Brain aneurysm (cerebral aneurysm)

2021-08-10 09:38 AM

Sudden headache, nausea, vomiting, neck pain, blurred vision, light sensitivity, loss of consciousness, confusion, drooping eyelid.

Define

A brain aneurysm (cerebral aneurysm) is a bulging of a blood vessel in the brain. It usually looks like a berry hanging from a stem.

Brain aneurysms can leak or rupture causing bleeding into the brain. Most often, ruptured brain aneurysms occur in the space between the brain and the thin tissues that cover the brain. This type of hemorrhagic stroke is called a subarachnoid hemorrhage. A ruptured brain aneurysm quickly becomes life-threatening and requires prompt medical treatment.
 
However, most brain aneurysms do not rupture, create health problems, or cause symptoms. Brain aneurysms are often discovered during tests for other problems. Treatment of a stable brain aneurysm may be appropriate in some cases and may prevent future rupture.

Symptoms

Aneurysm rupture: A sudden severe headache is the main symptom of a ruptured aneurysm. This headache is often described as the worst headache. Common signs and symptoms of a ruptured aneurysm include:

Sudden severe headache.

Nausea and vomiting.

Neck pain.

Blurred vision or double vision.

Sensitive to light.

A drooping eyelid.

Loss of consciousness.

Confused.

Leaking aneurysm: In some cases, an aneurysm can leak a small amount of blood. This can cause unexpected, very severe headaches. This bleeding is almost always followed by a more severe rupture.

Stable brain aneurysm: A stable brain aneurysm may have no symptoms, especially if it is small. However, large stable aneurysms can press on brain tissues and nerves, which can cause:

Pain above and behind one eye.

Change in vision or double vision.

Numbness, weakness, or paralysis on one side of the face.

A drooping eyelid.

A ruptured aneurysm is a medical emergency. In about 50 percent of cases, a ruptured brain aneurysm is fatal. Seek immediate medical attention if a headache develops, which is suddenly extremely severe.

If someone suddenly complains of a severe headache, or the person loses consciousness or has a seizure, call emergency medical care.

Causes

Brain aneurysms develop as a result of thinning and degeneration of artery walls. Aneurysms often form in branches or branches in arteries because these parts are weaker. Although aneurysms can appear anywhere in the brain, they are most common in the arteries at the base of the brain.

Risk factors

Several factors can contribute to weakness in the artery walls and increase the risk of brain aneurysms. These contributing factors include:

Elderly.

Smoke.

Hypertension.

Arterial hardening.

Family history of a brain aneurysm, especially first-generation, such as a parent or sibling.

Drug abuse, especially cocaine use.

Head injury.

Consume a lot of alcohol.

Some blood infections.

Low estrogen levels after menopause.

Certain birth disorders are known to increase the risk of brain aneurysms. These include:

Inherited connective tissue disorders, such as Ehlers-Danlos syndrome, weaken blood vessels.
 
Polycystic kidney disease, an inherited disorder that often increases blood pressure.

Abnormal narrowing of the aorta, the blood vessels that carry oxygen-rich blood from the heart to the body.

Cerebral arteriovenous malformation (AVM), an abnormal connection between the arteries and veins in the brain that disrupts the normal flow of blood between them.

Complications

When a brain aneurysm ruptures, the bleeding usually lasts only a few seconds. Blood can cause direct damage to surrounding cells, and bleeding can damage or kill other cells. It also increases the pressure inside the skull. If the pressure becomes too high, the blood and oxygen supply to the brain can be interrupted until loss of consciousness or even death can occur.

Complications that can develop after a brain aneurysm rupture include:

Bleeding again. An aneurysm that has ruptured or leaked is at risk of bleeding again. Re-bleeding can cause further damage to brain cells.

Vasoconstriction. After a brain aneurysm ruptures, blood vessels in the brain can widen and narrow erratically. This condition can limit blood flow to brain cells (ischemic stroke) and cause further cell damage.

Hydrocephalus. When an aneurysm bursts, bleeding occurs in the space between the brain and surrounding tissue (subarachnoid hemorrhage) - most often it can block the flow of fluid that surrounds the brain and spinal cord (cerebrospinal fluid). This condition can lead to hydrocephalus, a cerebrospinal fluid that increases pressure on the brain and can damage brain tissue.

Decreased blood sodium. Subarachnoid hemorrhage from a ruptured brain aneurysm can disrupt the sodium balance. This can happen due to damage to the hypothalamus. Low sodium in the blood (hyponatremia) can cause swelling of brain cells and permanent damage.

Tests and diagnostics

If you have a sudden severe headache or another symptom that may be related to a ruptured aneurysm, you will undergo an examination or a series of tests to determine if there has been bleeding into the space between the brain and surrounding tissues. periphery or another form of stroke. If bleeding has occurred, it will be determined if the cause of the bleeding is a ruptured aneurysm.

If you have symptoms of a stable brain aneurysm, such as pain behind your eye, vision changes, and numbness on one side of your face, you'll likely undergo the same tests.

Diagnostic tests include

Computed tomography (CT) scan. CT is usually the first test used to determine if there is bleeding in the brain. With this test, it is also possible to inject a dye that makes it easier to see blood flow in the brain and can indicate damage from a ruptured aneurysm. This variation of the test is called CT angiography.

