Talk:Intracranial aneurysm

Picture caption error
There looks to be some sort of error on the main picture caption. Something concerning the "Lua" or something. Under the "Specialty" header, it says: "Lua error: bad argument #1 to 'find' (string expected, got nil)." --MrMineHeads (talk) —Preceding undated comment added 00:37, 24 January 2019 (UTC)

note
this article was cut and pasted word for word from Kingturtle 03:18 May 2, 2003 (UTC)

No it wasn't. 1) The page was cut and pasted and then modified. 2) This text appears on the page: "All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated." Hence, no copyright violation. Lukobe

Wikified and Vasospasm Edits
--Felgerkarb 22:57, 17 June 2006 (UTC)
 * Added headers, restructured a little.
 * Changed the rupture rate number. This is a complex issue. I think the 4% per year is more appropriate for AVM's rather than aneurysms. The rate varies widely with aneurysm size, and I think it would be appropriate to go into that further. The bottom line is that any aneurysm, however small, can rupture, that is why at our institution we don't stratify by size, we just quote 1.3% per year.
 * Vasospasm: Big topic, I only touched upon it a little. Triple-H therapy is contentious these days, though everyone agrees that hypotension is bad.
 * Citations: I honestly intended to site, linking to PubMed, but for some reason the PubMed server doesn't seem to be working right now. Sorry

Treatment
Removed 'fewer risks' for coiling of cerebral aneurysms, as this isn't entirely accurate. Coiling has a set of different risks, and perhaps fewer minor complications. The stroke rate (major complication) is similar to clipping, though with a statistically insignificant trend to fewer complications. The complication rate is also dependent on age. Further, I assume you were talking about peri-procedural complications. The data, while promising, is still not conclusive that coiling has a lower long term complication/recurrence/rebleed rate than clipping. Basically, I didn't want someone reading this and thinking it is a 'slam dunk' that coiling is better than clipping.Felgerkarb 20:28, 26 October 2006 (UTC)


 * I believe the User:Nus1937 made a common error in conflating the aneurysm recurrence rate with the aneurysm rebleed rate. The data clearly shows a higher recurrence rate with coiling, and the higher rate of aneurysm retreatment. What the data does not show, somewhat counterintuitively, is a difference in the rate of recurrent hemorrhage after coiling vs. clipping. I corrected the error, and, in fact, one of the citations he quoted makes this point (Campi et al 2007). I also formatted the citations.

I also removed the following as being POV:

'At present it appears that only older patients with aneurysms that are difficult to reach surgically are more likely to benefit from endovascular coiling.'

The data suggests that older patients do better with coiling than clipping, but that does not translate into younger patients doing worse with coiling vs. clipping. As the OP mentions, the complication rates are equivalent between the two procedures (with a trend towards lower major complications in coiling) --Felgerkarb 20:42, 6 August 2007 (UTC)

Not sure why, but the rebleed/recurrence problem got back in, this time citing an editorial page in a neurosurgery journal. The data as of 2010 still shows no significant difference in rebleed rates between coiled and clipped aneurysms after 30 days. Also, the treatment section failed to mention the persistently lower mortality rate (7%) in subarachnoid patients treated with coiling versus clipping.

I think if it keeps coming back in, we might have to consider an NPOV flag, as it isn't supported by the data. No one would dispute a higher recurrence rate, and some might logically think that this means a higher re-bleed rate, but it just shows how little we understand about the physiology of aneurysms and aneurysm rupture when we see that the data does not show such a relationship. Why is there a POV issue? In the US at least, there is somewhat of a 'turf war' over the treatment of aneurysms between people who advocate surgical treatment and endovascular treatment. Not as much of an issue in Europe. I don't have linkage, but there was a great Lancet study which noted that in Europe, the treatment modality was determined by the aneurysm characteristics, but in the US it had more to do with what kind of doctor first saw you.

Felgerkarb (talk) 17:42, 18 March 2010 (UTC)

The section headed 'Medical Hypotensive Therapy' badly needs sources and a review by someone familiar with the field. —Preceding unsigned comment added by 98.129.220.162 (talk) 07:15, 20 June 2010 (UTC)

I have to agree, also, while I am a little leery of the section. Especially it reads much like a grammatically superior example of my spam inbox in parts, it may not be unfounded, I managed to dig up 3 articles that mention it with some relation to aneurysms, however 2 of them are from the same person credited in the article. I'll leave it to someone more qualified to decide what's applicable and where:

[http://www.ncbi.nlm.nih.gov/pubmed/9309283 Unexpected results in long-term medically treated ... [Acta Neurochir (Wien). 1997 ] ]

RESULTS OF HYPOTENSIVE THERAPY IN ARTERIAL HYPERTENSION [British Medical Journal 1961 ]

[http://www.ncbi.nlm.nih.gov/pubmed/7102386 Symptomatic unruptured giant aneurysms: medical tr... [Acta Neurochir (Wien). 1982 ] ]

--NJ (talk) 00:21, 12 August 2011 (UTC)

Prognosis
I'd like to request public opinion on whether it is accurately to say "Generally, about two thirds of patients have a poor outcome, death or permanent disability...". Lots of people with loved ones in critical condition read this, whethere it gives or takes hope from them. We need quotation!


