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Intracranial aneurysm sounds, bruits and murmurs, are explained by flow instabilities causing vibrations. Stable flow prevents these vibrations, offering insights into aneurysm mechanics.

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Area of Science:

  • Biomedical Engineering
  • Fluid Dynamics
  • Medical Acoustics

Background:

  • The origin of intracranial aneurysm sounds (bruits and murmurs) has been debated since the 1960s.
  • Proposed mechanisms include resonance from stable flow or vibration from unstable flow (laminar vortex shedding or turbulent).
  • This knowledge gap hinders using intracranial sounds as markers for aneurysm remodeling or rupture risk.

Purpose of the Study:

  • To investigate the mechanisms and magnitude of flow-induced vibrations in intracranial aneurysms.
  • To model intracranial aneurysm sounds using advanced computational techniques.
  • To differentiate between proposed mechanisms for bruit and murmur generation.

Main Methods:

  • High-fidelity fluid-structure interaction simulations were performed.
  • Simulations modeled pulsatile flow conditions in six patient-specific intracranial aneurysm cases.
  • Vibrational analysis focused on flow-induced oscillations of the aneurysm sac.

Main Results:

  • Five cases exhibited flow instabilities causing broad-band vibrations (bruits) and resonant sac motion (murmurs).
  • Vibrational amplitudes ranged from 0.1 to 1 μm; murmurs extended into diastole.
  • One case with stable flow showed no vibration; simulated spectrograms matched clinical recordings.

Conclusions:

  • Plausible explanations for distinct intracranial aneurysm sounds (bruits and murmurs) were provided.
  • The mechanical environment of a vibrating aneurysm wall was characterized.
  • Future research should quantify the effects of these vibrations on vascular wall integrity.