Aneurysm of the main artery of the brain. The most common form of cerebral artery aneurysms is saccular. How does it manifest itself? paroxysmal headache

Such a change in the vessel occurs due to a decrease in the mechanical-elastic properties of its wall. The bulge puts pressure on adjacent tissues and nerves.

A brain aneurysm is usually located on the arteries that are located at its base. This place is known as the Circle of Willis. About 85 percent of aneurysms develop in its anterior part. This includes the carotid arteries, as well as their main branches that feed the middle and anterior regions of the brain. The most dangerous rupture of the aneurysm, which is accompanied by subarachnoid hemorrhage. What are the reasons for such a change in the vessels of the brain?

Photo of an aneurysm in a blood vessel

Causes

There are many factors that can lead to the development of this disease. Let's try to briefly describe them.

1. Congenital weakness of the connective tissue.
2. Heredity. It is noticed that an aneurysm can develop in those in whose family there were facts of this disease.
3. Marfan syndrome. This is a genetic disease of the connective tissue.
4. Diseases that lead to weakening of blood vessels, such as atherosclerosis.
5. Cystic medial necrosis. In this case, a dissecting aortic aneurysm is observed. A small tear forms in the inner choroid, blood enters the middle layer. Thus, the layers are separated from each other, and a new channel is laid. There are cases when, through a new gap, the blood returns to the main channel. Also, the delamination process can continue along the entire length.
6. Hypertonic disease. It can cause the development of the disease, especially if not treated properly.
7. Smoking. Statistics show that smokers develop aneurysms more often than those who have overcome this addiction.
8. Vascular injury. This factor is most typical for young people. This is especially true for accidents and extreme sports.
9. Formation of infected thrombi. Spreading along the wall of blood vessels, they contribute to the development of the disease.

Classification

A cerebral aneurysm can be classified according to the arteries it affects.

1. Cerebral anterior communicating artery.
2. Middle cerebral artery.
3. Internal cerebral artery.
4. Arteries of the vertebrobasilar system.
5. Multiple aneurysms that affect two or more arteries.

There is also a classification according to the Hunt-Hess scale, which subdivides the disease depending on the symptoms.

• Zero degree. This is an asymptomatic aneurysm, which is also unruptured and accidentally discovered.
• The first degree is also asymptomatic, but there may be a slight headache and slight stiffness of the posterior neck muscles.
• The second degree is characterized by a moderately severe headache, stiffness of the same muscles. There is also no neurological deficit, except for 6th cranial nerve palsy.
• In the third degree, drowsiness and a slight neurological deficit are observed.
• The fourth degree is marked by a state of stupor, moderately severe hemiparesis. Autonomic disturbances may also occur, as well as early decerebrate rigidity.
• The fifth degree is the last. This is a deep coma, agony and decerebrate rigidity.

According to the appearance of subarachnoid hemorrhage, there is a classification of the degree of the Fisher scale, which is important in CT scanning.

1. Grade one is the apparent absence of hemorrhage.
2. The second degree is a subarachnoid hemorrhage, the thickness of which is less than one millimeter.
3. Third degree - the thickness of the hemorrhage is more than one millimeter. In this case, the risk of vasospasm is very high.
4. Fourth degree - any thickness of the hemorrhage, there is also a hemorrhage in the ventricles of the brain or parenchymal expansion.

Symptoms

If the aneurysm is small and does not change, there may be no symptoms or they may be mild. However, before a large rupture, the following symptoms are observed:

• very strong and sharp headache;
• nausea;
• vomit;
• blurred vision;
• loss of consciousness.

Depending on how much blood came out, the following symptoms are observed:

• a severe headache that starts unexpectedly and may last for several hours or even several days;
• nausea;
• vomit;
• nap;
• coma.

If a rupture occurs, the brain itself may be damaged. This condition is called hemorrhagic stroke, which can lead to the following phenomena:

• convulsions;
• vision problems;
• problems understanding language or speaking;
• weakness or paralysis of the legs or arms.

