Neurocritical Care

, Volume 2, Issue 2, pp 119–123 | Cite as

Ruptured intracranial aneurysms in the elderly

Epidemiology, diagnosis, and management
  • Jacques Sedat
  • Mustapha Dib
  • David Rasendrarijao
  • Denys Fontaine
  • Michel Lonjon
  • Philippe Paquis
Review Article


Spontaneous subarachnoid hemorrhage (SAH) is often a devastating condition and a significant cause of worldwide morbidity and mortality. Because the percentage of senior citizens is increasing in many countries and because of the increased incidence of SAH in elderly patients, ruptured intracranial aneurysm is an increasingly frequent pathology in western countries. Twenty years ago, older people were considered to have such a poor prognosis that they were frequently excluded from active treatment on the unique basis of their advanced age. Improving results published in recent studies showed that the classic fatalistic attitude associated with age and intracranial aneurysm (IA) should be reconsidered. Therefore, because of improvements in surgical results and neuro-intensive care, the appearance of interventional neuroradiology, and more aggressive rehabilitation programs, the management of ruptured IA in the elderly is changing. This article aims to review epidemiology, emphasize the specific aspects of the disease in the elderly, and present the current management of SAH in an elderly population.

Key Words

Subarachnoid hemorrhage intracranial aneurysm elderly 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Rinkel GJ, Djibuti M, Algra E. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998;29:251–256.PubMedGoogle Scholar
  2. 2.
    Iwamoto H, Kiyohara Y, Fujishima M. Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period: the Hisayama Study. Stroke 1999;30:1390–1395.PubMedGoogle Scholar
  3. 3.
    Chason JL, Hindman WM. Berry aneurysms of the circle of Willis: results of a planned autopsy study. Neurology 1958;8:41–44.PubMedGoogle Scholar
  4. 4.
    Inagawa T, Hirano A. Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 1990;34:361–365.PubMedCrossRefGoogle Scholar
  5. 5.
    Winn HR, Jane JA, Tailor J. Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms. J Neurosurg 2002;96:43–49.PubMedCrossRefGoogle Scholar
  6. 6.
    Sekhar LN, Heros RC. Origin, growth, and rupture of saccular aneurysms: A review. Neurosurgery 1981;8:248–260.PubMedCrossRefGoogle Scholar
  7. 7.
    Ingall T, Asplund K, Mahonen M. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke 2000;31:1054–1061.PubMedGoogle Scholar
  8. 8.
    Linn FH, Rinkel GJ, Algra A. Incidence of SAH. Role of region, year, and rate of computed tomography: a meta-analysis. Stroke 1996;27:625–629.PubMedGoogle Scholar
  9. 9.
    Fridriksson SM, Hillman J, Saveland H. Intracranial aneurysm surgery in the 8th and 9th decades of life: impact on population-based management outcome. Neurosurgery 1995;37:627–635.PubMedCrossRefGoogle Scholar
  10. 10.
    Inagawa T. What are the actual incidence and mortality rates of subarachnoid hemorrhage? Surg Neurol 1997;47:47–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Yamashita K, Kashiwagi S, Kato S. Cerebral aneurysms in the elderly in yamaguchi, Japan; Analysis of the Yamaguchi data Bank of cerebral aneurysm from 1985 to 1995. Stroke 1998;28:1926–1933.Google Scholar
  12. 12.
    Phillips LH II, Whisnant JP, O’Fallon WM. The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 1980;30:1034–1040.PubMedGoogle Scholar
  13. 13.
