Cerebral vascular aneurysms

Cerebral vascular aneurysms are pathological dilations of one or a pair of blood vessels, which is manifested by bulging of their walls. The disease can be congenital and acquired. Its danger lies in the sudden rupture of the aneurysm, which provokes intracranial bleeding, which leads to severe neurological complications or death. The only effective way to treat pathology is surgery. To stabilize the patient before surgery, medication therapy is prescribed.

The content of the article:
Causes of cerebral vascular aneurysms
Arterial hypertension
Atherosclerosis
Infection
Traumatic brain injury
Classification of cerebral vascular aneurysms
Symptoms of cerebral vascular aneurysm
Rupture of a cerebral aneurysm
Diagnosis of cerebral vascular aneurysm
Treatment of cerebral vascular aneurysms
Prognosis of cerebral vascular aneurysm
Cerebral vascular aneurysms
Causes of cerebral vascular aneurysms
The role of factors provoking vascular aneurysm is still being studied by scientists. Most researchers agree that the disease occurs due to the impact on the body of several causes at once. In neurology, it is customary to distinguish congenital and acquired causes of aneurysm formation.

Congenital factors include genetic anomalies that provoke a pathological change in the structure of connective tissue fibers, as well as the formation of arteriovenous anastomoses between arteries and veins. The most common genetic abnormalities that are combined with an aneurysm include the following:

fibromuscular dysplasia;
Osler-Randu syndromes;
Moyamoya;
Marfana;
Ehlers-Danlos;
elastic pseudoxanthoma;
systemic lupus erythematosus;
tuberous sclerosis.
Arterial hypertension
Arterial hypertension plays an important role in the occurrence of the disease, the main manifestation of which is a persistent increase in blood pressure (blood pressure). With a prolonged course of this pathology and the absence of adequate medical treatment, a number of serious vascular injuries occur. Increased pressure provokes increased hemodynamic stress on the vascular wall. If the patient has other predisposing factors, this pathological process leads to the formation of an aneurysm.

Atherosclerosis
In many cases, arterial hypertension is accompanied by atherosclerosis — a violation of lipid metabolism. In addition, atherosclerosis can itself cause aneurysms in the vessels of the brain, since atherosclerotic plaques weaken the walls of blood vessels.

Infection
Another common cause of the disease is infection. In infectious foci, inflammation occurs, leading to the formation of pro-inflammatory substances that can damage vascular walls. Bacteria also have a negative effect on blood vessels. People with infectious diseases such as meningitis, fungal infection, bacterial endocarditis are more at risk of aneurysm.

Traumatic brain injury
The cause of an aneurysm may be a closed craniocerebral injury. After a strong and sharp mechanical impact, delaminating aneurysms may form, which differ from the usual ones in that they appear due to the leakage of blood between the membranes of the vessels. As a result, a cavity is formed in the vessel, gradually delaminating its shells. The consequence of this process may be bleeding, rupture or a decrease in blood flow in the brain.

Classification of cerebral vascular aneurysms
Neurology uses an extensive classification of blood vessel aneurysms. First of all, they can be divided into three main types: true, false (traumatic) and stratified. True, in turn, are divided into sclerotic, syphilitic, mycotic and arrosive, false — into arterial, arteriovenous and combined, delaminating — into aneurysms of the aorta and peripheral arteries.

Depending on the form of pathology, it is customary to distinguish fusiform and baggy aneurysms. The classification of aneurysms, depending on the arteries on which they are localized, distinguishes the following types of pathology: multiple aneurysms (located on several arteries at once), as well as aneurysms on the middle cerebral artery, on the arteries of the vertebro-basilar system, on the internal carotid artery, on the anterior cerebral artery.

Accurate detection of the localization and size of the aneurysm has a crucial role in the selection of optimal methods of treatment of the disease. The size of the aneurysm causes the possibility of its rupture. Depending on the size of the formation, they are miliary (no more than 3 mm), ordinary (up to 15 mm), large (ranging from 16-25 mm), giant (more than 25 mm).

Symptoms of cerebral vascular aneurysm
Most patients who have a vascular aneurysm, up to its rupture, do not complain of any specific symptoms. This is the reason for the high percentage of patient mortality. Sometimes an aneurysm manifests itself with mild symptoms, which the patient almost always ignores. However, it is possible to identify a number of symptoms indicating the presence of an aneurysm, which usually manifest if its size increases. The most characteristic symptoms include the following:

Visual impairment. If the aneurysm is localized near the optic nerves, this leads to their partial compression and vision problems. The closer the formation is located to the nerve junction, the more serious the consequences of a brain aneurysm may appear (partial or complete blindness).
Headache. Painful sensations appear due to compression of the soft and spider membranes of the brain, in which many nerve fibers and pain receptors are localized. Headache usually has a unilateral subacute character, is pulsating, localized in the area behind the eyes.
Convulsions. Large aneurysms, the size of which exceeds 25 mm, squeeze the motor parts of the cerebral cortex, which provokes convulsions. By their nature, seizures differ from seizures of epilepsy, but it is possible to detect differences between them only after differential diagnosis.
Damage to the cranial nerves. Compression of the cranial nerves often leads to complications such as paralysis of facial muscles, severe tinnitus, drooping of the upper eyelid, auditory hallucinations, taste disorders.
Transient ischemic attack. It is a violation of cerebral circulation lasting about a day. Typical symptoms of such an attack are vomiting, nausea, loss of consciousness, dizziness, memory loss, loss of orientation in space, speech impairment, paralysis.
Rupture of a cerebral aneurysm
The most dangerous complication of a vascular aneurysm is its rupture and subsequent subarachnoid hemorrhage, which often causes the death of the patient. Many patients notice a number of symptoms a few weeks before the rupture of education. If you immediately seek medical help after their appearance, you can significantly increase the chances of recovery.

