Knowledge

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Knowledge

Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts, information, descriptions, or skills, which is acquired through experience or education by perceiving, discovering, or learning.

Knowledge can refer to a theoretical or practical understanding of a subject. It can be implicit (as with practical skill or expertise) or explicit (as with the theoretical understanding of a subject); it can be more or less formal or systematic. In philosophy, the study of knowledge is called epistemology; the philosopher Plato famously defined knowledge as "justified true belief", though this definition is now thought by some analytic philosophers to be problematic because of the Gettier problems, while others defend the platonic definition. However, several definitions of knowledge and theories to explain it exist.

Knowledge acquisition involves complex cognitive processes: perception, communication, and reasoning; while knowledge is also said to be related to the capacity of acknowledgement in human beings.

Theories of knowledge

Robert Reid, Knowledge (1896). Thomas Jefferson Building, Washington, D.C.

The eventual demarcation of philosophy from science was made possible by the notion that philosophy's core was "theory of knowledge," a theory distinct from the sciences because it was their foundation... Without this idea of a "theory of knowledge," it is hard to imagine what "philosophy" could have been in the age of modern science.

— Richard Rorty, Philosophy and the Mirror of Nature

The definition of knowledge is a matter of ongoing debate among philosophers in the field of epistemology. The classical definition, described but not ultimately endorsed by Plato, specifies that a statement must meet three criteria in order to be considered knowledge: it must be justified, true, and believed. Some claim that these conditions are not sufficient, as Gettier case examples allegedly demonstrate. There are a number of alternatives proposed, including Robert Nozick's arguments for a requirement that knowledge 'tracks the truth' and Simon Blackburn's additional requirement that we do not want to say that those who meet any of these conditions 'through a defect, flaw, or failure' have knowledge. Richard Kirkham suggests that our definition of knowledge requires that the evidence for the belief necessitates its truth.

In contrast to this approach, Ludwig Wittgenstein observed, following Moore's paradox, that one can say "He believes it, but it isn't so," but not "He knows it, but it isn't so." He goes on to argue that these do not correspond to distinct mental states, but rather to distinct ways of talking about conviction. What is different here is not the mental state of the speaker, but the activity in which they are engaged. For example, on this account, to know that the kettle is boiling is not to be in a particular state of mind, but to perform a particular task with the statement that the kettle is boiling. Wittgenstein sought to bypass the difficulty of definition by looking to the way "knowledge" is used in natural languages. He saw knowledge as a case of a family resemblance. Following this idea, "knowledge" has been reconstructed as a cluster concept that points out relevant features but that is not adequately captured by any definition.

Communicating knowledge

Los portadores de la antorcha (The Torch-Bearers) – Sculpture by Anna Hyatt Huntington symbolizing the transmission of knowledge from one generation to the next (Ciudad Universitaria, Madrid, Spain)

Symbolic representations can be used to indicate meaning and can be thought of as a dynamic process. Hence the transfer of the symbolic representation can be viewed as one ascription process whereby knowledge can be transferred. Other forms of communication include observation and imitation, verbal exchange, and audio and video recordings. Philosophers of language and semioticians construct and analyze theories of knowledge transfer or communication.

While many would agree that one of the most universal and significant tools for the transfer of knowledge is writing and reading (of many kinds), argument over the usefulness of the written word exists nonetheless, with some scholars skeptical of its impact on societies. In his collection of essays Technopoly, Neil Postman demonstrates the argument against the use of writing through an excerpt from Plato's work Phaedrus (Postman, Neil (1992) Technopoly, Vintage, New York, p. 73). In this excerpt, the scholar Socrates recounts the story of Thamus, the Egyptian king and Theuth the inventor of the written word. In this story, Theuth presents his new invention "writing" to King Thamus, telling Thamus that his new invention "will improve both the wisdom and memory of the Egyptians" (Postman, Neil (1992) Technopoly, Vintage, New York, p. 74). King Thamus is skeptical of this new invention and rejects it as a tool of recollection rather than retained knowledge. He argues that the written word will infect the Egyptian people with fake knowledge as they will be able to attain facts and stories from an external source and will no longer be forced to mentally retain large quantities of knowledge themselves (Postman, Neil (1992) Technopoly, Vintage, New York, p. 74).

