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There is an increased incidence of congenital polycystic kidneys, bromuscular dysplasia of the extracranial arteries, moyamoya, and coarctation of the aorta among persons with saccular aneurysms A saccular aneurysm occurs in approximately 5 percent of cases of arteriovenous malformation, usually on the main feeding artery of the malformation Numerous reports have documented a familial occurrence of saccular aneurysms, lending support to the idea that genetic factors play a role in their development The number of rst-degree relatives found to harbor an unsuspected aneurysm has been about 4 percent in most series This low rate, the nding that half of the discovered aneurysms are small, and the complications of surgery make routine screening of siblings, children, and parents of patients with ruptured aneurysms impractical, according to the Magnetic Resonance Angiography in Relatives of Patients with Subarachnoid Hemorrhage Study Group However, since aneurysms of the familial variety tend to be larger at the time of rupture and more numerous than in patients who have sporadic ones, there are exceptions to this statement (Ruigrok et al) While hypertension is more frequently present than in the general population, nevertheless aneurysms most often occur in persons with normal blood pressure Pregnancy does not appear to be associated with an increased incidence of aneurysmal rupture, although there is always concern about the possibility of rupture during the straining of natural delivery Atherosclerosis, though present in the walls of some saccular aneurysms, probably plays no part in their formation or enlargement Approximately 90 to 95 percent of saccular aneurysms lie on the anterior part of the circle of Willis (Fig 34-22) The four most common sites are (1) the proximal portions of the anterior communicating artery, (2) at the origin of the posterior communicating artery from the stem of the internal carotid, (3) at the rst major bifurcation of the middle cerebral artery, and (4) at the bifurcation of the internal carotid into middle and anterior cerebral arteries Other sites include the internal carotid artery in the cavernous sinus, at the origin of the ophthalmic artery, the junction of the posterior communicating and posterior cerebral arteries, the bifurcation of the basilar artery, and the origins of the three cerebellar arteries Aneurysms that rupture in the cavernous sinus may give rise to an arteriovenous stula (page 749) There are several types of aneurysm other than saccular, eg, mycotic, fusiform, diffuse, and globular The mycotic aneurysm is caused by a septic embolus that weakens the wall of the vessel in which it lodges (page 727) The others are named for their predominant morphologic characteristics and consist of enlargement or dilatation of the entire circumference of the involved vessels, usually the internal carotid, vertebral, or basilar arteries The latter are also referred to as arteriosclerotic aneurysms, since they frequently show atheromatous deposition in their walls, but it is likely that they are at least partly developmental in nature Some are gigantic and press on neighboring structures or become occluded by thrombus; they rupture only infrequently (see further on) Clinical Syndrome With rupture of the aneurysm, blood under high pressure is forced into the subarachnoid space (usually in relation to the circle of Willis), and the resulting clinical events assume one of three patterns: (1) the patient is stricken with an excruciating generalized headache and vomiting and falls unconscious almost immediately; (2) headache develops in the same manner but the patient remains relatively lucid the most common syndrome; (3) rarely, consciousness is lost quickly with-. microsoft excel barcode font package Get Barcode Software - Microsoft Store
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