    Sacco RL, Wolf PA, Bharucha NE. Subarachnoid and intracranial hemorrhage: Natural history, prognosis, and precursive factors in the Framingham study. Neurology 1984;34:847–854.PubMedGoogle Scholar
  14. 14.
    Bonita R, Thomson S. Subarachnoid hemorrhage: epidemiological, diagnosis, management and outcome. Stroke 1985;16:591–594.PubMedGoogle Scholar
  15. 15.
    Ohkuma H, Fujita S, Suzuki S. Incidence of Aneurysmal Subarachnoid Hemorrhage in Shimokita, Japan, From 1989 to 1998. Stroke 2002;33:195–199.PubMedCrossRefGoogle Scholar
  16. 16.
    Inagawa T, Yamamoto M, Kamiya K. Ogasawara H: Management of elderly patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 1988;69:332–339.PubMedGoogle Scholar
  17. 17.
    Longstreth WT Jr, Nelson LM, Koepsell TD. Subarachnoid hemorrhage and hormonal factors in women: a population-based case control study. Ann Intern Med 1994;121:168–173.PubMedGoogle Scholar
  18. 18.
    Schieving WI, Wijdicks EFM, Parisi JE. Sudden death from aneurysmal subarachnoid hemorrhage. Neurology 1995;45:871–874.Google Scholar
  19. 19.
    Huang J, Van Gelder JM. The probability of sudden death from rupture of intracranial aneurysms: a meta-analysis. Neurosurgery 2002;51:1101–1107.PubMedCrossRefGoogle Scholar
  20. 20.
    Sedat J, Dib M, Lonjon M. Endovascular treatment of ruptured intracranial aneurysms in patients over 65 years: follow-up after one year of 52 patients. Stroke 2002;33:2620–2625.PubMedCrossRefGoogle Scholar
  21. 21.
    Lanzino G, Kassell NF, Germanson TP. Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg 1996;85:410–118.PubMedCrossRefGoogle Scholar
  22. 22.
    Inagawa T. Management outcome in the elderly patient following subarachnoid hemorrhage. J Neurosurg 1993;78:554–561.PubMedGoogle Scholar
  23. 23.
    Kassel NF, Torner JC, Jane JA. The international cooperative study on the timing of aneurysm surgery: Part 1—overall management results. J Neurosurg 1990;73:18–36.Google Scholar
  24. 24.
    Pinsker MO, Gerstner W, Wolf S. Surgery and outcome for aneurysmal subarachnoid hemorrhage in elderly patients. Acta Neurochir Suppl 2002;82:61–64.PubMedGoogle Scholar
  25. 25.
    Chung RY, Carter BS, Norbash A. Management Outcomes for Ruptured and Unruptured Aneurysms in the Elderly. Neurosurgery 2000;47:827–833.PubMedCrossRefGoogle Scholar
  26. 26.
    Hutter BO, Gilsbach JM. Which neuropsychological deficits are hidden behind a good outcome (Glasgow=1) after aneurysmal subarachnoid hemorrhage? Neurosurgery 1993;33:999–1005.PubMedCrossRefGoogle Scholar
  27. 27.
    Vollmer DG, Torner JC, Jane JA. Age and outcome following traumatic coma: why do older patients fare worse. J Neurosurg 1991;75(Suppl):S37-S39.Google Scholar
  28. 28.
    Taylor CL, Yuan Z, Selman WR. Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors. J Neurosurg 1995;83:812–819.PubMedGoogle Scholar
  29. 29.
    Lann Q, Ikeda H, Jimbo H. Considerations on surgical treatment for elderly patients with intracranial aneurysms. Surg Neurol 2000;53:231–238.CrossRefGoogle Scholar
  30. 30.
    Inagawa T. Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien) 1990;106:119–126.CrossRefGoogle Scholar
  31. 31.
    Pleizier CM, Ruigrok YM, Rinkel GJE. Relation between age and number of aneurysms in patients with subarachnoid haemorrhage. Cerebrovasc Dis 2002;14:51–53.PubMedCrossRefGoogle Scholar
  32. 32.
    Juvela S. Risk Factors for Multiple Intracranial Aneurysms. Stroke 2000;31:392–397.PubMedGoogle Scholar
  33. 33.