Classical early modern theories of knowledge, especially those advancing the influential empiricism of the philosopher John Locke, were based implicitly or explicitly on a model of the mind which likened ideas to words. This analogy between language and thought laid the foundation for a graphic conception of knowledge in which the mind was treated as a table, a container of content, that had to be stocked with facts reduced to letters, numbers or symbols. This created a situation in which the spatial alignment of words on the page carried great cognitive weight, so much so that educators paid very close attention to the visual structure of information on the page and in notebooks.

Major libraries today can have millions of books of knowledge (in addition to works of fiction). It is only recently that audio and video technology for recording knowledge have become available and the use of these still requires replay equipment and electricity. Verbal teaching and handing down of knowledge is limited to those who would have contact with the transmitter or someone who could interpret written work. Writing is still the most available and most universal of all forms of recording and transmitting knowledge. It stands unchallenged as mankind's primary technology of knowledge transfer down through the ages and to all cultures and languages of the world.

Haraway on situated knowledge

"Situated knowledges" redirects here. For the Donna Haraway essay, see Situated Knowledges.

 

Situated knowledge is knowledge specific to a particular situation. It was used by Donna Haraway as an extension of the feminist approaches of "successor science" suggested by Sandra Harding, one which "offers a more adequate, richer, better account of a world, in order to live in it well and in critical, reflexive relation to our own as well as others' practices of domination and the unequal parts of privilege and oppression that makes up all positions." This situation partially transforms science into a narrative, which Arturo Escobar explains as, "neither fictions nor supposed facts." This narrative of situation is historical textures woven of fact and fiction, and as Escobar explains further, "even the most neutral scientific domains are narratives in this sense," insisting that rather than a purpose dismissing science as a trivial matter of contingency, "it is to treat (this narrative) in the most serious way, without succumbing to its mystification as 'the truth' or to the ironic skepticism common to many critiques."

Haraway's argument stems from the limitations of the human perception, as well as the overemphasis of the sense of vision in science. According to Haraway, vision in science has been, "used to signify a leap out of the marked body and into a conquering gaze from nowhere." This is the "gaze that mythically inscribes all the marked bodies, that makes the unmarked category claim the power to see and not be seen, to represent while escaping representation." This causes a limitation of views in the position of science itself as a potential player in the creation of knowledge, resulting in a position of "modest witness". This is what Haraway terms a "god trick", or the aforementioned representation while escaping representation. In order to avoid this, "Haraway perpetuates a tradition of thought which emphasizes the importance of the subject in terms of both ethical and political accountability".

Some methods of generating knowledge, such as trial and error, or learning from experience, tend to create highly situational knowledge. Situational knowledge is often embedded in language, culture, or traditions. This integration of situational knowledge is an allusion to the community, and its attempts at collecting subjective perspectives into an embodiment "of views from somewhere." 

Even though Haraway's arguments are largely based on feminist studies, this idea of different worlds, as well as the skeptic stance of situated knowledge is present in the main arguments of post-structuralism. Fundamentally, both argue the contingency of knowledge on the presence of history; power, and geography, as well as the rejection of universal rules or laws or elementary structures; and the idea of power as an inherited trait of objectification.

Partial knowledge

The parable of Blind men and an elephant suggests that people tend to project their partial experiences as the whole truth

 

One discipline of epistemology focuses on partial knowledge. In most cases, it is not possible to understand an information domain exhaustively; our knowledge is always incomplete or partial. Most real problems have to be solved by taking advantage of a partial understanding of the problem context and problem data, unlike the typical math problems one might solve at school, where all data is given and one is given a complete understanding of formulas necessary to solve them.

This idea is also present in the concept of bounded rationality which assumes that in real life situations people often have a limited amount of information and make decisions accordingly. 

