Multiple Giant Aneurysms

Has anyone come across cases of multiple giant aneurysms, in middle aged adult patients, not HIV positive? I’ve seen a few recently, and am wondering whether this is a specific vasculopathic entity.

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3 Responses to Multiple Giant Aneurysms

  1. MCastillo MCastillo says:

    My best thoughts are that your patient probably has an underlying collagen vascular disease either acquired or congenital. Some neurocutaneous syndromes may also be associated with unusual aneurysms. An unrecognized immune deficiency may result in infections, such as fungi (see the books by Lasjaunias) which may lead to development of fusiform aneurysms. Multiple dissections are rare (deficiency of neural crest cells?) as are multiple blood blister like aneurysms. Vascular ectasia with HIV is generally seen in children.

  2. Willem Jan van Rooij says:

    In our database of 1350 coiled intracranial aneurysms I could find 5 patients with more than 1 aneurysm larger than 10 mm (thus not even giants). In all 5 patients the aneurysms were located on both carotid arteries (ophthalmic and cavernous segments). All patients were HIV negative. Patients with multiple large (giant) aneurysms are thus extremely rare. Whether or not this is a specific vasculopathic entity is of little clinical importance. Any theories like the one from Bicetre are just speculations not supported by facts. Many patients with intracranial aneurysms have more than one aneurysm (around 25%), small, large or giant that is probably a different coincidental expression of the same entity.

  3. tkrings says:

    Despite the respectable number of coiled aneurysms presented by Van Rooij, patient populations between the St. Elisabeth hospital in Tilburg and both the University Hospitals of Toronto (TWH) and Paris (Bicetre) seem to be different. Experiences and the decision as to what is of “clinical importance” derived from those different patient populations will naturally differ, too. No group that presents large numbers or groups that present hypotheses are to be condemned solely on the fact of their different approach towards the advancement of science. Sentences such as “Any theories like the one from Bicetre are just speculations not supported by facts”, should be used more cautiously in a scientific forum.

    Concerning the specific question at hand, in our data bank at the TWH in Toronto encompassing 1917 patients with intracranial aneurysms we have 147 patients with (true) giant aneurysms, and four patients in whom the giant aneurysms were multifocal – when also taking into account those that measure >10mm, the number rises to 15. Interestingly, they all exhibit similar features including: rim like contrast enhancement, perifocal edema, onion-skin layering of the intramural hematoma and bleeding sites distant from the perfused lumen, similar to our experience with the 23 giant aneurysms seen in the CHU Bicetre (which is why we think that these aneurysms are not the “same entity” as “classical saccular aneurysms” and why we think that other treatment strategies may have to be contemplated making this distinction a clinically important one).

    Although simplicity is beautiful, it may not always add new insights, since advances in our understanding of diseases are not always derived from large numbers but via observational studies, hypotheses and theories.

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