    Anderson GB, Steinke DE, Petruk KC. Computed tomographic angiography versus digital substraction angiography for the diagnosis and early treatment of ruptured intracranial aneurysms. Neurosurgery 1999;45:1315–1320.PubMedCrossRefGoogle Scholar
  34. 34.
    Qureshi AI, Suarez JI, Parekh PD. Risk factors for multiple intracranial aneurysms. Neurosurgery 1998;43:22–27.PubMedCrossRefGoogle Scholar
  35. 35.
    Kaminogo M, Yonekura M, Shibata S. Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke 2003;34:16–22.PubMedCrossRefGoogle Scholar
  36. 36.
    Kashiwagi S, Yamashita K, Kato S. Elective neck clipping for unruptered aneurysms in elderly patients. Surg Neurol 2000;53:14–20.PubMedCrossRefGoogle Scholar
  37. 37.
    Sakaki S, Ohta S, Ohue S. Outcome in elderly patients with ruptured intracranial aneurysm. Clin Neurol Neurosurg 1989;91:21–27.PubMedCrossRefGoogle Scholar
  38. 38.
    Yano S, Hamada J, Kai Y. Surgical indications to maintain quality of life in elderly patients with ruptured intracranial aneurysms. Neurosurgery 2003;52:1010–1016.PubMedCrossRefGoogle Scholar
  39. 39.
    Mayfrank L, Hutter BO, Kohorst Y. Influence of intraventricular hemorrhage on outcome after rupture of intracranial aneurysm. Neurosurg Rev 2001;24:185–191.PubMedCrossRefGoogle Scholar
  40. 40.
    Vermeij FH, Hasan D, Vermeulen M. Predictive factors for deterioration from hydrocephalus after subarachnoid hemorrhage. Neurology 1994;44:1851–1855.PubMedGoogle Scholar
  41. 41.
    Yoshioka H, Inagawa T, Tokuda Y. Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage. Surg Neurol 2000;53:119–125.PubMedCrossRefGoogle Scholar
  42. 42.
    Dorai Z, Hynan LS, Kopitnik TA. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 2003;52:763–771.PubMedCrossRefGoogle Scholar
  43. 43.
    May C, Kaye JA, Atack JR. Cerebrospinal fluid production is reduced in healthy aging. Neurology 1990;40:500–503.PubMedGoogle Scholar
  44. 44.
    Pang D, Sclabassi RJ, Horton JA. Lysis of intraventricular blood clot with urokinase in a canine model: Part 3—effects of intraventricular urokinase on clot lysis and posthemorrhagic hydrocephalus. Neurosurgery 1986;19:553–572.PubMedCrossRefGoogle Scholar
  45. 45.
    Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid haemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980;6:1–19.PubMedCrossRefGoogle Scholar
  46. 46.
    Inagawa T. Cerebral vasospasm in elderly patients with ruptured intracranial aneurysms. Surg Neurol 1991;36:91–98.PubMedCrossRefGoogle Scholar
  47. 47.
    Torbey MT, Hauser TK, Bhardwaj A. Effect of age on cerebral blood flow velocity and incidence of vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 2001;32:2005–2011.PubMedGoogle Scholar
  48. 48.
    Charpentier C, Audibert G, Guillemin F. Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke 1999;30:1402–1408.PubMedGoogle Scholar
  49. 49.
    Artiola L, Fortuny I, Adams CBT. Surgical mortality in an aneurysm population: effects of age, blood pressure and preoperative neurological state. J Neurol Neurosurg Psychiatry 1980;43:879–882.Google Scholar
  50. 50.
    Ishii R. Regional cerebral blood flow in patients with ruptured intracranial aneurysms. J Neurosurg 1979;50:587–594.PubMedGoogle Scholar
  51. 51.
    Meyer E, Low D, Meyer M. Subarachnoid haemorrhage: older patients have low cerebral blood flow. Br Med J 1982;285:1149–1153.Google Scholar
  52. 52.
    Ellenbogen B. Subarachnoid hemorrhage in the elderly. Gerontol Clin 1970;12:115–120.CrossRefGoogle Scholar
  53. 53.
