Cerebral aneurysm - Hospital Medical Information

Justice
It refers to the case where the inner elastic layer and the middle membrane forming the inner part of the cerebral blood vessel are damaged and deficient and the blood vessel walls swell up to form a new intravascular space. More than 90% are found in the thick cerebral artery of the brain at the base of the brain called Willis ( circle of Willis ) and the rest are distal (the proximal part of the blood vessel near the heart , the distal part farther away, Which supplies blood directly to the brain ) occurs in the cerebral arteries, or in the arteries that are responsible for the larynx or horseshoe of the brain . Most cases are less than 10 mm in size but occasionally larger aneurysms may develop. More than 25 mm is referred to as a giant aneurysm. The aneurysm is divided into a cystic aneurysm, a pseudoaneurysm, and a dissecting aneurysm.


Types of aneurysms
Types of aneurysms
cause
The exact cause of the aneurysm is unknown yet. However , it is presumed that an aneurysm develops and grows due to cracks in the wall of the blood vessels, which are generated on the hemodynamically high pressure area, based on the occurrence of the artery or proximal part . It is commonly found in the 40s to 60s, and in about 20%, multiple aneurysms are found. In rare cases, an aneurysm may occur if the blood vessel is inflamed, the trauma is damaged, or if there is a genetic problem with the vessel wall. Noedong venous malformations and moyamoya disease ( moyamoya disease if you have cerebrovascular disease such as) should also be accompanied by an aneurysm. Smoking, hypertension, or drug use has been reported to cause aneurysms of the cerebral arteries, but this has not been clear.


Symptom
The aneurysm of the aneurysm is often seen as a result of hemorrhage, and the aneurysm of the cerebral artery compresses the surrounding nervous tissue, leading to abnormal neurologic symptoms . The membrane that surrounds the brain is the soft membrane and the membrane, and the space between them is called the subarachnoid space. This space is filled with body fluids called cerebrospinal fluid. The aneurysm originating from the cerebral artery is located in the subarachnoid space. When the bleeding occurs , blood is spread primarily in the subarachnoid space, which is called subarachnoid hemorrhage .

Sometimes the blood penetrate the brain parenchyma or cause a brain hemorrhage or brain tissue through another space in the brain ventricles to reach sometimes accompanied by intraventricular hemorrhage. Bleeding time headaches to occur, patients have a hammer head severe enough to express eopeotdago seems beaten down firmly on the life or less so sick pains to appeal.

Bleeding itself causes the menstrual irritation, nausea, vomitingIn severe cases, the pressure in the skull, which is a tight space, is increased, and when the brain is severely compressed, it falls into a state of consciousness or coma , and in severe cases, it may die before reaching the hospital.

In addition, accompanying cerebral hemorrhage may result in neurological deficits associated with damaged areas, such as hemiparesis . When blood vessels contracting around the cerebral arteries due to the blood component flowing into the subarachnoid space over time , blood supply to the brain decreases, causing neurological deficits or decreased consciousness or cognitive function (speaking, writing, thinking, Etc.) may be present.

On the other hand, if the circulation of the cerebrospinal fluid, which causes bleeding fills the subarachnoid space, which prevents smooth, which builds up the cerebrospinal fluid in the ventricles or subarachnoid space hydrocephalus occurs and, thereby consciousness decreased, gait disorders, memory disorders, and urinary frequency, etc. Of the symptoms.

If there is no evidence of bleeding, the aneurysm itself may constrict the surrounding structures, or may cause abnormal neurological symptoms of the peripheral nerve due to very fine bleeding . In the case of large aneurysms if the aneurysm occurred in a traffic artery and well-accompanied by a compression symptoms such as brain tumors, and the third time it is situated close to the nerve eyelidsSymptoms such as sagging, diplopia, etc. are sometimes accompanied. Recently, there are many cases that are found without any symptoms . The incidence is increasingly found by brain magnetic resonance imaging ( MRI ) or computed tomography ( CT ) as a medical examination or other diseases .

Diagnosis
Listed as abnormally protrude from the scan were normal cerebral blood vessels when the structures found are diagnosed with cerebral aneurysm. Sometimes the bleeding when we accompany the arteries and flow can not seem pushed by the hematoma, this case is confirmed by a test performed again after about two weeks. Subarachnoid hemorrhage , cerebral hemorrhage, intraventricular hemorrhage, vasospasm and hydrocephalus can be diagnosed by brain imaging, and sometimes imaging tests On when a cerebral aneurysm bursts strongly suspected from the symptoms but not the subarachnoid hemorrhage cerebrospinal fluid through the test A small subarachnoid hemorrhage may also be diagnosed.

