Incidence of Aneurysmal Subarachnoid Hemorrhage with Procedures Requiring General Anesthesia in Patients with Unruptured Intracranial Aneurysms

Masoud, Hesham; Nair, Vijaylakshmi; Odulate-Williams, Adekorewale; Sharma, Sameer; Gould, Grahame; Thatcher, Joshua; Nguyen, Thanh N.

doi:10.1159/000490582

Cited by 3 publications

(1 citation statement)

References 15 publications

(15 reference statements)

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“…Furthermore, general anesthesia appears safe for patients with unruptured intracranial aneurysms, with one retrospective study reporting 0 cases of subarachnoid hemorrhage in a patient sample of 134 unsecured aneurysms and 208 inductions over a 5.7-year follow-up period. 45…”

Section: Conservative Managementmentioning

confidence: 99%

Endovascular and Medical Management of Unruptured Intracranial Aneurysms

Reddy

Masoud

2023

Semin Neurol

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Unruptured intracranial aneurysms are often discovered incidentally on noninvasive imaging. As use of noninvasive imaging has increased, our understanding of the presumed prevalence of intracranial aneurysms in adults has increased. Incidentally found aneurysms are often asymptomatic; however, they can rarely rupture and cause life-threatening illness. Elective treatment of intracranial aneurysms carries risks which need to be considered along with patient-specific factors (e.g., anatomy, medical comorbidities, personal preferences). In this article, we review the natural history, risk factors for cerebral aneurysm formation and rupture, evidence for medical management, and the safety profile and efficacy of available endovascular treatment options.

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Section: Conservative Managementmentioning

confidence: 99%

Endovascular and Medical Management of Unruptured Intracranial Aneurysms

Reddy

Masoud

2023

Semin Neurol

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Aneurysmal Subarachnoid Hemorrhage After Cesarean Section Under Spinal Anesthesia: A Case Report

Eddin

Shaikh

2022

Preprint

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Background The incidence of cerebral aneurysms in the pregnant population is similar to that of the non-pregnant population. Subarachnoid hemorrhage occurs in 5.8 per 100,000 deliveries among women between 15- and 44-year-old. Studies have found that the incidence of aneurysmal rupture is higher during the third trimester and lower during the first trimester. The risk of aneurysmal rupture and subarachnoid hemorrhage during general anesthesia or spinal anesthesia is unclear. We report a case of aneurysm rupture in the postpartum period. Case We describe a case of a 28-year-old woman, Gravida 3 Para 2, who went elective Cesarean delivery under spinal anesthesia at 39 weeks. She developed a headache, right-sided body weakness, and left-sided focal seizures postoperatively. Computed Tomography (CT) scan showed basal ganglia hemorrhage with intraventricular extension, subarachnoid hemorrhage, and midline shift to the right side. The World Federation of Neurological Surgeons (WFNS) grade was 4, and the modified Fischer grade was 4. A right frontal external ventricular drain was inserted, and the patient was admitted to the intensive care unit (ICU). Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) showed a small left supraclinoid aneurysm, and the patient underwent balloon-assisted coiling. Seven days later, the Glasgow Coma Scale (GCS) dropped again, the Computed Tomography (CT) scan showed brain edema, and decompressive craniectomy was done. The patient subsequently improved, and later the external ventricular drain (EVD) was removed, and the patient was referred to a rehabilitation center. Cranioplasty was done three months later. Glasgow Outcome Scale (GOS-E) after six months was 6 (moderate disability). Conclusion The use of vasopressors and cerebrospinal fluid (CSF) leakage may increase the risk of cerebral aneurysm rupture after spinal anesthesia.

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A High-grade Aneurysmal Subarachnoid Hemorrhage in the Peripartum Period

Shaikh,

Saadeddin,

Ummunnisa

et al. 2024

Journal of Emergencies, Trauma, and Shock

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Aneurysmal subarachnoid hemorrhage (aSAH) is a rare but devastating complication with increased morbidity and mortality. It is still unclear whether the incidence is increased during pregnancy and in the peripartum period. However, the incidence of cerebral aneurysmal rupture is higher during the third trimester than in the first trimester. The risk of aneurysmal rupture and subarachnoid hemorrhage (SAH) during general anesthesia or spinal anesthesia is unclear. We report a case of left supraclinoid aneurysm rupture after spinal anesthesia for Low Segment Caesarean Section (LSCS) in the immediate postpartum period causing high-grade aSAH.

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Incidence of Aneurysmal Subarachnoid Hemorrhage with Procedures Requiring General Anesthesia in Patients with Unruptured Intracranial Aneurysms

Cited by 3 publications

References 15 publications

Endovascular and Medical Management of Unruptured Intracranial Aneurysms

Endovascular and Medical Management of Unruptured Intracranial Aneurysms

Aneurysmal Subarachnoid Hemorrhage After Cesarean Section Under Spinal Anesthesia: A Case Report

A High-grade Aneurysmal Subarachnoid Hemorrhage in the Peripartum Period

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