From the Guidelines
Acom aneurysm rupture typically presents with sudden, severe headache, nausea, vomiting, photophobia, neck stiffness, and altered mental status, and prompt recognition is critical as early intervention significantly improves outcomes. The clinical features of Acom aneurysm rupture can be varied, but common presentations include:
- Sudden, severe headache often described as the "worst headache of my life"
- Nausea and vomiting
- Photophobia
- Neck stiffness
- Altered mental status ranging from confusion to coma
- Focal neurological deficits, including vision changes, weakness, or cranial nerve palsies
- Memory impairment, particularly short-term memory loss, due to the aneurysm's proximity to structures involved in memory formation 1
- Behavioral changes, confabulation, or personality alterations
- Meningeal irritation signs like nuchal rigidity
- Seizures, hydrocephalus, or cardiac arrhythmias due to autonomic dysfunction in severe cases
- Elevated blood pressure as a compensatory mechanism The diagnosis is confirmed with CT scan showing subarachnoid blood, followed by CT angiography or conventional angiography to precisely locate the aneurysm, as recommended by the American Heart Association/American Stroke Association guideline for the management of patients with aneurysmal subarachnoid hemorrhage 1. Treatment involves securing the aneurysm via endovascular coiling or surgical clipping to prevent rebleeding, which carries high mortality, and the choice of treatment should be determined by specialist(s) with endovascular and surgical expertise to determine the relative risks and benefits of surgical or endovascular treatment according to patient and aneurysm characteristics 1.
From the Research
Clinical Features of ACOM Aneurysm Rupture
- ACOM aneurysms are the most frequently occurring type of ruptured intracranial aneurysms 2
- Rupture of ACOM aneurysms can lead to subarachnoid hemorrhage, which can be complicated by cerebral vasospasm and resultant ischemia, causing neurological deficit 3
- Clinical outcomes and complications of ruptured ACOM aneurysms can vary depending on the treatment modality, with some studies suggesting no significant difference in outcomes between clipping and coiling 4, 5
Treatment Options for ACOM Aneurysm Rupture
- Clipping and coiling are two common treatment options for ruptured ACOM aneurysms, with the choice of treatment depending on various factors such as aneurysm morphology and patient demographics 4, 5
- Some studies suggest that clipping may be associated with a lower risk of recurrence compared to coiling 5
- Accurate understanding of anatomic variations and proper imaging studies are essential for the treatment of complex aneurysms like ACOM aneurysms 6
Complications of ACOM Aneurysm Rupture
- Cerebral vasospasm is a common complication of subarachnoid hemorrhage due to ACOM aneurysm rupture, which can lead to ischemia and neurological deficit 3
- Recurrence of ACOM aneurysms is a potential complication of treatment, with some studies suggesting a higher risk of recurrence with coiling compared to clipping 5
- Other complications of ACOM aneurysm rupture include infarction, CSF diversion, and rebleed, although the rates of these complications may not differ significantly between clipping and coiling 5