Aneurysmal imaging
Aneurysmal imaging
inspection
Brain computer tomography ( CT ), MRI ( MRI ), brain blood vessels checks in angiography. Recent advances in technology have allowed us to diagnose and plan for treatment of cerebral aneurysms using only brain CT or brain magnetic resonance imaging , a noninvasive test . However, invasive brain angiography is still the most important test, and it plays a crucial role in diagnosing and planning the treatment plan.

cure
In the case of non-fatal arterial aneurysms, the age, health status, position, shape and size of the aneurysm should be considered. If the size of the aneurysm is less than 2 mm or the age of the patient is old and other serious diseases are present, Conservative treatment may be performed while observing. In the case of a ruptured aneurysm, the possibility of rebleeding is reduced and the patient is actively treated to treat the complications that occur later.

There are two types of treatment: cranial and cerebral aneurysm ligation and intravascular coil embolization. Aneurysm ligation is a neurosurgeon as surgery of the traditional method of force in removing the skull pieces and originating site (in the back a small clip securing the aneurysm is located between the brain tissue origin of) ligation ( surgical words commonly used in the vascular Or tie up a part of it). If it is not possible to ligate completely if the position is bad or the shape is bad, the remaining part is covered with special gauze so that the operation will be performed so that even if bleeding occurs, it will buffer.

Endovascular coil embolization has developed spectacularly in recent years, usually legsA small tube of metal is inserted through the femoral artery to access the cerebral artery, and then the coil is inserted into the aneurysm. In simple terms, it is less burdensome than laparoscopic ligation in patients. However, since all aneurysms can not be treated by coil embolization, it may cause dangerous results. Treatment of vasospasm and hydrocephalus , complications that may occur after

subarachnoid hemorrhage , may be necessary. Because vasospasm contracts the cerebral artery, it can approach the blood vessel and administer medication or expand directly by balloon. Hydrocephalus refers to the state of cerebrospinal fluid accumulation in the brain, which can be solved by flowing cerebrospinal fluid out of the skull. If hydrocephalus develops temporarily, external drainage can be performed temporarily. If permanent CSF absorption occurs, surgery will be performed so that CSF can be absorbed in other parts of the body. Typically, CSF is introduced into the abdominal cavity There is a ventricular -abdominal shunt.

Surgery to directly ligate the aneurysm with craniotomy

Cerebral angiography with intravascular coil embolization
Complications / Complications
In the case of a ruptured cerebral aneurysm, about 15% died before arriving at the hospital, about 28% died during treatment, and about 18% of the survivors could be fatal enough to report normal life without disability. Although the mortality rate has been lowered and the patient has returned to normal life with the recent advancement of medicine, it still has a high prevalence and mortality rate. The first bleeding inde patient's condition is the most important prognostic factor immediately, poor awareness care more severe the defect is significant poor prognosis regardless of treatment is influenced in establishing the presence and future treatment plan.

On the other hand, rebleeding, vasospasm , and hydrocephalus are the most common complications after first bleeding, and rebleeding is most frequent within 24 hours after the first bleeding and mortality rate is considerably higher than 70%. Vasospasm occurs in about two - thirds of cases, and about one - third in cases of symptoms. It usually occurs between 3 and 14 days after bleeding, and if not treated, it may cause cerebral infarction. Hydrocephalus can be acute or chronic, and causes symptoms due to increased intracranial pressure.

If there is no evidence of hemorrhage and neurological deficits are present, the symptoms are often retained even after treatment of the aneurysm . For example, in the case of aneurysms occurring in the traffic artery after the third time nerveIn the event of a disability, it is often maintained after treatment.

The incidence of asymptomatic cerebral aneurysms is increasing. The possibility of rupture depends on the size and location of the aneurysm. The possibility of hemorrhage of non-parotid cerebral aneurysm is larger, older, and located in the posterior circulation than in the entire circulation When reported as high. Therefore, based on this, the treatment and the timing of treatment are decided. Unruptured aneurysms international research group of researchers ( International Study name of of Unruptured Intracranial aneurysms Investigators , ISUIA According to an article published in), but depending on the size of the aneurysm and reported that the rupture probability in each year approximately 0.05 to 1% The possibility of rupture of the large cerebral aneurysm is as high as 30 ~ 50%.

In addition, heart diseases such as arrhythmia or myocardial infarction are often associated with complications such as electrolyte abnormalities such as hyponatremia or neurogenic pulmonary edema . In other words, in patients with subarachnoid hemorrhage , it is difficult to monitor the condition of other body parts as well as brain lesions.


Prevention Methods
There is no clear preventive measure because it does not know the cause. However, it is advisable to check the cerebral angiogram once a year if there is no symptom at the age of middle-aged or older . If it is found in advance, it can be treated before it ruptures and causes problems.

Living Guide
Although the cause of the aneurysm is unclear, the hypothesis that the cerebral blood vessels continue to undergo pressure due to continued pressure on the aneurysm may be accepted to some extent, so proper exercise and healthy eating should keep the blood vessels strong It can be helpful. On the other hand, the causal relationship is not clear, but it is good to note that hypertension and smoking are reported to be relevant.

Diet
I will drink.