Generality
The term cerebral aneurysm indicates a pathological dilation, similar to a sac, of an arterial vessel present in the brain. The presence of this small protuberance is very dangerous, because it could break and cause a cerebral hemorrhage, with dramatic results for the patient.
The diagnosis must be rapid and precise, as the care to be given to the patient must be immediate. In fact, surgery and pharmacological treatments, if applied promptly, can save the patient's life.
What is a brain aneurysm?
A brain aneurysm is a permanent protuberance, similar to a pouch, of an arterial vessel in the brain. The appearance of this vascular malformation, reported by diagnostic images, is very reminiscent of a berry attached to a branch.
The presence of a brain aneurysm is very dangerous; in fact, when it is crossed by the blood circulating in the brain, it can break, as the vessel wall at that point is weaker and more fragile.
Figure: a cerebral aneurysm and the portions that compose it: neck, body and dome. From the site: www.neuros.net
Rupture of the aneurysm leads to blood loss in the brain ( cerebral hemorrhage ) and, subsequently, to hemorrhagic stroke . Hemorrhagic stroke is a dramatic pathological condition that requires immediate patient relief.
WHY IS IT IN THE BRAIN? WHERE EXACTLY?
An aneurysm can form in every blood vessel in the human body. However, there are points, such as the abdominal aorta and the brain, in which this formation is more frequent, due to the specific anatomy of the vasal system therein.
The most dramatic consequence of a cerebral aneurysm, or haemorrhagic stroke, occurs, usually, in the space between the skull, the meninges and the brain ( subarachnoid space ): in these cases we speak of subarachnoid hemorrhage and stroke subarachnoid hemorrhagic
TYPES OF CEREBRAL ANEURISMA
Pouch-like cerebral aneurysms are the most common, but they are not the only ones. In fact, there is another different typology of aneurysms, the fusiform ones.
- Saccular aneurysms (or saccular ): they are the most frequent ones, similar to berries or balloons. They consist of a neck (at the base) and a bulging dome. Only one side of the affected arterial vessel protrudes.
- Fusiform aneurysms : they are less common than the previous ones and consist of a swelling of the entire vessel. A neck and a dome cannot be distinguished, but they are however well evident.
Figure: a cerebral aneurysm with a saccular or saccular shape (above) and a fusiform (below). From the site: www.neuros.net.
Epidemiology
According to some Italian statistical data, about 1% of the population suffers from a brain aneurysm.
Of this fraction, 0.2-0.3% undergoes, during the life, a subarachnoid hemorrhage. Each year, the number of people subject to subarachnoid hemorrhage is 10-15 individuals per 100, 000.
20-30% of people who suffer an aneurysm rupture die before reaching the hospital; 50% die within 30 days of the event.
The age group most affected is between 40 and 60, although each individual (whether young or adult) is potentially at risk.
Finally, there was a greater predisposition by women: the relationship with men is 3 to 2.
Causes
A brain aneurysm (but in general all types of aneurysms) tends to form where the wall of a blood vessel is thinned and weakened.
The vessel traits most susceptible to developing an aneurysm are those at the level of the bifurcations, since the blood that passes through these regions has a more turbulent flow. In fact, the vigorous impact of the blood circulation, at the level of these already weakened areas, helps to make the vessel wall protrude.
But what are the causes that weaken the walls of a vase by laying the foundations for the formation of an aneurysm?
THE RISK FACTORS
The risk factors, linked to an aneurysm, are numerous. They can be distinguished in potentially treatable risk factors and untreatable risk factors .
By potentially treatable risk factors we mean all those conditions for which there is a medical / pharmacological or behavioral remedy. For example, chronic hypertension (one of the main causes of aneurysm) can be treated either by hypotensive drugs or by adopting a healthy lifestyle (hyposodic diet and movement).
By untreatable risk factors, on the other hand, we mean some characteristics of the patient that cannot be changed, such as age, race, genetic predisposition, etc.
The risk factors that can be treated:
| Untreatable risk factors:
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RISK FACTORS PRESENT AT BIRTH
Next to treatable and non-treatable risk factors, there is a third category of causes, of a congenital nature, that is, present since birth. These are particular pathologies, often characterized by abnormalities of the blood vessels of the circulatory system.