Scientific knowledge

Sir Francis Bacon, "Knowledge is Power"

The development of the scientific method has made a significant contribution to how knowledge of the physical world and its phenomena is acquired. To be termed scientific, a method of inquiry must be based on gathering observable and measurable evidence subject to specific principles of reasoning and experimentation. The scientific method consists of the collection of data through observation and experimentation, and the formulation and testing of hypotheses. Science, and the nature of scientific knowledge have also become the subject of Philosophy. As science itself has developed, scientific knowledge now includes a broader usage in the soft sciences such as biology and the social sciences – discussed elsewhere as meta-epistemology, or genetic epistemology, and to some extent related to "theory of cognitive development". Note that "epistemology" is the study of knowledge and how it is acquired. Science is "the process used everyday to logically complete thoughts through inference of facts determined by calculated experiments." Sir Francis Bacon was critical in the historical development of the scientific method; his works established and popularized an inductive methodology for scientific inquiry. His famous aphorism, "knowledge is power", is found in the Meditations Sacrae (1597).

Until recent times, at least in the Western tradition, it was simply taken for granted that knowledge was something possessed only by humans – and probably adult humans at that. Sometimes the notion might stretch to Society-as-such, as in (e. g.) "the knowledge possessed by the Coptic culture" (as opposed to its individual members), but that was not assured either. Nor was it usual to consider unconscious knowledge in any systematic way until this approach was popularized by Freud.

Other biological domains where "knowledge" might be said to reside, include: (iii) the immune system, and (iv) in the DNA of the genetic code. See the list of four "epistemological domains": Popper, (1975); and Traill (2008: Table S, p. 31) – also references by both to Niels Jerne.

Such considerations seem to call for a separate definition of "knowledge" to cover the biological systems. For biologists, knowledge must be usefully available to the system, though that system need not be conscious. Thus the criteria seem to be:

• The system should apparently be dynamic and self-organizing (unlike a mere book on its own).
• The knowledge must constitute some sort of representation of "the outside world", or ways of dealing with it (directly or indirectly).
• Some way must exist for the system to access this information quickly enough for it to be useful.

Scientific knowledge may not involve a claim to certainty, maintaining skepticism means that a scientist will never be absolutely certain when they are correct and when they are not. It is thus an irony of proper scientific method that one must doubt even when correct, in the hopes that this practice will lead to greater convergence on the truth in general.

Religious meaning of knowledge

In many expressions of Christianity, such as Catholicism and Anglicanism, knowledge is one of the seven gifts of the Holy Spirit.

The Old Testament's tree of the knowledge of good and evil contained the knowledge that separated Man from God: "And the LORD God said, Behold, the man is become as one of us, to know good and evil..." (Genesis 3:22)

In Gnosticism, divine knowledge or gnosis is hoped to be attained.

विद्या दान (Vidya Daan) i.e. knowledge sharing is a major part of Daan, a tenet of all Dharmic Religions. Hindu Scriptures present two kinds of knowledge, Paroksh Gyan and Prataksh Gyan. Paroksh Gyan (also spelled Paroksha-Jnana) is secondhand knowledge: knowledge obtained from books, hearsay, etc. Pratyaksh Gyan (also spelled Pratyaksha-Jnana) is the knowledge borne of direct experience, i.e., knowledge that one discovers for oneself. Jnana yoga ("path of knowledge") is one of three main types of yoga expounded by Krishna in the Bhagavad Gita. (It is compared and contrasted with Bhakti Yoga and Karma yoga.)

In Islam, knowledge (Arabic: علم, ʿilm) is given great significance. "The Knowing" (al-ʿAlīm) is one of the 99 names reflecting distinct attributes of God. The Qur'an asserts that knowledge comes from God (2:239) and various hadith encourage the acquisition of knowledge. Muhammad is reported to have said "Seek knowledge from the cradle to the grave" and "Verily the men of knowledge are the inheritors of the prophets". Islamic scholars, theologians and jurists are often given the title alim, meaning "knowledgeble".

In Jewish tradition, knowledge (Hebrew: דעת da'ath) is considered one of the most valuable traits a person can acquire. Observant Jews recite three times a day in the Amidah "Favor us with knowledge, understanding and discretion that come from you. Exalted are you, Existent-One, the gracious giver of knowledge." The Tanakh states, "A wise man gains power, and a man of knowledge maintains power", and "knowledge is chosen above gold". 

As a measure of religiosity in sociology of religion

According to the sociologist Mervin F. Verbit, knowledge may be understood as one of the key components of religiosity. Religious knowledge itself may be broken down into four dimensions:

• content
• frequency
• intensity
• centrality

The content of one's religious knowledge may vary from person to person, as will the degree to which it may occupy the person's mind (frequency), the intensity of the knowledge, and the centrality of the information (in that religious tradition, or to that individual).

