Rupture of a Middle Cerebral Artery Aneurysm 11 Years After Diagnosis Verification

Unruptured cerebral aneurysms are detected in 3–5% of the adult population. Aneurysm rupture results in intracranial hemorrhage, with a mortality rate of approximately 45% and disability in about 30% of cases. Risk assessment scales for rupture of unruptured aneurysms (UCAS, ISUIA, PHASES, UIATS, ELAPSS) were developed to guide treatment strategy; however, their practical application has revealed a systematically underestimation of hemorrhage risk. In particular, a meta-analysis of more than 1,500 cases of aneurysmal hemorrhage demonstrated that 50–80% of the observed aneurysms had initially been classified as low risk, indicating significant limitations of current rupture risk assessment tools and highlighting the need for the development of dynamic models to predict hemorrhage probability that account for changes in clinical status and aneurysm morphology over time. The presented clinical case of middle cerebral artery aneurysm management illustrates the necessity to transform current approaches to determining treatment strategies for unruptured aneurysms.