1. Venous Hypertension and Intracranial Aneurysm Rupture Fong Y Tsai,* Andrew Yen*, Wan-You Guo**Chin C Wu** *UC Irvine Medical Center, Orange,Ca ** Taipei Veterans General Hospital,Taipei,Taiwan

2. Risks of Rupture Cerebral Aneurysm 1) Size and site: No difference in size, posterior fossa and posterior communicating and PCA more likely rupture, 2) Configuration: lobulation 3) Smoking, hypertension 4) Wall shear stress and tension 5) Hemodynamic patterns 6) Flow patterns: hemodynamic profile

3. Risks of ruptured Cerebral Aneurysm Hemodynamic profiles: 1)Flow patterns: Intraneurysmal flow 2)Jet wave: ruptured aneurysm with small jet size 3)Impingment region:Dome,body,neck, ruptured with small impingement zone 4)Geometry of aneurysm

4. Asymmetry Dural Sinus Potential factor: venous hypertension from asymmetrical dural sinus

5. Materials:Retrospective 193 patients: 131 females and 62 males Age ranged from 15 to 90 in female and 26 to 81 in males 140 had ruptured aneurysm 87 of 140 had venous asymmetry Females: 60 of 91 ruptured aneurysm had venous asymmetry Males: 27 of 49 ruptured aneurysm had venous asymmetry

6. Case Presentation Case 1 57/F presented with worse headache of life with clinical Grade 2 SAH

10. Case Presentation Case 2 53/M presented with recurrent headache, negative neural examinations

14. Case Presentation Case 3 37/M recurrent headache

18. Case Presentation Case 4 66/F presented with severe headache and grade 2 clinically

19. 66/F Severe Headache stage 2 clinically

22. Venous Pressure Measurement By MRI Phase Contrast Standard fluid dynamics Poiseuille’s Law:

23. Pressure Measurement

24. Q2(R) Q2(L) Q1(L) Q1(R) Right central Q1(L) Q2(R) Q2(L) Right lateral Left lateral Left central

25. Flow Chart, right side

26. Flow Chart, left side

27. Calculation Of Pressure RQ R0.682.497-1.855= 0.642 L0.740.294-(-0.381)= 0.675 ΔP r /P l =75.26%

28. Pressure Gradient Left venous pressure is 24.76% higher than right side

29. Conclusion Preliminary data demonstrated association of rupture cerebral aneurysm with venous sinus asymmetry Preliminary MR phase contrast venous pressure measurement showed pressure gradient in asymmetry of dural sinuses