Arterial cerebral aneurysms are one of the common causes of life-threatening intracranial hemorrhages. Arterial aneurysms are a limited or diffuse expansion of the lumen of an artery or protrusion of its wall. Most often, saccular aneurysms are found, which look like a small thin-walled sac in which the bottom, middle part, and neck can be distinguished. More rare forms are spherical, fusiform (fusiform), or S-shaped.
The wall of the brain aneurysm is a plate of cicatricial connective tissue of varying thickness. In the cavity of the aneurysm, there may be blood clots of various ages.
The cause of arterial brain aneurysm formation is established only in a small number of patients. About 4-5% of aneurysms develop in connection with the ingress of infected emboli into the arteries of the brain. These are the so-called mycotic aneurysms. Atherosclerosis plays an undoubted role in the origin of large spherical and S-shaped aneurysms. The occurrence of saccular aneurysms is associated with congenital inferiority of the arterial system of the brain. Atherosclerosis and hypertension, as well as trauma, play a significant role. Aneurysms can be single or multiple.
Clinical manifestations of the cerebral brain aneurysm
Almost all vascular diseases of the brain have common symptoms – a cerebral aneurysm is no exception.
The appearance of neurological symptoms is associated with the squeezing of various nerve formations by the aneurysm: cranial nerves, parts of the brain, nearby blood vessels. The most common complaint of people with intracranial vascular anomalies is headache (cephalalgia). It can be of a different nature, location and intensity. Migraine-like pains that extend the half of the head, occiput pain, neck, or eyeball are possible. Localization of discomfort depends on the location of the aneurysm. In case of impaired CSF flow, the hydrocephalic syndrome may develop due to increased intracranial pressure, accompanied by a diffuse headache with a feeling of pressure on the eyeballs and nausea.
Cephalalgia can be combined with signs of compression of certain cranial nerves or parts of the brain aneurysm :
- double vision (diplopia) in the horizontal plane with impaired abduction of the eyeball outward with damage to the abducens nerve by an aneurysm in the cavernous sinus;
- oculomotor disorders, combined with ptosis, unilateral constriction of the pupil, and a decrease in its response to light, occur when the oculomotor nerve is damaged by a large aneurysm at the junction of the internal carotid and anterior communicating arteries or aneurysm of the superior choroidal artery;
- loss of visual fields due to compression of the optic nerve or the outer part of the chiasm by the supracliniform aneurysm of the internal carotid artery or aneurysm in the area of the bifurcation of this vessel;
- peripheral paresis of the facial nerve (with drooping of the lower eyelid, impaired tear production, and pronounced asymmetry of the face) due to the pressure of the brain aneurysm of the main artery;
- unilateral facial pain with loss of sensitivity when the trigeminal nerve is compressed by an aneurysm located within the cavernous sinus;
- hemiparesis or hemiplegia with unilateral pyramidal symptoms, impaired sensitivity, and a decrease in the possibility of voluntary movements with intracerebral hematoma or stealing syndrome of the motor cortex;
- bulbar syndrome with an aneurysm located in the posterior cranial fossa;
- various forms of aphasia (speech disorders) and other disorders of cortical functions;
- emotional lability, emotional volitional disturbances with decreased drive control or apathy, mnestic decrease, pseudobulbar syndrome with damage to the frontal lobes and hypothalamus with aneurysms of the anterior cerebral or anterior communicating artery, including intracerebral localization.
Causes and types of ruptured cerebral aneurysm
Causes of ruptured cerebral aneurysm
The reason for the development of an intracranial cerebral aneurysm cannot always be accurately determined. According to statistics, a certain role is assigned to predisposition at the genetic level.
In addition to heredity, the following factors affect:
- high blood pressure;
- atherosclerosis (vascular calcification);
- head trauma;
- age 50 and older;
- alcohol and drug abuse;
- diseases of the circulatory system;
- low estrogen levels after menopause;
- smoking (promotes atherosclerosis, increases blood pressure).
The classification of pathology is based on its form:
- Saccular brain aneurysm. It occurs most often among cases of aneurysms in the brain area.
- Exfoliating aneurysm. The formation has an elongated shape and is located between the layers of the vessel wall. It is often found on the aorta due to the appearance of an intimal defect. Blood begins to gradually penetrate, stratifying the walls and provoking the formation of a cavity. In the blood vessels of the brain, pathology is much less common than in the aorta.