Intelligence

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Intelligence

Intelligence has been defined in many ways: the capacity for logic, understanding, self-awareness, learning, emotional knowledge, reasoning, planning, creativity, critical thinking, and problem solving. More generally, it can be described as the ability to perceive or infer information, and to retain it as knowledge to be applied towards adaptive behaviors within an environment or context.

Intelligence is most often studied in humans but has also been observed in both non-human animals and in plants. Intelligence in machines is called artificial intelligence, which is commonly implemented in computer systems using programs and, sometimes, specialized hardware.

History of the term

The word "Intelligence" derives from the Latin nouns intelligentia or intellēctus, which in turn stem from the verb intelligere, to comprehend or perceive. In the Middle Ages, the word intellectus became the scholarly technical term for understanding, and a translation for the Greek philosophical term nous. This term, however, was strongly linked to the metaphysical and cosmological theories of teleological scholasticism, including theories of the immortality of the soul, and the concept of the Active Intellect (also known as the Active Intelligence). This entire approach to the study of nature was strongly rejected by the early modern philosophers such as Francis Bacon, Thomas Hobbes, John Locke, and David Hume, all of whom preferred the word "understanding" (in place of "intellectus" or "intelligence") in their English philosophical works. Hobbes for example, in his Latin De Corpore, used "intellectus intelligit", translated in the English version as "the understanding understandeth", as a typical example of a logical absurdity. The term "intelligence" has therefore become less common in English language philosophy, but it has later been taken up (with the scholastic theories which it now implies) in more contemporary psychology.

Definitions

The definition of intelligence is controversial. Some groups of psychologists have suggested the following definitions:

From "Mainstream Science on Intelligence" (1994), an op-ed statement in the Wall Street Journal signed by fifty-two researchers (out of 131 total invited to sign):

A very general mental capability that, among other things, involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly and learn from experience. It is not merely book learning, a narrow academic skill, or test-taking smarts. Rather, it reflects a broader and deeper capability for comprehending our surroundings—"catching on," "making sense" of things, or "figuring out" what to do.

From Intelligence: Knowns and Unknowns (1995), a report published by the Board of Scientific Affairs of the American Psychological Association:

Individuals differ from one another in their ability to understand complex ideas, to adapt effectively to the environment, to learn from experience, to engage in various forms of reasoning, to overcome obstacles by taking thought. Although these individual differences can be substantial, they are never entirely consistent: a given person's intellectual performance will vary on different occasions, in different domains, as judged by different criteria. Concepts of "intelligence" are attempts to clarify and organize this complex set of phenomena. Although considerable clarity has been achieved in some areas, no such conceptualization has yet answered all the important questions, and none commands universal assent. Indeed, when two dozen prominent theorists were recently asked to define intelligence, they gave two dozen, somewhat different, definitions.

Besides those definitions, psychology and learning researchers also have suggested definitions of intelligence such as the following:

Researcher	Quotation
Alfred Binet	Judgment, otherwise called "good sense", "practical sense", "initiative", the faculty of adapting one's self to circumstances ... auto-critique.
David Wechsler	The aggregate or global capacity of the individual to act purposefully, to think rationally, and to deal effectively with his environment.
Lloyd Humphreys	"...the resultant of the process of acquiring, storing in memory, retrieving, combining, comparing, and using in new contexts information and conceptual skills".
Howard Gardner	To my mind, a human intellectual competence must entail a set of skills of problem solving — enabling the individual to resolve genuine problems or difficulties that he or she encounters and, when appropriate, to create an effective product — and must also entail the potential for finding or creating problems — and thereby laying the groundwork for the acquisition of new knowledge.
Linda Gottfredson	The ability to deal with cognitive complexity.
Robert Sternberg & William Salter	Goal-directed adaptive behavior.
Reuven Feuerstein	The theory of Structural Cognitive Modifiability describes intelligence as "the unique propensity of human beings to change or modify the structure of their cognitive functioning to adapt to the changing demands of a life situation".
Shane Legg & Marcus Hutter	A synthesis of 70+ definitions from psychology, philosophy, and AI researchers: "Intelligence measures an agent's ability to achieve goals in a wide range of environments", which has been mathematically formalized.
Alexander Wissner-Gross	F = T ∇ S${\displaystyle _{\tau }}$ "Intelligence is a force, F, that acts so as to maximize future freedom of action. It acts to maximize future freedom of action, or keep options open, with some strength T, with the diversity of possible accessible futures, S, up to some future time horizon, τ. In short, intelligence doesn't like to get trapped".