 * Done. The most recent article notes a general decline in mortality rates, but doesn't comment on any change in the proportion of patients who survive with severe disability. Unfortunately, aneurysmal subarachnoid hemorrhage is still a very bad thing. Felgerkarb 18:55, 7 May 2007 (UTC)

Rated the Page
I added a ranking to the page. I rated it as a | Start Class on the quality scale. Its a start due to it uses many large words that wouldn't be understandable to the general public. I also rated it as a | Mid Importance article on the Importance scale. Aaron5367 01:56, 30 October 2007 (UTC)

Grading
Citations would be very helpful here. Is the survivability of "Instant Death" (Grade 6) really 4%? —Preceding unsigned comment added by 142.177.56.164 (talk) 02:27, 26 February 2009 (UTC)

This is odd to me. Grade 6 is by definition death, so there should be no survivability. If someone graded you as a 6, and you survived, you were 'mis-diagnosed' as dead, as it were. Tried to clear this up in the text.

Felgerkarb (talk) 17:46, 18 March 2010 (UTC)

Benefits and Risks
Has anyone else noticed the odd little comments in parenthesis in the benefits and risks section? 128.192.51.127 (talk) 18:05, 24 February 2010 (UTC)

Photo caption needs help
Will the person who posted the photo with the aneurysm and coils ("A resected MCA aneurysm with multiple coils.") please edit the caption to explain to us lay people exactly what the heck we are seeing here? To be honest, it looks more like a fur ball on the carpet than a resected artery.

Thanks for help me out here, Wordreader (talk) 21:45, 2 October 2011 (UTC)

This is a terrible picture and should probably be removed. Most of the strands you see leaving the "fur ball" are streched coils which is not what they look like when they are placed into an aneurysm (unless something went terribly, terribly wrong). 129.112.109.41 (talk) 18:08, 24 July 2014 (UTC)

Detection?
Can these things be detected before they break, such as with an MRI? — Preceding unsigned comment added by 70.120.93.186 (talk) 08:25, 14 February 2012 (UTC)

Rename to intracranial aneurysm?
Cerebral aneurysm is not really accurate as the aneurysm is not of the cerebrum but of an artery. The most accurate description would be intracranial arterial aneurysm, but intracranial aneurysm is more commonly used. On google cerebral aneurysm is a little more common than intracranial aneurysm, but on pubmed intracranial aneurysm outnumbers cerebral aneurysm by a factor 10:1. Should we rename? --WS (talk) 13:11, 27 February 2013 (UTC)
 * Support. Intracranial aneurysms is more specific. LT90001 (talk) 06:05, 28 July 2013 (UTC)
 * Ok, did the move. --WS (talk) 06:45, 29 July 2013 (UTC)

Symptoms before rupture
In the article for aneurysms in general, the signs and symptoms section lists symptoms for before the intracranial aneurysm has ruptured as well as after. This article mentions only the symptoms experienced after it has ruptured. Should both be included? — Preceding unsigned comment added by 153.162.161.140 (talk) 11:19, 29 July 2013 (UTC)
 * Done.Separating symptoms allows reference to the main article (Subarachnoid hemorrhage) instead of duplicating all possible neurological symptoms in their entirety.LT90001 (talk) 12:17, 29 July 2013 (UTC)

Use of 'saccular' aneurysm
The term 'saccular aneurysm' has been used in this article because, despite the commonly used vernacular 'berry aneurysm', 'saccular aneurysm' is more technically correct, and more consistent with the morphological description of aneurysms in other locations. LT90001 (talk) 09:14, 30 July 2013 (UTC)

Merge from Fusiform and dolichoectatic aneurysms
Suggest merging content from fusiform and dolichoectatic aneurysms into the pathophysiology section of this atricle. Thoughts? LT90001 (talk) 06:04, 28 July 2013 (UTC)
 * Done. LT90001 (talk) 09:10, 30 July 2013 (UTC)

Merge Intracranial berry aneurysm
Intracranial berry aneurysm is what is usually meant with cerebral aneurysm and the article overlaps for 90% with this article, so I would suggest merging it. --WS (talk) 13:11, 27 February 2013 (UTC)
 * Support. Berry aneurysms are a form of cerebral aneurysm, so it makes sense to have them on the same page and reduce duplication. LT90001 (talk) 06:06, 28 July 2013 (UTC)
 * Done. Now that these articles are all in one place, it is time to focus on the article's general quality and sources. LT90001 (talk) 09:11, 30 July 2013 (UTC)

Merge Charcot-Bouchard aneurysms
While other articles are being merged, I don't see why Charcot-Bouchard aneurysms can't also be merged into this article. LT90001 (talk) 12:22, 30 July 2013 (UTC)
 * Don't know about that one, although they are technically intracranial aneurysm, they are very distinct in many ways and are not what is usually referred to as intracranial aneurysm. Trying to merge that could cause confusion to readers. Maybe it is better to briefly mention them and then link to the main article? --WS (talk) 14:11, 30 July 2013 (UTC)
 * The majority of intracranial hemorrhages are the two mentioned (saccular, fusiform), and you point out the synonymous use of the terminology intracranial to mean saccular. On the other hand, I feel it's a dichotomy to incorporate not incorporate C-B microaneurysms into this article which already aggregates two distinct aneurysms fusiform (HTN-related, ischaemic stroke) and saccular (congenital, CoW, hemorrhagic stroke). On balance, given that C-B can be considered a rarer pathology and the exception rather than the rule, it might be better to maintain these as separate articles for now and consider merging at a later date. LT90001 (talk) 04:07, 1 August 2013 (UTC)

Review on fluid dynamics and inflammation
Circulation 10.1161/CIRCULATIONAHA.113.001444 JFW &#124; T@lk  14:52, 21 January 2014 (UTC)