Brain aneurysm. How is it recognized and treated?

A brain aneurysm is called a “delay bomb” for a reason. They develop throughout life, and their detection is often accidental. Some brain aneurysms never rupture, others do so suddenly, causing a severe, staggering headache. Their appearance is related to heredity or is associated with other cardiovascular ailments.

Aneurysm – what is it?

A brain aneurysm is a pathological change in the structures of blood vessels. Its development occurs primarily in the arteries, and much less frequently in the veins. Interestingly, brain aneurysms most often occur in the front of Willis’ arterial circle, where the arteries of the brain fork. They are one of the most common causes of spontaneous bleeding inside the skull.

How does a brain aneurysm develop? This change is a widening of the blood vessel. It occurs when one of the several layers of the artery wall weakens. Under the pressure of the flowing blood, the vessel lumen expands, taking a round, oval or irregular shape. The walls of the brain aneurysm are thin and very weak, so they can easily rupture. Clots form inside the lesions and blood flow is disturbed.

Unfortunately, the mere presence of a brain aneurysm does not make itself felt. Usually, the patient finds out about its occurrence by accident during periodic examinations, diagnosing other diseases by imaging diagnostics (computed tomography or magnetic resonance imaging) or already at the time of medical intervention in the emergency department. According to statistics, brain aneurysm affects 5 percent. population of people around the world. The most common (as much as 80%) type of such a lesion is saccular aneurysm. Rupture occurs annually in 1 in 10 people on a global scale. It survives from 000 percent. up to 40 percent of them. It all depends on how quickly medical help arrives.

Brain aneurysm sizes vary. Some are a few millimeters in diameter, others grow up to several centimeters. And they are the greatest threat to the life and health of the patient. At what age is the most common brain aneurysm in the population? It turns out that people over 45 are in the highest risk group, mostly women.

Aneurysm – what is it made of?

Anyone can suffer from a brain aneurysm. Sometimes it is difficult for doctors to determine the causes. Nevertheless, there are people who are particularly vulnerable to its creation. Among the factors increasing the risk of aneurysm, there are acquired and congenital. It is mainly about:

1. congenital vascular defects – a defect in the structure of their walls, manifested by weakness or even lack of a muscular or elastic membrane,
2. atherosclerosis – weakens blood vessels, lowers their elasticity and limits blood flow,
3. arterial hypertension,
4. arterial injuries and inflammation as the primary causes of arterial epithelial dysfunction,
5. diabetic angiopathies,
6. infections
7. genetic burden – a family history of brain aneurysm should be a warning sign for other relatives; Genetic causes include Marfan syndrome and Ehlers-Danlos syndrome (EDS), but brain aneurysm may be inherited from a family history of type 1 neurofibromatosis.
8. connective tissue disorders that trigger a brain aneurysm in children (rare).

Doctors indicate additional risk factors for the development of a brain aneurysm. These are:

1. stimulants, especially when abused – drugs, alcohol, cigarettes,
2. age – the vast majority of detected cases are in patients aged 30 to 60, but mainly in people over 45; only 2 percent cases concern children and adolescents under 18 years of age,
3. gender – according to statistics, women are 3 times more likely to develop a brain aneurysm,
4. untreated high blood pressure.

Is it possible to develop a brain aneurysm from impact? The formation of such changes is chronic, which means that it lasts quite a long time. Therefore, it is not possible for a brain aneurysm to grow out after an accident. It is worth noting, however, that the shock may break such a structure.

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Brain aneurysm – types

There are several types of brain aneurysm. They arise in different parts of the brain and take different shapes. Stands out:

1. baggy aneurysm of the brain – is one of the most common aneurysms, it has a spherical or oval shape, and its size ranges from a few millimeters to several centimeters, most often located in the vessels of the arterial circle of the brain,
2. miliary aneurysm of the brain, also called microturotic aneurysm – small protrusions on the branches of cerebral arteries, which are formed mainly in the cerebellum, thalamus, bridge, shell and mantle of the brain,
3. fusiform aneurysm – resembles a highly developed and branched blood vessel in all directions, it has an irregular shape, it is formed mainly on the internal carotid and basilar arteries, as well as branches of the brain arteries directly adjacent to them, the most common causes of this type of aneurysm include the course of the syndrome Marfan and atherosclerotic changes in blood vessels,
4. Dissecting aneurysm – the most rare aneurysm in the brain, more often it is formed in the abdominal aorta as a result of damage to the inner wall of a blood vessel, it may also result from the course of Marfan syndrome.

