Cerebral aneurysm
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Aneurysm of cerebral vessels (intracranial aneurysm, cerebral aneurysm) is a protrusion of the arterial wall due to a violation of its normal three-layer structure. Aneurysm of cerebral vessels is localized mainly in the places of arterial branching.
According to experts, this pathology is very common (it is present in about 5% of the population), but since in most cases it is asymptomatic, it remains undiagnosed or is found in a patient during an examination for other reasons.
The main danger of a cerebral aneurysm is that it can rupture. This leads to non-traumatic subarachnoid hemorrhage. Most often, an intracranial aneurysm rupture occurs in people aged 40 to 60 years.
Bulging of the arterial wall of the cerebral vessel
Causes and risk factors
To date, there is no single theory explaining the formation of the named vascular pathology. Most researchers believe that cerebral aneurysm is a multifactorial pathology. Changes in the structure of the walls of blood vessels can lead to:
- atherosclerosis;
- hyalinosis;
- exposure to ionizing radiation;
- hereditary predisposition;
- inflammation of the vascular wall of a bacterial or mycotic nature;
- traumatic vascular injury.
In addition to the above, there are factors that directly affect the development of the aneurysm, and then provoke the rupture of its sac. These include:
- arterial hypertension;
- uneven blood flow, in which the movement of blood through the vessel becomes turbulent, rather than laminar.
Forms of the disease
Depending on the size of the protrusion of the artery wall, aneurysms of the cerebral vessels are of the following types:
- miliary (less than 3 mm);
- small (from 4 to 10 mm);
- medium (from 11 to 15 mm);
- large (from 16 to 25 mm);
- giant (from 26 mm and more).
At the site of localization, aneurysms are divided as follows:
- aneurysms of the vertebrobasilar system;
- aneurysms of the internal carotid artery;
- aneurysms of the middle cerebral artery;
- aneurysm of the anterior cerebral artery.
In about 15% of cases, patients have several aneurysms at the same time located on different arteries.
Several aneurysms located on different arteries
Depending on the shape of the cerebral aneurysm, it can be spindle-shaped and saccular. The second form occurs about 50 times more often than the first.
Disease stages
Depending on the characteristics of the clinical picture, there are three stages of cerebral aneurysm:
- Asymptomatic.
- Unexploded (tumor-like).
- Bursting (apoplectic).
Symptoms
As mentioned above, in most cases, intracranial aneurysms are asymptomatic. But sometimes the bulging of the arterial wall puts pressure on certain brain structures, which leads to brain symptoms. This course of the disease is called tumor-like. Most often, tumor-like aneurysms are localized in the cavernous sinus and the region of the chiasm (optic chiasm).
In the case of the location of the cerebral aneurysm in the area of the chiasm, the following are noted:
- narrowing of the visual fields;
- deterioration in visual acuity;
- optic nerve atrophy.
Decreased acuity and narrowing of visual fields may occur due to aneurysm
Symptoms of an aneurysm located in the cavernous sinus:
- oculomotor disorders (strabismus, convergence disorder);
- trigeminal neuralgia.
With a long-standing cerebral aneurysm, the process of destruction of the skull bones can begin.
When an aneurysm ruptures, bleeding occurs into the subarachnoid space, ventricles, or the very substance of the brain. In this case, the disease takes on an apoplectic character.
The main signs of a ruptured cerebral aneurysm:
- sharp intense headache;
- nausea;
- repeated vomiting;
- stiff neck;
- hyperesthesia;
- the appearance of meningeal symptoms (Kernig, Brudzinsky);
- disturbances of consciousness;
- mental disorders;
- epileptiform seizures.
Diagnostics
With an asymptomatic course, cerebral aneurysms usually become random diagnostic findings that are found when examining a patient for another reason. When clinical symptoms appear, a cerebral aneurysm is diagnosed on the basis of the existing neurological symptoms, as well as data from instrumental studies, which include:
- X-ray of the skull;
- computer or magnetic resonance imaging of the brain;
- X-ray or magnetic resonance angiography.
Brain aneurysm on MRI
The detection of blood in the cerebrospinal fluid obtained during a lumbar puncture is confirmation of a ruptured cerebral aneurysm.
Tumor-like forms of cerebral aneurysm require differential diagnosis with volumetric processes of the brain (abscess, cyst, tumor). In the apoplectic form of the disease, differential diagnosis is carried out with meningitis, ischemic stroke, transient cerebral circulation disorders, and an attack of epilepsy.
Treatment
Patients with small cerebral aneurysms should be under constant medical supervision to control the size of the arterial wall protrusion and the course of the disease. Surgical treatment is not indicated at this stage. If necessary, conduct conservative therapy aimed at preventing aneurysm enlargement. For this purpose, antiarrhythmic, antihypertensive, antibacterial drugs, statins to lower cholesterol levels and other drugs are prescribed as indicated.
Surgical treatment of a cerebral aneurysm prevents its possible rupture. The main methods of surgical intervention in this case are:
- endovascular occlusion;
- clipping of the bulge neck;
- artificial thrombosis;
- stereotactic electrocoagulation.
Endovascular embolization of cerebral aneurysm
A ruptured cerebral aneurysm is an urgent condition requiring urgent specialized medical care. Conservative therapy is carried out, similar to therapy for hemorrhagic stroke. If indicated, surgery is performed to remove the hematoma. When bleeding into the ventricular cavity, it is drained.
Possible complications and consequences
Intracerebral hemorrhage, which occurs when a cerebral aneurysm ruptures, can be fatal. In case of survival, patients need long and expensive rehabilitation. At the same time, 25% of patients have persistent disabling consequences.
Forecast
Small-sized cerebral aneurysms in the absence of growth can exist throughout the patient's life without manifesting clinically.
When a cerebral aneurysm ruptures, about 15% of patients die at the prehospital stage. Every second patient with a ruptured intracranial aneurysm dies within the first month of the disease. In 50% of the survivors, neurological disorders of one degree or another are observed.
Prevention
Prevention of cerebral aneurysms should be based on the elimination of risk factors that contribute to damage to the vascular wall. Here's what it consists of:
- quitting smoking and alcohol abuse;
- normalization of body weight;
- blood pressure control;
- proper nutrition with the obligatory inclusion in the diet of foods rich in polyunsaturated fatty acids;
- moderate exercise;
- timely detection and treatment of diseases.
YouTube video related to the article:
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
