Document Detail

Intracranial aneurysms and arterial hypertension: a review and hypothesis.
MedLine Citation:
PMID:  10940419     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Intracranial aneurysms and systemic arterial hypertension coexist in a high percentage of patients. The relationship between intracranial aneurysms and hypertension is poorly defined. METHODS: Therefore, we reviewed the role of hypertension in the pathogenesis of saccular aneurysms as previously reported in clinical, experimental, and autopsy studies. RESULTS: Among 24 relevant clinical and/or autopsy studies, the mean incidence of pre-existing hypertension was 43.5% in aneurysm patients compared to 24.4% in the normal population. Although definitive evidence is lacking, data from multiple types of investigations indicate that systemic arterial hypertension creates a greater risk for the development of intracranial aneurysms than previously believed. The underlying pathophysiological mechanism(s) are also poorly defined. CONCLUSIONS: We propose a unifying hypothesis: Endothelial injury, occlusion of the vasa vasorum, and disruption of the synthesis of collagen and elastin are likely the most important factors in initiating the development of aneurysms. Chronic hypertension potentially affects all of these factors. Consequently, chronic hypertension may cause intimal thickening, necrosis of the tunica media, changes in the compositional matrix, and degeneration of the internal elastic lamina to develop in the arterial wall. These structural changes could cause a focal weakening in the arterial wall with resultant bulging. This theory accounts for the high incidence of intracranial aneurysms in the absence of any known associated hereditary or connective-tissue disease. Nor does it exclude the possibility of other etiological factors. From the perspective of prevention, however, it offers clear opportunities for prophylaxis.
S Inci; R F Spetzler
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Surgical neurology     Volume:  53     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2000 Jun 
Date Detail:
Created Date:  2000-09-07     Completed Date:  2000-09-07     Revised Date:  2010-03-23    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  530-40; discussion 540-2     Citation Subset:  IM    
Department of Neurosurgery, University of Hacettepe School of Medicine, Ankara, Turkey.
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MeSH Terms
Aged, 80 and over
Collagen / metabolism
Elastin / metabolism
Endothelium, Vascular / metabolism,  pathology
Hypertension / complications*
Intracranial Aneurysm / etiology*,  pathology
Middle Aged
Reg. No./Substance:
9007-34-5/Collagen; 9007-58-3/Elastin

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