Human intelligence

Human intelligence is the intellectual power of humans, which is marked by complex cognitive feats and high levels of motivation and self-awareness. Intelligence enables humans to remember descriptions of things and use those descriptions in future behaviors. It is a cognitive process. It gives humans the cognitive abilities to learn, form concepts, understand, and reason, including the capacities to recognize patterns, comprehend ideas, plan, solve problems, and use language to communicate. Intelligence enables humans to experience and think.

Much of the above definition applies also to the intelligence of non-human animals.

In animals

The common chimpanzee can use tools. This chimpanzee is using a stick to get food.

Although humans have been the primary focus of intelligence researchers, scientists have also attempted to investigate animal intelligence, or more broadly, animal cognition. These researchers are interested in studying both mental ability in a particular species, and comparing abilities between species. They study various measures of problem solving, as well as numerical and verbal reasoning abilities. Some challenges in this area are defining intelligence so that it has the same meaning across species (e.g. comparing intelligence between literate humans and illiterate animals), and also operationalizing a measure that accurately compares mental ability across different species and contexts. 

Wolfgang Köhler's research on the intelligence of apes is an example of research in this area. Stanley Coren's book, The Intelligence of Dogs is a notable book on the topic of dog intelligence. Non-human animals particularly noted and studied for their intelligence include chimpanzees, bonobos (notably the language-using Kanzi) and other great apes, dolphins, elephants and to some extent parrots, rats and ravens. 

Cephalopod intelligence also provides important comparative study. Cephalopods appear to exhibit characteristics of significant intelligence, yet their nervous systems differ radically from those of backboned animals. Vertebrates such as mammals, birds, reptiles and fish have shown a fairly high degree of intellect that varies according to each species. The same is true with arthropods. 

g factor in non-humans

Evidence of a general factor of intelligence has been observed in non-human animals. The general factor of intelligence, or g factor, is a psychometric construct that summarizes the correlations observed between an individual's scores on a wide range of cognitive abilities. First described in humans, the g factor has since been identified in a number of non-human species.

Cognitive ability and intelligence cannot be measured using the same, largely verbally dependent, scales developed for humans. Instead, intelligence is measured using a variety of interactive and observational tools focusing on innovation, habit reversal, social learning, and responses to novelty. Studies have shown that g is responsible for 47% of the individual variance in cognitive ability measures in primates and between 55% and 60% of the variance in mice (Locurto, Locurto). These values are similar to the accepted variance in IQ explained by g in humans (40–50%).

In plants

It has been argued that plants should also be classified as intelligent based on their ability to sense and model external and internal environments and adjust their morphology, physiology and phenotype accordingly to ensure self-preservation and reproduction.

A counter argument is that intelligence is commonly understood to involve the creation and use of persistent memories as opposed to computation that does not involve learning. If this is accepted as definitive of intelligence, then it includes the artificial intelligence of robots capable of "machine learning", but excludes those purely autonomic sense-reaction responses that can be observed in many plants. Plants are not limited to automated sensory-motor responses, however, they are capable of discriminating positive and negative experiences and of "learning" (registering memories) from their past experiences. They are also capable of communication, accurately computing their circumstances, using sophisticated cost–benefit analysis and taking tightly controlled actions to mitigate and control the diverse environmental stressors.

Artificial intelligence

Artificial intelligence (or AI) is both the intelligence of machines and the branch of computer science which aims to create it, through "the study and design of intelligent agents" or "rational agents", where an intelligent agent is a system that perceives its environment and takes actions which maximize its chances of success. Kaplan and Haenlein define artificial intelligence as “a system’s ability to correctly interpret external data, to learn from such data, and to use those learnings to achieve specific goals and tasks through flexible adaptation”. Achievements in artificial intelligence include constrained and well-defined problems such as games, crossword-solving and optical character recognition and a few more general problems such as autonomous cars. General intelligence or strong AI has not yet been achieved and is a long-term goal of AI research. 

