Cerebral ischemia as a presenting feature of intracranial aneurysms: a negative prognostic indicator in the management of aneurysms

Cerebral ischemia (stroke) can be a presenting clinical feature of intracranial aneurysms and may herald poor prognosis. A retrospective review of admissions for aneurysms over a 6-year period revealed that 12 patients (5%) had stroke or stroke-like presentations among 236 patients with intracranial aneurysms. Patient demographics, characteristics of aneurysms, and management were analyzed. Of 12 patients reviewed, nine had anterior circulation aneurysms. Two patients presented with subarachnoid hemorrhage and 10 with unruptured aneurysms. Eleven patients had stroke at the time of presentation, and five had a previous history of transient ischemic attacks. Ten patients had hypertension and eight were active smokers. The mean size of 10 aneurysms was 11.8 mm. Surgical extirpation of the aneurysms was performed in all cases. Four cases revealed thrombus in the aneurysm and one was atherosclerotic. The 6-month outcome was good in seven patients (58%) and fair in four patients (33%). One patient died. This outcome was significantly worse (P < 0.01) compared to that of good grade aneurysms in our database. Hypertension was a significant indicator of poor outcome (P < 0.02). Ischemic episodes as a presenting feature of intracranial aneurysms could be indicators of poor prognosis. Routine evaluation of stroke patients for aneurysms may help in early diagnosis. In addition, surgical obliteration of aneurysms could prevent subsequent strokes and neurological deficits.