Periodicidad semestral: flujo continuo.
ISSN - Electrónico: 2661-6947 / DOI: 10.36015 • LILACS BIREME (19784); LATINDEX (20666)
INTRODUCTION. In Ecuador, cerebrovascular diseases are the third leading cause of death in the general population; there are few data in the medical literature on aneurysmal subarachnoid hemorrhage and unruptured aneurysms, so it was essential to describe a clinical profile. OBJECTIVE. To characterize the clinical profile of patients diagnosed with cerebral aneurysm. MATERIALS AND METHODS. Descriptive observational study. Population of 450 and sample of 447 patients with a diagnosis of cerebral aneurysm seen in the Neurology Unit of the Carlos Andrade Marín Hospital, period January 2010 to December 2018. Clinical and imaging data were collected through the review of digital medical records obtained from the MIS/AS400 computer system, and were analyzed in the statistical program International Business Machines Statistical Package for the Social Sciences, version 23. RESULTS. A total of 605 aneurysms were identified in 447 patients. A total of 80,5% (360; 447) had ruptured aneurysms, of which 81,4% (293; 360) had a single aneurysm. The most common risk factor was hypertension with 44,3% (198; 447), the manifestations observed were: subarachnoid hemorrhage with 98,9% (356; 360) in ruptured aneurysms; and headache with 65,5% (57; 87) in unruptured aneurysms. DISCUSSION. We found relevant data not consistent with the world scientific literature, such as the low number of asymptomatic and unruptured aneurysms, compared with its counterpart. CONCLUSION. It was evidenced that intracranial aneurysms produced a wide range of clinical manifestations, ranging from SAH as the most frequent in the group of ruptured aneurysms, to completely asymptomatic patients in the group of unruptured aneurysms.
Duque-Ortega L, Correa-Vélez S, Jiménez-Yépes CM. Dinámica de flujo computacional en aneurismas cerebrales. Rev. CES Med. 2015; 29(2):239–54. Disponible en: http://www.scielo.org.co/pdf/cesm/v29n2/v29n2a08.pdf
Texakalidis P, Sweid A, Mouchtouris N, Peterson EC, Sioka C, Rangel-Castilla L, et al. Aneurysm Formation, Growth, and Rupture: The Biology and Physics of Cerebral Aneurysms. World Neurosurg [Internet]. 2019; 130:277–84. Available from: https://doi.org/10.1016/j.wneu.2019.07.093
Moscote Salazar LR, Agrawal A, Zenteno M, Lee A. Do We Need to Recognize Intracranial Aneurysms into Aneurysmsome and Aneurysmatic Complex: Need for New Concepts in Pathobiology of Intracranial Aneurysms. Insights Neurosurg. 2016; 01(03):3–4. Available from: https://neurosurgery.imedpub.com/do-we-need-to-recognize-intracranialaneurysms-into-aneurysmsome-andaneurysmatic-complex-need-fornew-concepts-in-pathobiology-ofint.php?aid=17318
Brown RD, Broderick JP. Unruptured intracranial aneurysms: Epidemiology, natural history, management options, and familial screening. Lancet Neurol. 2014; 13(4):393–404. DOI: 10.1016/S1474-4422(14)70015-8
Suarez JI, Sheikh MK, Macdonald RL, Amin-Hanjani S, Brown RD, de Oliveira Manoel AL, et al. Common Data Elements for Unruptured Intracranial Aneurysms and Subarachnoid Hemorrhage Clinical Research: A National Institute for Neurological Disorders and Stroke and National Library of Medicine Project. Neurocrit Care. 2019; 30 (Suppl 1):4–19. DOI: 10.1007/s12028-019-00723-6
Boulouis G, Rodriguez-Régent C, Rasolonjatovo EC, Ben Hassen W, Trystram D, Edjlali-Goujon M, et al. Unruptured intracranial aneurysms: An updated review of current concepts for risk factors, detection and management. Rev Neurol (Paris). 2017 Nov; 173(9):542–51. DOI: 10.1016/j.neurol.2017.05.004
Long B, Koyfman A, Runyon MS. Subarachnoid Hemorrhage: Updates in Diagnosis and Management. Emerg Med Clin North Am [Internet]. 2017;35(4):803–24. DOI: http://dx.doi.org/10.1016/j.emc.2017.07.001
Krishnamurthi R V., Ikeda T, Feigin VL. Global, Regional and Country-Specific Burden of Ischaemic Stroke, Intracerebral Haemorrhage and Subarachnoid Haemorrhage: A Systematic Analysis of the Global Burden of Disease Study 2017. Neuroepidemiology. 2020;54(2):171–9. Available from: https://www.karger.com/Article/Abstract/506396
Moreno-Zambrano D, Santamaría D, Ludeña C, Barco A. Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 Años de Mortalidad, Realidad Actual y Recomendaciones. Rev Ecuat. Neurol 2016;25(1):17–20. Available from: http://revecuatneurol.com/wp-content/uploads/2017/05/Enfermedad-cerebrovascular-ecuador-analisis-mortalidad.pdf
Greving JP, Wermer MJH, Brown RD, Morita A, Juvela S, Yonekura M, et al. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: A pooled analysis of six prospective cohort studies. Lancet Neurol. 2014;13(1):59–66. Available from: https://researchportal.helsinki.fi/en/publications/development-of-the-phases-score-for-prediction-of-risk-of-rupture
Jung K-H. New Pathophysiological Considerations on Cerebral Aneurysms. Neurointervention. 2018;13(2):73–83. DOI: https://doi.org/105469/neuroint.2018.01011
