Perianeurysmal edema as a predictive sign of aneurysmal rupture

Report of 2 cases

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  • 1 Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo;
  • | 2 Department of Neurosurgery, Hospital Sirio Libanês, São Paulo;
  • | 3 Radiology Service, Hospital do Coração, São Paulo;
  • | 4 Radiology Service, Cedimagem, Juiz de Fora, Minas Gerais; and
  • | 5 Endovascular Service, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
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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.

Abbreviations used in this paper:

IPH = intraparenchymal hemorrhage; SAH = subarachnoid hemorrhage.

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