Clinical characteristics, computed tomography angiography patterns and associated complications of intracranial aneurysms among patients attending Muhimbili Orthopedic Institute

Abstract

ABSTRACT Background: Intracranial aneurysms, characterized by localized dilatation of the arterial wall in the brain, affect approximately 3% of the population and are a significant cause of non-traumatic subarachnoid hemorrhage.(1,2) This study, conducted at the Muhimbili Orthopedic Institute (MOI) in Tanzania, explored cerebral aneurysm patterns using computed tomography angiography (CTA), filling a critical gap in localized research. Findings revealed that aneurysms were more common in females (73.3%) and in those aged 50 and above (70%). Hypertension emerged as a key risk factor, present in 69.2% of cases. Most aneurysms were solitary (89.1%) and saccular (76.1%), with medium-sized aneurysms (5-10 mm) being the most prevalent. The anterior communicating artery (AComA) was the primary site, also associated with a heightened risk of rupture, especially as 47.9% of cases involved subarachnoid hemorrhage. This research highlights a need for targeted prevention strategies and tailored treatment protocols for patients at MOI, improving healthcare outcomes in Tanzania. As the first comprehensive study of its kind in this region, it sets a precedent for future research that can enhance patient management, reduce complications, and establish more precise treatment approaches for cerebral aneurysms in similar healthcare contexts. Objective: The aim of the study was to determine the clinical characteristics, radiological patterns, and associated complications of intracranial aneurysms among patients attending MOI with a diagnosis of intracranial aneurysm by CT angiography between January 2023 and April 2024 Methodology: The study was a hospital based retrospective cross-sectional study conducted at Muhimbili Orthopedic Institute. It was done by determining clinical presentation, the radiological patterns of intracranial aneurysms by using CTA and determining the factors associated with having an aneurysm and ruptured an. The sample was 71 patients 18 years and above who were suspected of having an ICA referred for CTA. A checklist was used to collect the demographics, clinical presentation of the study population. vi The CTA images were read, and findings were saved for analysis. In this study STATA version 27 was used for analysis. Results: The study recruited a total of 71 patients among these patients, 63% were females. The age range between 20 and 80 years with a mean of 52 years. Most of the patients were between 50 to 59 years. Most (73.2%) had hypertension. Forty-six (64.78%) had intracranial aneurysms and majority (73.3%) were female (p = 0.047). Solitary (89.1%), and saccular aneurysms (76.1%) were more common. Anterior communicating artery (ACOM) was the most common site for aneurysms (37%). A significant correlation was found between female gender and having an aneurysm (p value = 0.047). Also, Acom was the most common location with ruptured aneurysm compared to cavernous segment of ICA which showed non-rupturing despite being large. Conclusion: The study showed a significant predominance of females in the population with intracranial aneurysms (ICAs), emphasizing the necessity to investigate gender specific risk factors. Furthermore, the specific risk associated with the anterior communicating artery (ACOM) aneurysms, which are prone to rupture and cause subarachnoid hemorrhage despite their small size, underscores the importance of site specific considerations in the risk assessment and management of ICAs. These findings are crucial for refining clinical practices and guiding future research on the epidemiology and treatment of intracranial aneurysms. Recommendation: It is recommended to develop targeted screening programs for high-risk groups, particularly older adults and females, to detect intracranial aneurysms (ICAs) early. Given the higher rupture risk of small anterior communicating artery aneurysms, screening and monitoring should be prioritized in these cases.