Intracranial aneurysms and arterial hypertension: A review and hypothesis

被引:98
作者
Inci, S
Spetzler, RF
机构
[1] Hacettepe Univ, Dept Neurosurg, Sch Med, TR-06100 Ankara, Turkey
[2] Barrow Neurol Inst, Phoenix, AZ 85013 USA
来源
SURGICAL NEUROLOGY | 2000年 / 53卷 / 06期
关键词
intracranial aneurysms; hypertension; pathogenesis;
D O I
10.1016/S0090-3019(00)00244-5
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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. (C) 2000 by Elsevier Science Inc.
引用
收藏
页码:530 / 540
页数:11
相关论文
共 124 条
[1]   ARE CEREBRAL ANEURYSMS ATHEROSCLEROTIC [J].
ADAMSON, J ;
HUMPHRIES, SE ;
OSTERGAARD, JR ;
VOLDBY, B ;
RICHARDS, P ;
POWELL, JT .
STROKE, 1994, 25 (05) :963-966
[2]   INTRACRANIAL ANEURYSMS - AGE, SEX, BLOOD-PRESSURE, AND MULTIPLICITY IN AN UNSELECTED SERIES OF PATIENTS [J].
ANDREWS, RJ ;
SPIEGEL, PK .
JOURNAL OF NEUROSURGERY, 1979, 51 (01) :27-32
[3]   CEREBRAL MACROANEURYSMS IN A GHANAIAN ADULT-POPULATION - AN AUTOPSY STUDY [J].
ANIM, JT .
ATHEROSCLEROSIS, 1985, 54 (01) :37-42
[4]  
ARTIOLA I, 1981, J NEUROSURG, V54, P26
[5]   CONNECTIVE-TISSUE ANALYSIS OF THE CANINE CIRCLE OF WILLIS IN HYPERTENSION [J].
BAGSHAW, RJ ;
BARRER, SJ ;
COX, RH .
NEUROSURGERY, 1987, 21 (05) :655-659
[6]   SYNDROME OF INTRACRANIAL ANEURYSM ASSOCIATED WITH FIBROMUSCULAR HYPERPLASIA OF RENAL ARTERIES [J].
BELBER, CJ ;
HOFFMAN, RB .
JOURNAL OF NEUROSURGERY, 1968, 28 (06) :556-&
[7]   COARCTATION OF ABDOMINAL-AORTA WITH ANEURYSM OF MIDDLE CEREBRAL-ARTERY [J].
BLIZNAK, J ;
BARGAINER, JD .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1974, 122 (01) :29-32
[8]   CEREBRAL ANEURYSM IN AN INFANT WITH FIBROMUSCULAR HYPERPLASIA OF RENAL-ARTERIES - CASE-REPORT [J].
BOLANDER, H ;
HASSLER, O ;
LILIEQUIST, B ;
WEST, KA .
JOURNAL OF NEUROSURGERY, 1978, 49 (05) :756-759
[9]   SUBARACHNOID HEMORRHAGE - EPIDEMIOLOGY, DIAGNOSIS, MANAGEMENT, AND OUTCOME [J].
BONITA, R ;
THOMSON, S .
STROKE, 1985, 16 (04) :591-594