Effect of Headache on the Pathologic Findings of Unruptured Cerebral Saccular Aneurysms
Effect of Headache on the Pathologic Findings of Unruptured Cerebral Saccular Aneurysms
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头痛对未破裂脑囊动脉瘤病理结果的影响
DOI：
10.1016/j.wneu.2017.01.069
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发表时间：
2017
期刊：
影响因子：
2
通讯作者：
Houkin Kiyohiro
中科院分区：
文献类型：
--
作者：
Hokari Masaaki;Nakayama Naoki;Shimoda Yusuke;Houkin Kiyohiro
背景有些动脉瘤患者表现出警告性头痛而没有轻微出血，这可能是由于动脉瘤壁的拉伸引起的。最近，我们的病理学研究观察到内膜下纤维蛋白沉积在大多数破裂的动脉瘤。然而，在一些未破裂的动脉瘤中也观察到这些结果。在这份报告中，2个未破裂的动脉瘤显示内膜下纤维蛋白，有趣的是，其中一个病人在神经影像学检查前1个月内出现了严重的头痛。我们对未破裂的动脉瘤进行了病理分析，并收集了他们的各种临床变量，包括严重头痛，阐明“危险”未破裂动脉瘤的临床特征。方法本研究包括未破裂囊状动脉瘤样本（n= 17）在夹闭后被切除。我们比较了临床变量的差异，包括警告头痛，动脉瘤与纤维蛋白沉积和无fibrindeposition.Resultsfibrindeposition之间存在于内膜下层4例患者和4例患者的外膜。4例既往患者中有3例出现警告性头痛，1例出现动脉瘤生长。在后4例患者中，1例显示动脉瘤生长，而其他患者显示相对较大的动脉瘤。在其余的9个动脉瘤没有纤维蛋白沉积，单核细胞浸润，观察在一个，所有的动脉瘤都很小，没有病人经历过警告头痛或动脉瘤growth.ConclusionsSubintimal纤维蛋白沉积经常观察到的警告头痛的动脉瘤患者。这些病理结果在临床上是鼓舞人心的，可能表明这些动脉瘤表现出新形成的动脉瘤的快速拉伸，这可能导致早期破裂。
BackgroundSome patients with aneurysm exhibit warning headaches without minor bleeding, and this could be caused by stretching of the aneurysm wall. Recently, our pathologic study observed subintimal fibrin deposition in a majority of the ruptured aneurysms. However, these findings also were observed in some unruptured aneurysms. In this report, 2 unruptured aneurysms exhibited subintimal fibrin, and interestingly, one of the patients experienced severe headache within 1 month before neuroimaging.ObjectiveWe performed pathologic analysis of unruptured aneurysms and collected their various clinical variables, including severe headache, to clarify the clinical characteristics of “dangerous” unruptured aneurysms.MethodsThis study included unruptured saccular aneurysm samples (n= 17) that were resected after clipping. We compared the differences in clinical variables, including warning headache, between aneurysms with and without fibrin deposition.ResultsFibrin deposition was present in the subintimal layer in 4 patients and in the periouter membrane in 4 patients. Three of the 4 former patients experienced warning headaches, and one presented aneurysm growth. Of the latter 4 patients, one exhibited aneurysm growth, whereas the others presented with relatively large aneurysms. In the remaining 9 aneurysms without fibrin deposition, monocyte infiltration was observed in one, all aneurysms were small, and no patients experienced warning headaches or aneurysm growth.ConclusionsSubintimal fibrin deposition is observed frequently in patients with aneurysm with warning headaches. These pathologic findings are clinically inspiring and may suggest that these aneurysms exhibit rapid stretching by newly formed aneurysms, which can result in rupture at an early stage.