Intracranial infective aneurysms presenting with haemorrhage: An analysis of angiographic findings, management and outcome

Aim: This study is an analysis of angiographic findings in 17 patients with infective aneurysms who presented with intracranial haemorrhage and reviews the management and outcome in the context of the existing literature. Materials and Methods: A retrospective study of infective aneurysms in 17 patients was carried out. Cranial angiography was performed in all patients. The location, size and outline of aneurysms were analysed. Ten patients were managed conservatively and six patients underwent surgery for the ruptured infective aneurysms and were followed up for a period of 35.8 months and 23 months, respectively. Results: Twenty-two aneurysms were identified (five unruptured) in 17 patients. Twenty aneurysms (90.9%) were distal in location and two (9.1%) proximal. Sixty percent were in the posterior circulation with 55% in the posterior cerebral artery (PCA) territory, 27.3% in the middle cerebral artery (MCA) territory and 9.1% in the anterior cerebral artery (ACA) territory. Fourteen aneurysms were small (3-5 mm) and eight were medium sized (6-9 mm). 72.7% of aneurysms had irregular outline and 27.3% regular outline. Out of the 10 ruptured aneurysms managed conservatively, eight resolved. One patient died, presumably due to rebleed, and one had infarction due to parent vessel thrombosis. Six aneurysms were surgically managed with good results. Of the five unruptured aneurysms one was surgically managed and the remaining four conservatively managed patients did not bleed during follow-up. Conclusion: Patients with ruptured infective aneurysms fared well with medical management and the outcome in this series is better than that reported in literature. Patients on conservative management, however, need closer monitoring with angiographic follow-up. Active management is required with enlarging or persisting aneurysms.