelan M, & Brisman R, et al: Management of extracranial carotid stenosis and intracranial aneurysms. J Neurosurg 51:147150, 1979 Stern J, Whelan M, Brisman R, et al: Management of extracranial carotid stenosis and intracranial aneurysms. J Neurosurg 51:147–150, 1979

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    ter Berg HWM, , Bijlsma JB, & Veiga Pires JA, et al: Familial association of intracranial aneurysms and multiple congenital anomalies. Arch Neurol 43:3033, 1986 ter Berg HWM, Bijlsma JB, Veiga Pires JA, et al: Familial association of intracranial aneurysms and multiple congenital anomalies. Arch Neurol 43:30–33, 1986

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    Walker AE, & Allègre GW: The pathology and pathogenesis of cerebral aneurysms. J Neuropathol Exp Neurol 13:248259, 1954 Walker AE, Allègre GW: The pathology and pathogenesis of cerebral aneurysms. J Neuropathol Exp Neurol 13:248–259, 1954

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    Walton JN: Subarachnoid Haemorrhage. Edinburgh/London: Churchill Livingstone, 1956 Walton JN: Subarachnoid Haemorrhage. Edinburgh/London: Churchill Livingstone, 1956

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    Wilson G, , Riggs HE, & Rupp C: The pathologic anatomy of ruptured cerebral aneurysms. J Neurosurg 11:128134, 1954 Wilson G, Riggs HE, Rupp C: The pathologic anatomy of ruptured cerebral aneurysms. J Neurosurg 11:128–134, 1954

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    Yamanaka C, , Hirohata T, & Kiya K, et al: Basilar bifurcation aneurysm association with bilateral internal carotid occlusion. Neuroradiology 29:8488, 1987 Yamanaka C, Hirohata T, Kiya K, et al: Basilar bifurcation aneurysm association with bilateral internal carotid occlusion. Neuroradiology 29:84–88, 1987

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