    Johansson M, Cesarini KG, Contant CF. Changes in Intervention and outcome in Elderly Patients with Subarachnoid Hemorrhage. Stroke 2001;32:2845–2949.PubMedGoogle Scholar
  54. 54.
    Hamada J, Hasegawa S, Kai Y. Surgery and long-term outcome for ruptured anterior circulation aneurysms in patients in their ninth decade of life. Surg Neurol 1999;52:123–127.PubMedCrossRefGoogle Scholar
  55. 55.
    Takeuchi J: Aneurysm surgery in patients over the age of 80 years. Br J Neurosurg 1993;7:307–309.PubMedGoogle Scholar
  56. 56.
    Stachniak JB, Layon AJ, Day AI. Craniotomy for intracranial aneurysm and subarachnoid hemorrhage. Stroke 1996;27:276–281.PubMedGoogle Scholar
  57. 57.
    Raaymakers TWM, Rinkel GJE, Limburg M, et al. Mortality and morbidity of surgery for unruptured intracranial aneurysms. A meta-analysis. Stroke 1998;29:1531–1538.PubMedGoogle Scholar
  58. 58.
    Chyatte D, porterfield R. functional outcome after repair of unruptured intracranial aneurysms. J Neurosurg 2002;96:159,160.Google Scholar
  59. 59.
    Gress DR. Surgery for unruptured aneurysms. J Neurosurg 2002 Jan;96:159,160.PubMedGoogle Scholar
  60. 60.
    Khanna RK, Malik GM, Qureshi N. Predicting outcome following treatment of unruptured intracranial aneurysms: a proposed grading system. J Neurosurg 1996;84:49–54.PubMedGoogle Scholar
  61. 61.
    The International Study of Unruptured Intracranial Aneurysms Investigators: unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 1998;339:1725–1733.Google Scholar
  62. 62.
    Kobayashi M, Takayama H, Suga S. Changes in proton magnetic resonance spectroscopy and Wechsler adult intelligence scale revised after clipping of unruptured aneurysms. No Shinkei Geka 2000;28:691–698.PubMedGoogle Scholar
  63. 63.
    Guglielmi G, Vinuela F, Sepetka I. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: electrochemical basis, technique, and experimental results. J Neurosurg 1991;75:1–7.PubMedGoogle Scholar
  64. 64.
    Guglielmi G, Vinuela F, Dion J. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 1991;75:8–14.PubMedGoogle Scholar
  65. 65.
    Molyneux A, Kerr R, Stratton I. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms. A randomised trial. Lancet 2002;360:1267–1274.PubMedCrossRefGoogle Scholar
  66. 66.
    Rowe JG, Molyneux AJ, Byrne JV. Endovascular treatment of intracranial aneurysms: a minimally invasive approach with advantages for elderly patients. Age Ageing 1996;25:372–376.PubMedCrossRefGoogle Scholar
  67. 67.
    Hamada J, Morioka M, Miura M. Management outcome for ruptured anterior circulation aneurysms with a Hunt and Hess clinical grade of III in patients in the 9th decade of life. Surg Neurol 2001;56:294–300.PubMedCrossRefGoogle Scholar
  68. 68.
    Sawada M, Kaku Y, Hayashi K. Endovascular treatment of ruptured intracranial aneurysms using platinum coils in patients over 70 years of age. Interv Neuroradiol 2000;6:85–88.PubMedGoogle Scholar
  69. 69.
    Matsumoto Y, Ezura, M, Furui E. Endovascular treatment of ruptured intracranial aneurysms in patients aged over 90 years. Seventh Congress of the World Federation of Interventional and Therapeutic Neuroradiology Nov 2003; Recife, Brazil. [Abstract n30].Google Scholar

Copyright information

© Humana Press Inc. 2005

Authors and Affiliations

  • Jacques Sedat
    • 1
  • Mustapha Dib
    • 1
  • David Rasendrarijao
    • 2
  • Denys Fontaine
    • 2
  • Michel Lonjon
    • 2
  • Philippe Paquis
    • 2
  1. 1.Unité de Neuroradiologie InterventionnelleCHUNiceFrance
  2. 2.Service de NeurochirurgieCHU NiceFrance

Personalised recommendations