Brain aneurysms are also classified according to their size:

1. fine – smaller than 3 mm in diameter,
2. small – up to 10 mm in diameter,
3. medium – from 10 to 20 mm in diameter,
4. large – larger than 20 mm in diameter,
5. giant – larger than 25 mm in diameter.

Aneurysm on the brain – symptoms

The very formation of changes in blood vessels is not associated with any sensations. However, specific symptoms can be noticed before the aneurysm of the brain ruptures, when it becomes large and puts pressure on the adjacent structures of the brain. An unburdened brain aneurysm has visible symptoms such as:

1. oppressive headache,
2. ptosis
3. pupil dilation,
4. double vision and decreased caution of vision

Brain aneurysm rupture is associated with life-threatening subarachnoid bleeding. In this case, the following symptoms occur:

1. lightning, sudden and very severe headache felt on one side,
2. stiff neck,
3. vomiting and nausea
4. photophobia.

As a result of bloodshed from the aneurysm into the structures of the brain, unconsciousness, speech disorders and limb paresis may occur. Brain aneurysm breaks mainly at times of severe stress and physical exertion (also during sex). As it turns out, as many as 1/3 of the aneurysms burst during sleep. If any of the symptoms occur, call an ambulance as soon as possible.

Brain Aneurysm – diagnosis of hemorrhage

Rapid diagnostic testing is essential to stop the havoc caused by a ruptured aneurysm as quickly as possible. A cerebral hemorrhage can be confirmed by diagnostic imaging. The recommended examination is computed tomography of the head. If its execution is impossible, the doctor may resort to several other methods, for example:

1. lumbar puncture – cerebrospinal fluid is collected and the presence of blood in it will be confirmed by a hemorrhage,
2. four-vessel angiography of the brain – a type of X-ray with contrast to the intracranial arteries,
3. angiography – non-invasive diagnostic examination with the use of magnetic resonance imaging and computed tomography.

Brain aneurysm – treatment

Brain aneurysms affect an average of one in 20 people in the world. Many of these people are unaware of this because the change goes unnoticed throughout their lives with no obvious symptoms. Increasing the risk of a well-formed brain aneurysm rupture fluctuates around 1-2%. with every year. However, it is even lower in the case of smaller lesions (e.g. 5 mm brain aneurysm). Then it amounts to from 1 per mille to 1 percent every year.

The decision to treat is not easy due to unclear prognosis. Sometimes the actions taken are exaggerated because the brain aneurysm is not life-threatening (it may never develop). Unfortunately, it happens that an aneurysm, which is inconspicuous at first sight, may turn out to be fatal. On the other hand, when a brain aneurysm ruptures, surgery is always performed.

There are two treatments for brain aneurysms:

1. brain aneurysm embolization – works well in the case of non-cracked as well as cracked lesions on the artery; it is an endovascular treatment, which consists in filling the aneurysm with springs through a vascular catheter, under the control of an X-ray machine; the aim is to exclude the lesion from circulation and provoke its clotting; the procedure is performed under general anesthesia.
2. craniotomy surgery – the procedure involves opening the skull, and then putting the cranial flap back in place; the purpose of the operation is to protect the aneurysm in the event of another rupture; it is done in three ways – clipping (placing a clip on the neck of the aneurysm), wrapping (wrapping the lesion on the artery with muscle tissue if the clip cannot be attached) and trapping (creating new vascular connections and excluding the lesion from circulation, which is especially useful in large brain aneurysms).

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Brain aneurysm – complications

The worst happened, brain aneurysm ruptured and what next? Successful surgery does not guarantee full recovery and physical fitness before surgery. This is primarily determined by the location and size of the brain hematoma. It is assumed that as much as 30 percent. people who have had an aneurysm rupture struggle with severe and irreversible neurological damage. In turn, 60 percent. patients do not regain their pre-hemorrhage quality of life despite rehabilitation.

Due to the rupture of the brain aneurysm, complications such as:

1. secondary bleeding – very dangerous because it carries a much higher risk of death; manifests itself in the same way as the primary bleeding,
2. ischemic and hemorrhagic stroke – may occur from a few to a dozen or so after the rupture of the brain aneurysm,
3. posttraumatic epilepsy – can occur at any time,
4. hydrocephalus,
5. epileptic seizures,
6. paresis of the muscles of the limbs or face,
7. grated speaking ability (aphasia).

Additional extracranial complications of a brain aneurysm include:

1. pulmonary oedema,
2. Cushing’s ulcer (ulcer in the stomach caused by severe disturbance of the central nervous system),
3. Heart arythmia,
4. myocardial infarction.

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