Intracranial infective aneurysms presenting with haemorrhage: An analysis of angiographic findings, management and outcome

AIM: This study is an analysis of angiographic findings in 17 patients with infective aneurysms who presented with intracranial haemorrhage and review s the management and outcome in the context of the existing literature. MATERIALS AND METHODS: A retrospective study of infective aneurysms in 17 p atients was carried out. Cranial angiography was performed in all patients. The location, size and outline of aneurysms were analysed, Ten patients we re managed conservatively and six patients underwent surgery for the ruptur ed infective aneurysms and mere followed up for a period of 35.8 months and 23 months, respectively. RESULTS: Twenty-two aneurysms were identified (five unruptured) in 17 patie nts, Twenty aneurysms (90.9%) were distal in location and two (9.1%) proxim al, Sixty percent were in the posterior circulation with 55% in the posteri or cerebral artery (PCA) territory, 27.3% in the middle cerebral artery (IL ICA) territory and 9.1% in the anterior cerebral artery (ACA) territory, F ourteen aneurysms were small (3-5 mm) and eight were medium sized (6-9 mm), 72.7% of aneurysms had irregular outline and 27.3% regular outline. Out of the 10 ruptured aneurysms managed conservatively, eight resolved. One pati ent died, presumably due to rebleed, and one had infarction due to parent v essel thrombosis, Six aneurysms were surgically managed with good results. Of the five unruptured aneurysms one was surgically managed and the remaini ng four conservatively managed patients did not bleed during follow-up. CONCLUSION: Patients with ruptured infective aneurysms fared well with medi cal management and the outcome in this series is better than that reported in literature. Patients on conservative management, however, need closer mo nitoring with angiographic follow-up. Active management is required with en larging or persisting aneurysms, Venkatesh, S. K. ct al. (2000). Clinical R adiology 55, 946-953. (C) 2000 The Royal College of Radiologists.