Among the traits that researchers hope machines will exhibit are reasoning, knowledge, planning, learning, communication, perception, and the ability to move and to manipulate objects. In the field of artificial intelligence there is no consensus on how closely the brain should be simulated.

Intracranial aneurysm

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Intracranial_aneurysm

 

Intracranial aneurysm
Other names	Cerhttps://en.wikipedia.org/wiki/Intracranial_aneurysmebral aneurysm
Aneurysm of the basilar artery, and the vertebral arteries.
Specialty	Interventional neuroradiology, neurosurgery

Intracranial aneurysm, also known as brain aneurysm, is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.

Aneurysms in the posterior circulation (basilar artery, vertebral arteries and posterior communicating artery) have a higher risk of rupture. Basilar artery aneurysms represent only 3–5% of all intracranial aneurysms but are the most common aneurysms in the posterior circulation.

Classification

Diagram of cerebral aneurysm.

Cerebral aneurysms are classified both by size and shape. Small aneurysms have a diameter of less than 15 mm. Larger aneurysms include those classified as large (15 to 25 mm), giant (25 to 50 mm), and super-giant (over 50 mm).

Saccular aneurysms

Saccular aneurysms, also known as berry aneurysms, appear as a round outpouching and are the most common form of cerebral aneurysm.

Fusiform aneurysms

Fusiform dolichoectatic aneurysms represent a widening of a segment of an artery around the entire blood vessel, rather than just arising from a side of an artery's wall. They can rupture but usually do not. 

Microaneurysms

Microaneurysms, also known as Charcot-Bouchard aneurysms, typically occur in small blood vessels (less than 300 micrometre diameter), most often the lenticulostriate vessels of the basal ganglia, and are associated with chronic hypertension.^[3] Charcot–Bouchard aneurysms are a common cause of intracranial hemorrhage. 

Signs and symptoms

A small, unchanging aneurysm will produce few, if any, symptoms. Before a larger aneurysm ruptures, the individual may experience such symptoms as a sudden and unusually severe headache, nausea, vision impairment, vomiting, and loss of consciousness, or the individual may experience no symptoms at all.

Subarachnoid bleed

If an aneurysm ruptures, blood leaks into the space around the brain. This is called a subarachnoid hemorrhage. Onset is usually sudden without prodrome, classically presenting as a "thunderclap headache" worse than previous headaches. Symptoms of a subarachnoid hemorrhage differ depending on the site and size of the aneurysm. Symptoms of a ruptured aneurysm can include:

• a sudden severe headache that can last from several hours to days
• nausea and vomiting
• drowsiness, confusion and/or loss of consciousness
• visual abnormalities
• meningism

Almost all aneurysms rupture at their apex. This leads to hemorrhage in the subarachnoid space and sometimes in brain parenchyma. Minor leakage from aneurysm may precede rupture, causing warning headaches. About 60% of patients die immediately after rupture. Larger aneurysms have a greater tendency to rupture, though most ruptured aneurysms are less than 10 mm in diameter.

The risk of a subarachnoid hemorrhage is greater with a saccular aneurysm than a fusiform aneurysm.

Microaneurysms

A ruptured microaneurysm may cause an intracerebral hemorrhage, presenting as a focal neurological deficit.

Rebleeding, hydrocephalus (the excessive accumulation of cerebrospinal fluid), vasospasm (spasm, or narrowing, of the blood vessels), or multiple aneurysms may also occur. The risk of rupture from a cerebral aneurysm varies according to the size of an aneurysm, with the risk rising as the aneurysm size increases.

Vasospasm

Vasospasm, referring to blood vessel constriction, can occur secondary to subarachnoid hemorrhage following a ruptured aneurysm. This is most likely to occur within 21 days and is seen radiologically within 60% of such patients. The vasospasm is thought to be secondary to the apoptosis of inflammatory cells such as macrophages and neutrophils that become trapped in the subarachnoid space. These cells initially invade the subarachnoid space from the circulation in order to phagocytose the hemorrhaged red blood cells. Following apoptosis, it is thought there is a massive degranulation of vasoconstrictors, including endothelins and free radicals, that cause the vasospasm.