Check cerebrospinal fluid. If there has been a subarachnoid hemorrhage, there are likely red blood cells in the fluid that surrounds the brain and spinal cord (cerebrospinal fluid). The doctor will check the cerebrospinal fluid if there are symptoms of a ruptured aneurysm, but the CT scan has not shown evidence of bleeding. A lumbar puncture to drain the cerebrospinal fluid with a needle is called a lumbar puncture.

Magnetic resonance imaging (MRI). An MRI uses a magnetic field and radio waves to create detailed images of the brain, either two-dimensional slice images or three-dimensional images. Using dye, it is possible to sharpen the image of blood vessels and lesions of a ruptured aneurysm. This imaging test may provide a clearer picture than a CT scan.

Brain angiography. In this procedure, the doctor inserts a flexible tube into a large artery, usually in the groin - through the heart into arteries in the brain. A special dye is injected into the catheter that travels to the arteries in the brain. A series of X-ray images can then reveal details about the problems with the arteries and the damage of the ruptured aneurysm. This test is often used when other diagnostic tests do not provide enough information.

Stable cerebral aneurysm

The use of imaging techniques for stable brain aneurysms is generally discouraged. However, you can discuss with your doctor the potential benefits of the test if there are any:

A parent or sibling has had a ruptured brain aneurysm.

Congenital disorders increase the risk of brain aneurysms.

Treatments and drugs

Surgery

There are two common treatment options for a ruptured brain aneurysm.

Surgery is the procedure to close the ruptured aneurysm. Neurosurgery removes part of the skull to access the aneurysm and identify the blood vessels that feed the aneurysm. They then place a small metal clip on the neck of the aneurysm to block blood flow to it.

Endovascular is a less invasive procedure than surgery. Doctors insert a hollow plastic tube into an artery, usually in the groin, and it reaches this aneurysm. A guidewire is then used to push a soft metal tube through the catheter and into the aneurysm. The tube coils inside the aneurysm, disrupting blood flow and causing a blood clot.

Both procedures pose risks, especially bleeding in the brain and loss of blood flow to the brain. Intravascular coils are less invasive and possibly safer than the first, but they carry a higher risk of subsequent bleeding and additional procedures may be needed. Neurosurgery will be a recommendation based on the size of the brain aneurysm, the likelihood of undergoing surgery, and other factors.

Other treatments

Other treatments for an unruptured brain aneurysm are aimed at relieving symptoms and complications.

Pain relievers, such as acetaminophen can be used to treat headache pain.

Calcium channel blockers prevent calcium from entering the cells of the blood vessel walls. These drugs can reduce the spasm, the erratic widening and narrowing of blood vessels that can be a complication of a ruptured aneurysm. One of these drugs, nimodipine, has been indicated to reduce the risk of delayed brain injury caused by blood flow following a subarachnoid hemorrhage of a ruptured aneurysm.

Interventions to prevent stroke caused by insufficient blood flow include intravenous vasopressor, which elevates blood pressure to overcome the resistance of narrowed blood vessels. An alternative intervention to prevent stroke is angioplasty. In this procedure, the doctor uses a catheter to inflate a small balloon that widens a narrowed blood vessel in the brain. The catheter may also be used to give the brain a drug called a vasodilator, which causes blood vessels to widen.

Antiepileptic drugs may be used to treat seizures associated with a ruptured aneurysm. These drugs include levetiracetam, phenytoin, and valproic acid.

Catheters and surgery can relieve pressure on the brain from excess cerebrospinal fluid caused by a ruptured aneurysm. Catheters may be placed in the ventricles to drain excess fluid into the external sac. Occasionally, a shunt system - which includes a flexible silicone rubber tube (shunt) and a valve - may create a channel to drain fluid from the brain and into the abdominal cavity.

Treatment of stable cerebral aneurysms

Endovascular ablation or coiling may be used to keep brain aneurysms stable and help prevent future rupture. However, the known risks of these procedures outweigh the potential benefits.

Neurologists and neurosurgeons can help determine if treatment is appropriate. Factors to be considered in making an offer include:

Size and location of the aneurysm.

Age and general health.

Family history of the ruptured aneurysm.

Congenital problems increase the risk of ruptured aneurysms.

If you have high blood pressure, talk to your doctor about medications to manage. If a brain aneurysm is present, proper blood pressure control can reduce the risk of rupture.

Lifestyle and remedies

If you have an unruptured brain aneurysm, your risk of rupture can be reduced by making lifestyle changes:

Do not smoke or use drugs. If you smoke or use drugs, talk to your doctor about an appropriate strategy or treatment program to help quit.

Healthy eating and exercise. Dietary changes and exercise can help lower blood pressure. Talk to your doctor about appropriate changes.

Limit coffee. Caffeine is a stimulant that can cause a sudden increase in blood pressure.

Avoid stress. Sudden, vigorous and sustained effort, like lifting heavy weights, can cause a sudden increase in blood pressure.

Use caution when using aspirin. Talk to your doctor before taking aspirin or other medications that inhibit blood clotting because it can increase blood loss if an aneurysm ruptures.