Symptoms preceding the rupture of an aneurysm are dizziness, convulsions, double vision, pain in the area behind the eyes, speech problems, tinnitus, drooping of the upper eyelid. If the aneurysm ruptures, the patient has a sudden severe headache. It appears due to the effect of the broken blood on the membranes of the brain, on which there are many nerve endings.

Patients also have symptoms of irritation of the meninges that occur under the influence of blood on them. Patients complain of photophobia, pain in the muscles of the legs and back, inability to touch the chest with the chin due to limited mobility of the neck. Frequent signs of hemorrhage are nausea and vomiting, which were not caused by eating. Almost half of the patients have frequent loss of consciousness, which occur due to increased intracranial pressure. Over time, the pressure becomes so high that there is a serious violation of blood circulation in the brain. This leads to oxygen starvation of the brain, which provokes the loss of various neurological functions.

Diagnosis of cerebral vascular aneurysm
Diagnosis of a cerebral aneurysm should be a complex process, the main objectives of which are both the detection of pathology and the assessment of the patient’s health, the identification of other serious diseases. An important stage of diagnosis is the collection of anamnesis, which provides for the determination of the following indicators: family history of diseases, the presence of injuries in the patient, other systemic pathologies and allergic reactions, the time of the appearance of the first signs of the disease and their severity.

Then the neurologist proceeds to a physical examination, during which he applies the following procedures:

palpation — allows you to identify the symptoms of connective tissue diseases associated with an aneurysm;
auscultation — detects noises at the level of the aorta, carotid arteries and heart;
blood pressure measurement — increased blood pressure indicates the likelihood of an aneurysm rupture;
neurological examination is performed to assess skin and tendon—muscle reflexes, motor activity, irritation of the meninges.
Medical imaging techniques are also used for accurate diagnosis of vascular aneurysms:

Computed tomography: it reveals sac-like dilated vessels, destruction of bone tissue, symptoms of intracranial bleeding, the presence of blood clots in the aneurysm.
Angiography: it is necessary to track the trajectory of blood vessels and determine the location of their narrowing or expansion, as well as to detect blood clots.
Magnetic resonance imaging: used to detect bulging of the vascular wall, symptoms of cerebral hemorrhage, compression of nerve trunks.
Positron emission tomography: allows you to identify areas of reduced and excessive blood circulation.
Simple radiography of the cervical spine is used to detect symptoms of injury to the cervical spine in patients in a coma.
Transcranial Doppler ultrasound: detects spasm of brain vessels, areas with impaired blood flow and dilated vessels.
Electrocardiography: is a mandatory procedure during the preparation of the patient for surgery, because it allows you to identify the pathologies associated with aneurysm.
Lumbar puncture is necessary to determine the rupture of an aneurysm and subarachnoid hemorrhage.
Treatment of cerebral vascular aneurysms
Surgical operation is considered to be the only really effective way to treat aneurysms of cerebral vessels. Conservative treatment is used exclusively at the stage of stabilization of the state of health of patients. With the help of drug therapy, it will not be possible to eliminate the aneurysm, but this will reduce the risk of its rupture. Patients are also prescribed medications to eliminate the symptoms of a cerebral aneurysm.

To block calcium channels, which leads to vasodilation and improved blood circulation, nimodipine is prescribed. It is possible to slow down the spread of damaged nerve impulses with the help of anticonvulsant medications (phosphenitoin). To reduce the risk of aneurysm rupture, antihypertensive medications are indicated. According to the indications, painkillers and antiemetic medications are also prescribed

Surgical treatment
The main task of surgical treatment is considered to be the isolation of the aneurysm and its removal from the cerebral circulation. To do this, the following surgical techniques are used: craniotomy and aneurysm clipping, as well as endovascular aneurysm removal.

The first technique involves opening the patient’s skull and installing a special metal clip on the neck of the aneurysm. Thanks to this, doctors manage to achieve gradual necrosis of the aneurysm and its further replacement with connective tissue. Endovascular removal of an aneurysm involves the introduction of a flexible catheter into the bloodstream through a distant vessel and its further advancement into the aneurysm. At the next stage, a special spiral is inserted from the catheter into the aneurysm, provoking its blockage and subsequent death.

Prognosis of cerebral vascular aneurysm
The prognosis for the patient depends largely on the localization of the aneurysm and its size. If the aneurysm does not increase in size and does not cause any complications, then it may not require special treatment. The risk of death increases with aneurysm rupture and is about 30-50%. More than 25% of patients after the rupture of education have serious complications that lead to disability.

The only method of preventing sudden rupture of an aneurysm and hemorrhage is its surgical removal. You can also reduce the risk of this complication by using the following preventive measures: abstaining from alcohol and smoking, regular monitoring of blood pressure, a balanced diet, taking medications prescribed by a doctor, limiting physical activity. Self-medication is categorically contraindicated for patients, as it can provoke serious complications.

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