- Ehlers syndrome - Danlos . It is an inherited disease that affects connective tissue and makes blood vessels weaker.
- Polycystic kidney It is a hereditary disease, characterized by cysts in the kidneys. It causes chronic hypertension.
- Aortic coarctation . It is an abnormal narrowing of the aorta, which can cause high blood pressure.
- Arteriovenous malformation in the brain . Sufferers are born with an abnormal connection between arteries and veins, such that the flow of blood through these is interrupted.
Cerebral aneurysm: Symptoms, Diagnosis, Treatment and Prevention
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To learn more: Symptoms Cerebral Aneurysm
As long as the brain aneurysm remains intact and does not break down, it is rare for the patient to experience any particular symptoms or signs. If this happens it is because either the aneurysm is particularly large or because there is still a small loss of blood, despite the wall being intact.
SYMPTOMS OF A BREAKDOWN OF THE ANEAURISM
The most characteristic symptom of a brain aneurysm, which breaks down, is headache, or headache . This is a pain that certainly does not go unnoticed, as it is characterized by sudden onset and considerable severity. Often, it is defined by the affected individual as the strongest headache ever suffered in life.
In addition to headache, the patient may complain:
- Nausea and vomit
- Stiff neck
- Blurred and double vision
- Difficulty in moving the eyes
- Sensitivity to light
- Epilepsy
- Drooping eyelid
- Confusion
- Difficulty moving part of the facial muscles
Obviously, the aforementioned symptomatology is triggered by cerebral hemorrhage . It lasts a few seconds. However, this short period of time is sufficient, because the spilled blood floods the surrounding brain areas, compressing them and causing death. As has already been said, the most common hemorrhage is that which occurs at the level of the subarachnoid space .
SYMPTOMS OF A LIGHT BLOOD LOSS
Cerebral hemorrhage can also occur when the vessel wall of the aneurysm remains intact.
This is a small loss, yet capable of causing severe headache, with sudden onset.
In fact, this situation is the prelude to an imminent breakdown of the aneurysm. Therefore, it is also difficult to diagnose.
THE SYMPTOMS OF A NON-BROKEN CEREBRAL ANEURISM
The only cerebral aneurysms not yet broken, which cause a certain symptomatology, are the very large ones. The reason is simple: a large aneurysm compresses the brain tissue and the surrounding nerves.
The patient, in these cases, warns:
- Pain above and behind the eyes
- Dilated pupils
- Strange changes in vision or double vision
- Falling asleep, weakness and paralysis of the facial muscles
- Drooping eyelid
WHEN TO REFER TO THE DOCTOR
If action is not taken promptly and promptly, the rupture of an aneurysm has lethal consequences. Therefore, as soon as you notice an abnormal headache, as sudden and very strong, it is good not to delay and immediately request help.
COMPLICATIONS
When an aneurysm is broken in the brain, the complications related to it are mainly due to hemorrhage. The latter, in fact, in addition to irreparably damaging the brain tissue, can have several other consequences.
Increase intracranial pressure, making the patient lose consciousness or causing hydrocephalus .
Can cause vasospasm, or the reduction of the caliber of arterial vessels. This can cause, in the brain, a lack of blood supply and the onset of further damage ( ischemic stroke ).
It can develop hyponatremia, after brain damage has spread to the hypothalamus.
It can make the patient lose some motor skills and the faculty of language (this depends on the area of the brain involved and on the amount of time elapsed between the onset of symptoms and the beginning of treatment).
What are hydrocephalus and hyponatremia?
The term hydrocephalus indicates a pathological condition in which the cerebrospinal fluid increases dramatically within the subarachnoid space of the brain. This accumulation occurs when previously the intracranial pressure (hypertension) is increased. Possible causes of hypertension are: brain tumor, cerebral haemorrhage, meningitis, encephalitis, CNS malformations etc.
Hyponatremia, on the other hand, is a condition characterized by low levels of sodium in the blood. Sodium is a fundamental electrolyte, which allows the functioning of our body cells.
THE DANGER OF ANOTHER BLOOD
The hemorrhage following an aneurysm rupture lasts a few seconds. However, the likelihood of the episode recurring is considerable, as the vessel wall has weakened even more. Therefore, a first bleeding is often followed by other similar events.
CONTINUE: Cerebral Aneurysm - Diagnosis, Therapy, Prevention "