Mocco J, Brown RD, Torner JC, Capuano AW, Fargen KM, Raghavan ML, et al. Aneurysm morphology and prediction of rupture: An international study of unruptured intracranial aneurysms analysis. Clin Neurosurg. 2018;82(4):491–5. DOI: 10.1093/neuros/nyx226
Lawton M, Vates EG. Subarachnoid hemorrhage. N Engl J Med. 2017;377(3):257–66. DOI: 10.1056/NEJMcp1605827
Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol. 2016 Dec;12(12):699–713. DOI: 10.1038/nrneurol.2016.150
Wiebers DO. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10. DOI: 10.1016/s0140-6736(03)13860-3
Ajiboye N, Chalouhi N, Starke RM, Zanaty M, Bell R. Unruptured Cerebral Aneurysms: Evaluation and Management. Sci World J. 2015;2015. DOI: 10.1155/2015/954954
Zacharia BE, Hickman ZL, Grobelny BT, DeRosa P, Kotchetkov I, Ducruet AF, et al. Epidemiology of Aneurysmal Subarachnoid Hemorrhage. Neurosurg Clin N Am. 2010;21(2):221–33. DOI: 10.1016/j.nec.2009.10.002
Peña Tapia PG, Rodas López MF. Comunicado de 62 aneurismas cerebrales clipados en el Hospital Regional Docente Vicente Corral Moscoso de la ciudad de Cuenca, Ecuador. Rev Neurol. 2003;37(05):430-5. Available from: https://pubmed.ncbi.nlm.nih.gov/14533090/
Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and. Lancet. 2005;366(9488):809–17. DOI: 10.1016/S0140-6736(05)67214-5
Raps EC, Galetta SL, Rogers JD, Solomon RA, Lennihan L, Klebanoff LM, et al. The Clinical Spectrum of Unruptured Intracranial Aneurysms. Arch Neurol. 1993;50(3):265–8. DOI: 10.1001/archneur.1993.00540030031010
Lemos J, Eggenberger E. Neuro-Ophthalmological Emergencies. The Neurohospitalist. 2015;5(4):223–33. DOI: 10.1177/1941874415583117.
Etminan N, Dörfler A, Steinmetz H. Unruptured intracranial aneurysms—pathogenesis and individualized management. Dtsch Arztebl Int. 2020;117(14):235–42. DOI: 10.3238/arztebl.2020.0235
D’Souza S. Aneurysmal subarachnoid hemorrhage. J Neurosurg Anesthesiol. 2015;27(3):222–40. DOI: 10.1097/ANA.0000000000000130
Brinjikji W, Zhu YQ, Lanzino G, Cloft HJ, Murad MH, Wang Z, et al. Risk factors for growth of intracranial aneurysms: A systematic review and meta-analysis. Am J Neuroradiol. 2016;37(4):615–20. DOI: https://doi.org/10.3174/ajnr.A4575
Backes D, Rinkel GJE, Laban KG, Algra A, Vergouwen MDI. Patient-and aneurysm-specific risk factors for intracranial aneurysm growth: A systematic review and meta-analysis. Stroke. 2016;47(4):951–7. DOI: 10.1161/STROKEAHA.115.012162
Wang G-X, Zhang D, Wang Z-P, Yang L-Q, Yang H, Li W. Risk factors for ruptured intracranial aneurysms. Indian J Med Res. 2018;147(1):51-57. DOI: 10.4103/ijmr.IJMR_1665_15
Vlak MHM, Algra A, Brandenburg R, Rinkel GJE. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: A systematic review and meta-analysis. Lancet Neurol. 2011;10(7):626–36. DOI: 10.1016/S1474-4422(11)70109-0
Fung C, Mavrakis E, Filis A, Fischer I, Suresh M, Tortora A, et al. Anatomical evaluation of intracranial aneurysm rupture risk in patients with multiple aneurysms. Neurosurg Rev. 2019;42(2):539–47. DOI: 10.1007/s10143-018-0998-1
Bhogal P, AlMatter M, Hellstern V, Ganslandt O, Bäzner H, Henkes H, et al. Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms. Surg Neurol Int. 2018;9(1):1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778729/
Shojima M, Morita A, Nakatomi H, Tominari S. Size is the most important predictor of aneurysm rupture among multiple cerebral aneurysms: Post hoc subgroup analysis of unruptured cerebral aneurysm study Japan. Neurosurgery. 2018;82(6):864–9. DOI: 10.1093/neuros/nyx307
Harada K, Fukuyama K, Shirouzu T, Ichinose M, Fujimura H, Kakumoto K, et al. Prevalence of unruptured intracranial aneurysms in healthy asymptomatic Japanese adults: Differences in gender and age. Acta Neurochir (Wien). 2013;155(11):2037–43. DOI: 10.1007/s00701-013-1841-7
Doddasomayajula R, Chung BJ, Mut F, Jimenez CM, Hamzei-Sichani F, Putman CM, et al. Hemodynamic Characteristics of Ruptured and Unruptured Multiple Aneurysms at Mirror and Ipsilateral Locations. Am J Neuroradiol. 2017 Dec;38(12):2301–7. DOI: 10.3174/ajnr.A5397
The authors who publish in this journal accept the following conditions:
1. The authors retain the copyright and grant to the CAMbios MEDICAL-SCIENTIFIC JOURNAL HECAM the right of the first publication, with the work registered with the Creative Commons attribution license, which allows third parties to use the published material provided that they mention the authorship of the work and the first publication in this journal.
2. Authors can make other independent and additional contractual agreements for the non-exclusive distribution of the version of the article published in this journal (for example, include it in an institutional repository or publish it in a book) as long as it clearly indicates that the work was published. for the first time in the CAMbios MEDICAL-SCIENTIFIC JOURNAL HECAM.