Risk factors

Intracranial aneurysms may result from diseases acquired during life, or from genetic conditions. Lifestyle diseases including hypertension, smoking, excessive alcoholism, and obesity are associated with the development of brain aneurysms. Cocaine use has also been associated with the development of intracranial aneurysms.

Other acquired associations with intracranial aneurysms include head trauma and infections.

Genetic associations

Coarctation of the aorta is also a known risk factor, as is arteriovenous malformation. Genetic conditions associated with connective tissue disease may also be associated with the development of aneurysms. This includes:

• autosomal dominant polycystic kidney disease,
• neurofibromatosis type I,
• Marfan syndrome,
• multiple endocrine neoplasia type I,
• pseudoxanthoma elasticum,
• hereditary hemorrhagic telangiectasia and
• Ehlers-Danlos syndrome types II and IV.

Specific genes have also had reported association with the development of intracranial aneurysms, including perlecan, elastin, collagen type 1 A2, endothelial nitric oxide synthase, endothelin receptor A and cyclin dependent kinase inhibitor. Mutations in interleukin 6 may be protective. Recently, several genetic loci have been identified as relevant to the development of intracranial aneurysms. These include 1p34-36, 2p14-15, 7q11, 11q25, and 19q13.1-13.3.

Pathophysiology

Aneurysm means an outpouching of a blood vessel wall that is filled with blood. Aneurysms occur at a point of weakness in the vessel wall. This can be because of acquired disease or hereditary factors. The repeated trauma of blood flow against the vessel wall presses against the point of weakness and causes the aneurysm to enlarge. As described by the Law of Young-Laplace, the increasing area increases tension against the aneurysmal walls, leading to enlargement. 

Both high and low wall shear stress of flowing blood can cause aneurysm and rupture. However, the mechanism of action is still unknown. It is speculated that low shear stress causes growth and rupture of large aneurysms through inflammatory response while high shear stress causes growth and rupture of small aneurysm through mural response (response from the blood vessel wall). Other risk factors that contributes to the formation of aneurysm are: cigarette smoking, hypertension, female gender, family history of cerebral aneurysm, infection, and trauma. Damage to structural integrity of the arterial wall by shear stress causes an inflammatory response with the recruitment of T cells, macrophages, and mast cells. The inflammatory mediators are: Interleukin 1 beta, Interleukin 6, Tumor necrosis factor alpha (TNF alpha), MMP1, MMP2, MMP9, prostaglandin E2, complement system, reactive oxygen species (ROS), and angiotensin II. On the other hand, smooth muscle cells from the tunica media layer of the artery moved into the tunica intima, where the function of the smooth muscle cells changed from contractile function into pro-inflammatory function. This causes the fibrosis of the arterial wall, with reduction of number of smooth muscle cells, abnormal collagen synthesis, resulting in thinning of arterial wall and formation of aneurysm and rupture. On the other hand, no specific gene loci has been identified to be associated with cerebral aneurysm.

Generally, aneurysms larger than 7 mm in diameter should be treated because they are prone for rupture. Meanwhile, aneurysms less than 7 mm arises from anterior and posterior communicating artery are more easily ruptured when compared to aneurysms arising from other locations.

Saccular aneurysms

The most common sites of intracranial saccular aneurysms.

Saccular aneurysms are almost always the result of hereditary weakness in blood vessels and typically occur within the arteries of the Circle of Willis, in order of frequency affecting the following arteries:

• Anterior communicating artery
• Posterior communicating artery
• Middle cerebral artery
• Internal carotid artery
• Tip of basilar artery

Saccular aneurysms tend to have a lack of tunica media and elastic lamina around its dilated location (congenital), with wall of sac made up of thickened hyalinized intima and adventitia. In addition, some parts of the brain vasculature are inherently weak—particularly areas along the Circle of Willis, where small communicating vessels link the main cerebral vessels. These areas are particularly susceptible to saccular aneurysms. Approximately 25% of patients have multiple aneurysms, predominantly when there is familial pattern.

