Natural History

Much effort has focused on the natural history of intracranial aneurysms. Traditionally, the risk of rupture for the asymptomatic unruptured aneurysm has been estimated at 1.0-1.4% per year, with cumulative rates of rupture described as 10% at 10 years, 26% at 20 years, and 32% at 30 years. Recently, the rate of rupture of aneurysms less than 10 mm in diameter in patients without a history of other ruptured aneurysms was less than 0.05% per year. The rate for aneurysms less than 10 mm in diameter in those with a history of SAH from a separate aneurysm was 0.5% per year. The annual rupture rate of aneurysms that were 10 mm or larger in diameter was less than 1% per year in those with or without a prior history of SAH from a separate aneurysm.

Ruptured aneurysms have a very high risk of early and late rebleeding. Rebleeding often causes mortal injury and is associated with a 70% mortality rate. The risk of rebleeding is maximal in the first 24 hr (approximately 4%) and diminishes to 1 or 2% per day for the first 2 weeks. After the first month, the rate appears to stabilize at approximately 3% per year.

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