Brain aneurysm or cerebral aneurysm is a local extension of the artery section accompanied by the bag-shaped protrusion formations. The incidence of its disease in different countries is form 1 to 5%. Illness is asymptomatic. But aneurysm can rupture any moment causing the subarachnoid hemorrhage.
More than half of the brain aneurysm rupture cases have lethal results during the first month after this happened.
In 80% of cases, brain aneurysm is the result of the abnormal fetal development. Defective blood vessel formation causes the protrusions occurrence. This defect lies in a lack of muscle and elastic layers of the artery or their underdevelopment.
In the majority of cases the aneurysm is formed by the age of 16-18 years. Rarely (10%) this illness can be acquired. Possible causes are:
In other 10% of cases the cause is unknown. Sometimes the aneurysm occurs among the patients without any contributing factor, who doen’t have any congenital defect of the blood vessel wall.
Aneurysm has a tendency to gradually increase in size. Many patients experience rupture of the blood vessels with the hemorrhage into the subarachnoid space.
Anatomically aneurysm is a sac that is connected to the artery. It has three parts:
Sac directs the blood flow. It is constantly taking the force of the pulse wave on itself and this exactly is the reason of its expansion. Sac’s walls be come thinner and thinner. In some moment the wall’s rupture happens.
Cerebral aneurysms are located in the subarachnoid cisterns which is the reason why aneurysm rupture causes the subarachnoid hemorrhage in the majority of cases (80%).
Parenchyma hemorrhage with the formation of brain hematomas are less common (15%).
Rarely, the blood breaks into the ventricular system (5%). If the ventricular tamponade (plugging) develops it leads to death.
Subarachnoid hemorrhage usually lasts no more than few seconds. Then, the vessels constrict (compress). Mostly, the hemorrhage is over after the blood vessel constriction. If for some reason this doesn’t happen (anticoagulation, large size of the aneurysm), patient dies.
In the clinical course of the subarachnoid hemorrhage caused by the brain aneurysm rupture, the leading role is played by the following factors:
Brain aneurysm is asymptomatic until its rupture. Clinical manifestations of the subarachnoid hemorrhage developing afterwards are:
Autonomic dysfunctions are observed immediately after the aneurysm rupture and the following symptoms occur:
Meningeal syndrome is caused by their ritation of the meninges and determined by the breaking of the effused blood. Meningeal syndrome occurs in 6-12 hours after the aneurysm rupture.
The symptoms are:
Meningeal syndrome is subsiding gradually, depending on the blood cells breaking and the spinal fluid (neurolymph) sanitation. It takes about 2 weeks. If meningeal syndrome remains for 3 weeks and more, this can be a poor prognostic factor.
Cerebral symptoms are seizures, memory loss, dizziness, consciousness impairment (even coma), and mental disorders. All these symptoms can be observed if the brain aneurysm had ruptured.
Focal symptoms can be very diverse. It depends on the location of the pathological process and is determined by the functional disorders of the certain brain sections or cranial nerves.
A relatively mild course of the subarachnoid hemorrhage is one of the aneurysm rupture peculiarities.
Sometimes the amount of blood is so minor that patient keeps working and refers to the doctor with the complaints like headache, high blood pressure and body temperature.
Therapists often misdiagnose and symptoms regress gradually. In this case, the aneurysm is detected after its repeated hemorrhage.
One in 100,000 cases, the aneurysm is detected by chance during brain tests for the other illnesses. Aneurysm is detected only after its rupture in 90% .
Following methods are used for diagnostics:
Lumbar puncture. The doctor inserts the needle into the spinal canal below the spinal cord (lower back). He checks whether there is blood in the spinal fluid. This procedure can only be done no less than in an hour after the aneurysm rupture. If it is done earlier, the false result can be received.
Ultrasonic transcranial Doppler. Ultrasound helps to detect the spasm of blood vesselsas evidenced by a significant acceleration of the linear flow. This method of diagnostics allows planning on the treatment tactic as it is significantly influenced by the severity of arteriopathy. It can be moderate, severe or critical.
Cerebral angiographyis the “gold standard” of the diagnostics.The contrasting agent is injected into the vessels. Thenan X-ray image is done where the brain aneurysm can be visible clearly. Method helps also to assess the severity of the arteriopathy. Accuracy of the diagnostics is 95%. False results are possible during the acute period of the illness (up to 2 weeks after the rupture).
Patient can undergo the surgery during the 1-3 days after the aneurysm rupture. If due to late diagnostics this moment was missed, the arteriopathy is progressing (the vasoconstriction), ischemia (lack of oxygen) and cerebral edema are developing. This way, the surgery can only be done in 2-3 weeks.
Open and endovascular (with the access through the blood vessels) surgeries are used.
Minimally invasive interventions are possible only in case of minor bleedings, as they do not allow removing blood clots from the subarachnoid space.
Moreover, minimally invasive surgeries are done if the aneurysm hadn’t rupture, but was detected accidentally during the diagnostics for the other diseases. In this case, the timely termination of blood flow in the anomaly arteries helps to prevent the subarachnoid hemorrhage.
During the endovascular surgery, the balloon is inserted into the artery lumen and then the air is blown into it or the spiral is put. This causes the thrombus formation that blocks the blood flow through the damaged vessels.
Open surgery presupposes the performance of a craniotomy. Aneurysm is extracted from the blood flow by putting a clip on the body or the neck. If the exclusion of this vessel is impossible, then the enveloping of an aneurysm is performed. Aneurysm is protected from the rupture using the synthetic materials or the patient’s own muscule tissues.
Further, it leads to the connective tissue growth and artery walls thickening that significantly lower the risk of the repeated hemorrhage.
Brain aneurysm treatment without any complications has a favorable prognosis. Risk of its rupture is on average 1-2% a year. Riskis higher if th eaneurysm has large size.
In any case, patient has enough time to go to the clinic and to undergo a surgery, aimed at the exclusion of the aneurysm from the blood flow. Better to do it as early as possible, as an aneurysm has a tendency to gradually increase in size.
Mortality during the first week after the aneurysm rupture and the bleeding is 50%.
Highest chances for a survival have those patients who underwent a surgery during the acute illness period (up to 3 days after the rupture). Risk of the repeated hemorrhage from the aneurysm during the first month is 25%. Mortality is much higher here and reaches 70%.
Life prognosis is favorable after the timely and successful treatment. Repeated hemorrhage is excluded. Neurologic disorders remains in 70% of patients.
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