Diagnosis

CT angiography showing aneurysm measuring 2.6 mm in diameter at the ACOM (anterior communicating artery).

Once suspected, intracranial aneurysms can be diagnosed radiologically using magnetic resonance or CT angiography. But these methods have limited sensitivity for diagnosis of small aneurysms, and often cannot be used to specifically distinguish them from infundibular dilations without performing a formal angiogram. The determination of whether an aneurysm is ruptured is critical to diagnosis. Lumbar puncture (LP) is the gold standard technique for determining aneurysm rupture (subarachnoid hemorrhage). Once an LP is performed, the CSF is evaluated for RBC count, and presence or absence of xanthochromia.

Treatment

A selection of Mayfield and Drake aneurysm clips ready for implantation.

Emergency treatment for individuals with a ruptured cerebral aneurysm generally includes restoring deteriorating respiration and reducing intracranial pressure. Currently there are two treatment options for securing intracranial aneurysms: surgical clipping or endovascular coiling. If possible, either surgical clipping or endovascular coiling is typically performed within the first 24 hours after bleeding to occlude the ruptured aneurysm and reduce the risk of rebleeding.

While a large meta-analysis found the outcomes and risks of surgical clipping and endovascular coiling to be statistically similar, no consensus has been reached. In particular, the large randomised control trial International Subarachnoid Aneurysm Trial appears to indicate a higher rate of recurrence when intracerebral aneurysms are treated using endovascular coiling. Analysis of data from this trial has indicated a 7% lower eight-year mortality rate with coiling, a high rate of aneurysm recurrence in aneurysms treated with coiling—from 28.6-33.6% within a year, a 6.9 times greater rate of late retreatment for coiled aneurysms, and a rate of rebleeding 8 times higher than surgically-clipped aneurysms.

Surgical clipping

Aneurysms can be treated by clipping the base of the aneurysm with a specially-designed clip. Whilst this is typically carried out by craniotomy, a new endoscopic endonasal approach is being trialled. Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937. After clipping, a catheter angiogram or CTA can be performed to confirm complete clipping.

Endovascular coiling

Endovascular coiling refers to the insertion of platinum coils into the aneurysm. A catheter is inserted into a blood vessel, typically the femoral artery, and passed through blood vessels into the cerebral circulation and the aneurysm. Coils are pushed into the aneurysm, or released into the blood stream ahead of the aneurysm. Upon depositing within the aneurysm, the coils expand and initiate a thrombotic reaction within the aneurysm. If successful, this prevents further bleeding from the aneurysm. In the case of broad-based aneurysms, a stent may be passed first into the parent artery to serve as a scaffold for the coils.

Cerebral bypass surgery

Cerebral bypass surgery was developed in the 1960s in Switzerland by Gazi Yasargil, M.D. When a patient has an aneurysm involving a blood vessel or a tumor at the base of the skull wrapping around a blood vessel, surgeons eliminate the problem vessel by replacing it with an artery from another part of the body.

Prognosis

Outcomes depend on the size of the aneurysm. Small aneurysms (less than 7 mm) have a low risk of rupture and increase in size slowly. The risk of rupture is less than a percent for aneurysms of this size.

The prognosis for a ruptured cerebral aneurysm depends on the extent and location of the aneurysm, the person's age, general health, and neurological condition. Some individuals with a ruptured cerebral aneurysm die from the initial bleeding. Other individuals with cerebral aneurysm recover with little or no neurological deficit. The most significant factors in determining outcome are the Hunt and Hess grade, and age. Generally patients with Hunt and Hess grade I and II hemorrhage on admission to the emergency room and patients who are younger within the typical age range of vulnerability can anticipate a good outcome, without death or permanent disability. Older patients and those with poorer Hunt and Hess grades on admission have a poor prognosis. Generally, about two-thirds of patients have a poor outcome, death, or permanent disability.

Epidemiology

The prevalence of intracranial aneurysm is about 1-5% (10 million to 12 million persons in the United States) and the incidence is 1 per 10,000 persons per year in the United States (approximately 27,000), with 30- to 60-year-olds being the age group most affected. Intracranial aneurysms occur more in women, by a ratio of 3 to 2, and are rarely seen in pediatric populations.