- Vertebral aneurysm. Also rarely found in the blood vessels of the brain, it develops mainly on the wall of the aorta. Formation of a cylindrical shape, the vascular wall expands evenly.
- At the initial stage of formation, the aneurysm does not manifest itself in any way. As the pathology develops, the symptoms become pronounced. This is due to the pressure of the formation on the surrounding tissue or rupture and ingress of blood into the brain tissue.
Small (up to 11 mm), medium (up to 25 mm), and large (more than 25 mm) aneurysms are divided by size. Also, the disease can be congenital and acquired, with multiple and single formations.
Diagnostics of ruptured cerebral aneurysm
To identify an aneurysm and choose the right treatment tactics, it is necessary to carry out a complete diagnosis of the patient, including spiral computed tomography (CT), magnetic resonance imaging (MRI), and X-ray contrast angiography of the cerebral blood vessels. Accurate research results allow the neurologist and neuroangiosurgeon to choose the most appropriate treatment method.
- CT and MRI – tomography can quickly identify a ruptured aneurysm. The results can be obtained a few minutes after the tomography, which can play an important role in saving the patient.
- A referral to CT can also be prescribed if other pathologies are suspected during differential diagnostics. The MRI shows what exactly led to the development of changes in the structure of the blood vessels. This procedure is also performed after surgery. The picture clearly shows the consequences after the operation to remove the cerebral aneurysm.
- Angiography – allows you to accurately determine the localization and degree of vascular lesions. With the help of angiography, it is possible to determine whether surgical removal of the aneurysm is necessary or whether conservative treatment can be dispensed with. The disadvantage of this type of research is the high complexity of the manipulation. With the introduction of contrast into the blood, allergic reactions are possible. The revealed aneurysm is a “time bomb”, which sooner or later, but will certainly lead to rupture of the vessel and subarachnoid or intracerebral hemorrhage (hemorrhagic stroke). If surgical treatment is not carried out on time, the consequences of an aneurysm can be catastrophic.
- Coma after a ruptured aneurysm – occurs due to the ingress of blood into the subarachnoid space and mixing with cerebrospinal fluid
- Death. About 75% of patients die at the preoperative stage. The probability of death after surgery is reduced to 15%. Sudden vascular angiospasm is the cause of stroke, death, or, with a successful outcome, the patient’s disability.
Treatment of ruptured cerebral aneurysm
Surgery is the only effective treatment for cerebral aneurysm therapy. After receiving the results of the patient’s examination, the surgeon decides on the appropriateness of the surgical operation. Since the consequences of a ruptured cerebral aneurysm are lethal, surgical intervention can save the patient’s life.
Previously, the surgeon, together with the patient, discusses the possible risks and outcomes of the disease and determines the appropriate treatment method. According to the indications, the following types of operation are prescribed:
- Clipping aneurysm – the procedure is carried out as follows: a hole is cut in the skull through which a special metal clip is inserted and the wall of the damaged vessel is clamped. Life after clipping has many limitations; the patient is assigned a disability group. In addition, this type of surgery does not prevent the formation of a second aneurysm.
- Embolization of an aneurysm is one of the most common methods of treating disease.
Intravascular spiral embolization is possible with a saccular brain aneurysm and a small lumen of the anastomosis. With a wide lumen, it is possible to simultaneously apply a stent (closure of the lumen) with subsequent spiral embolization of the aneurysm. The tactics are chosen by the neuroradiosurgeon after the angiography.
Embolization of an aneurysm results in the cessation of blood flow in the aneurysm (protrusion), maintaining normal blood flow through the cerebral artery. In the process of embolization, a catheter is inserted through convenient vascular access (usually inguinal) under radiological control and held up to the aneurysm. Then a thinner micro-catheter with a micro-wire coiled inside it is inserted into the catheter and inserted into the aneurysm cavity.
As soon as the tip of the microcatheter is in the aneurysm cavity, a micro coil is released from the microcatheter, which changes its shape, and in the form of a random coil of wire occupies the aneurysm cavity. For larger aneurysms, several coils may be needed. An aneurysm filled with a wire spiral is turned off from the bloodstream and gradually overgrows with connective tissue, that is, the possibility of its rupture is excluded.
In most cases, endovascular embolization is the least invasive method of treating cerebral aneurysms today. If it is impossible to carry out intravascular embolization or stenting, the usual neurosurgical operation of vessel stenting or aneurysm clearing can be performed.
