Brain aneurysms are more likely to rupture if they are growing even if they are small, a new study in Radiology reports. Aneurysms of 7 mm or more are the size where the benefits of treatment generally outweigh the risks of rupture, based on earlier studies. This had been interpreted that size alone is determinative of rupture risk. But ones that grow in size over time are at even greater risk for rupture, regardless of size. This means that all aneurysms of any size need to be followed. If they are growing, then treatment needs to be considered. Monitoring can be done by annual CT examination which is readily available and not cost prohibitive.
There are approximately 30,000 brain aneurysm ruptures a year, and the death rate is 70%. With such catastrophic statistics, it is important to identify those aneurysms at most risk of rupture and treating them before that can happen. For those that do not suffer a fatal rupture, the neurological injury and subsequent permanent disability can be devastating. Aneurysms are often identified incidentally when scanning for something else. Of all asymptomatic aneurysms looked at in this study, about 20% showed growth over time. This rate of growth was much higher than expected. The rupture rate for a growing aneurysm was 2.4% per patient year, compared with 0.2% rupture rate for those without growth. When growth is present, there is a 12 fold increased risk of rupture.
Britcher Leone & Roth understand the importance of looking for and making accurate diagnoses of cerebral aneurysms that show themselves on CT and MRI brain exams while they are still symptomatic. Missing an aneurysmal dilatation of a cerebral artery on an imaging study is one type of radiological malpractice that can occur. Failure of ER physicians to appreciate the clinical history of a headache and/or stiff neck caused small sentinel bleed in a patient prior to complete rupture is example of emergency room malpractice that can lead to missed diagnoses. Only a careful examination of the medical facts can determine if the devastation of a neurologic event could have been prevented.