By definition, an aneurysm is an abnormal dilatation of an artery (like a blister), i.e., a weak area in an arterial wall. The prevalence of brain aneurysms for adults without SAH is approximately 3.2%. Unruptured aneurysms have been diagnosed at an increasing rate in recent years as a result of the improving quality and growing use of noninvasive imaging techniques. Factors that increase the likelihood of aneurysm detection are familial risk (>2 first-degree relatives with a history of aneurysm), older age (> 30), female sex, cigarette smoking, history of hypertension, and higher lipid levels. MCA aneurysms constitute about 20% of all intracranial brain aneurysms and are the third most common cause of aneurysmal SAH.
Familial aneurysms most commonly involve the MCA. SAH tends to occur at a significantly younger age compared to patients with sporadic brain aneurysms. While deciding whether to treat an unruptured brain aneurysm, the benefits of treating the unruptured aneurysm must outweigh the potential risks. Therefore, factors that must be evaluated include possibility of rupture, whether the aneurysm is multi-lobed, wall irregularities (known as blebs), aneurysm location, and aneurysm size. Additional important factors include recent sentinel headache, tobacco use, high blood pressure, a history of familial rupture, and enlarging of the aneurysm over time.
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