Rehabilitation of ruptured cerebral aneurysm
Rehabilitation does not reverse the effects of a stroke. Stroke rehabilitation goals are to mobilize strength and power, to gain confidence to continue your normal daily activities, despite the consequences of your stroke.
Rehabilitation aims at gaining independence for a person who has suffered a stroke in many areas.
- Self-help skills such as feeding, grooming, bathing, and dressing;
- Mobility skills such as fine movement, walking, or driving self-propelled wheelchairs;
- Communication skills;
- Cognitive skills such as memory or problem solving;
- Social skills for interacting with other people;
Specialists provide a treatment program specifically suited to each individual. The rehabilitation program that a person who has suffered a stroke will receive will depend on each specific case.
A rehabilitation program of a ruptured cerebral aneurysm may include:
- Restoring feeding;
- Electroneurostimulation to restore lost motor functions;
- Dynamic propriocorrection – wearing reflex-load suits, helps to restore motor functions;
- Diagnostics and treatment of vertigo;
- Balneotherapy – the effect of mineral waters – is used to treat, prevent and restore the body;
- Stabilometry – a program aimed at restoring the vestibular apparatus;
- Teaching methodology for free control of vertical posture based on biofeedback, in the form of dynamic exercises;
- Vibration stimulation on the support zones of the feet;
- It is possible both in normal walking mode and in the absence of the patient’s ability to move. This method stimulates nerve impulses that occur when walking and is effective for the prevention of thrombosis. Used after stroke and heart attack;
- Speech therapy – the restoration of lost speech skills;
- Studies of bioelectric potentials arising in human skeletal muscles upon excitation of muscle fibers. Allows you to identify the features of the functioning of muscles and nerve centers involved in the movement, as well as to trace their interaction;
- Therapeutic and rehabilitation effects on various receptors;
- Various types of hydrotherapy (hydromassage, swimming pool);
- Color therapy – treatment with visual color images;
- Special effect on auditory and visual analyzers, for the treatment of neurological disorders.
Methods for the prevention of brain aneurysm
Proper prophylaxis of the brain protects against the occurrence of pathologies in healthy people and alleviates the condition in sick people. Preventive measures are divided into primary and secondary. The first option is recommended to prevent vascular problems in a person who has no health problems or is at risk:
- abuses smoking and alcohol;
- leads an inactive and sedentary lifestyle;
- age over 30;
- has a genetic predisposition;
- suffers from diabetes and blood pressure;
- experiences frequent emotional stress.
In this case, the prevention of vascular diseases of the brain consists in revising nutrition and in observing the basic principles of a healthy lifestyle:
- give up foods high in cholesterol;
- engage in moderate physical activity (gymnastics, hardening, and long walks);
- consult a doctor for systematic headaches, fainting conditions, constant fatigue, and a sharp deterioration in vision.
Secondary prevention of the brain aneurysm involves improving health in the presence of vascular diseases. To avoid deterioration and complications, strengthen the blood vessels. To prevent atherosclerosis of the brain and other vascular diseases, control the possible risks. Perform the following manipulations:
- If you tend to increase or drop in blood pressure, measure the pressure every day;
- Get tested for cholesterol;
- An ECG should be passed;
- With diabetes, constantly check your blood sugar;
- Get an MRI of the brain for prevention.
Methods of prevention brain aneurysm without medication
Non-drug prevention of diseases of the spinal cord and brain consists of lifestyle changes. At the same time, regular physical activity, herbal medicine, and water procedures are recommended.
Prevention of brain aging involves adhering to the principles of nutrition:
- Replace animal fat with vegetable fat;
- Reduce the number of animal fats – offal, fatty meats, and butter;
- Consumption of marine fish such as cod, halibut, and mackerel are encouraged;
- The menu should contain a significant amount of fruits, vegetables, herbs, and berries;
- Choose low-fat fermented milk products from dairy products;
- Eat fractionally about 4-5 times a day;
- Boil the dishes, simmer and bake;
- Drink plenty of clean water;
- Add fruit drinks, compotes, and juices to the diet.
Prevention after a concussion also involves adhering to the principles of good nutrition.
Exercise to prevent a brain aneurysm. To prevent the occurrence of cardiovascular pathologies, the following are useful:
- running and cycling;
- water procedures with a light hardening effect (contrast shower and swimming pool).
Regular exercise will improve the firmness and elasticity of blood vessels. The best prevention of a concussion is safety. Wear a helmet when riding a bicycle or motorcycle, and special protective equipment for contact sports.