Complications

We mentioned some of the complications above. However, much more can be said about them. After an intracerebral hemorrhage has occurred, cerebral edema begins. Due to the fact that blood decay occurs and the brain tissue reacts to this, necrosis and inflammation of the brain tissues develop, as a result of which the damaged areas of the brain stop working. This leads to the fact that the parts of the body that are controlled by the damaged area of ​​the brain will stop working. Other complications can be identified:

• cerebral angiospasm;
• cerebral ischemia, in some cases leading to death;
• re-rupture of the aneurysm;
• internal hydrocephalus.

In addition, a number of other consequences that are characteristic of a stroke should be highlighted:

• swallowing disorder;
• weakness, paralysis, movement disorders;
• speech disorders;
• behavioral disorders;
• cognitive impairment;
• psychological disorders;
• violation of defecation and urination;
• perception problems;
• pain syndrome;
• epilepsy.

Special attention should be paid to one of the dangerous complications of hemorrhage, which is vasospasm. In this case, the spasm leads to narrowing of the vessel. The greatest risk of such a phenomenon occurs in the first three weeks after the first hemorrhage. At this time, the patient may experience a spasm of the arteries of the brain, which can cause a stroke.

Vascular spasm can be controlled in several ways. The main method of monitoring is a neurological examination, as well as observation in the therapy department. Using ultrasound, you can measure the speed of blood in the arteries, which increases due to spasm. Diagnostics also includes other methods.

Diagnostics

Cerebral aneurysm is diagnosed using nuclear magnetic resonance and computed tomography. Using these methods, you can determine the size and location of education.

Diagnosis begins with recognizing the symptoms that the patient describes. However, the identified symptoms are valuable only in the event of intracranial bleeding. In another case, on the basis of symptoms alone, it is impossible to make an accurate diagnosis. To do this, you need to conduct angiography, that is, a study of the vessels of the brain. This method helps to identify education, and it also serves the same purposes as those listed at the beginning of the subheading of the diagnostic method.

Treatment

Cerebral aneurysm includes many different cases, each of which is unique. Treatment is not always carried out. It happens that doctors simply carefully monitor this pathological process. If surgery is needed, two forms are in demand today: occlusion and clipping.

Clipping a vessel with a clip

Thanks to clipping, it is possible to exclude aneurysms from the blood flow, while maintaining the patency of the surrounding vessels and the carrier vessel. Clipping is a complex operation with twenty percent deaths. The main task of occlusion is to tightly fill the aneurysm microcoil with coils, which prevents the penetration of blood into it.

If an aneurysm ruptures, emergency treatment is required, which is based on achieving two goals: reducing intracranial pressure and restoring breathing. There are also two methods for fixing the aneurysm: endovascular embolization and surgical clipping.

An aneurysm that does not rupture may go unnoticed for a lifetime. Unfortunately, there is no exact prevention of pathology yet. However, if an ailment is detected, it is necessary to be under the constant supervision of a doctor. You should also regularly monitor the pressure, stop smoking, use alcohol and drugs, especially aspirin and those that thin the blood, with extreme caution. It is important to avoid stress and overexertion. After a break, the rehabilitation period lasts more than one month.

If an aneurysm of the cerebral vessels is detected, you need to approach your health especially carefully. Relying on yourself in this case is pointless if you do not want to die. The observation of a doctor and the right lifestyle will help to identify the gap in time and prolong a life that will be long and happy.

The information on the site is provided for informational purposes only and is not a guide to action. Do not self-medicate. Consult with your physician.

SHEIA.RU

Basilar Artery of the Cerebrum: Aneurysm, Tortuosity

Aneurysm and tortuosity of the basilar artery

For full-fledged work, the human brain needs a certain amount of blood rich in oxygen and a number of useful elements. Two groups of vessels are responsible for the implementation of this process - paired carotid arteries and paired vertebral arteries. The basilar artery (BA) is formed at the confluence of two spinal canals.

Among other blood vessels supplying the brain, which are formed from the branches of the vertebral arteries, the anterior artery of the spinal cord and the inferior posterior artery of the cerebellum are distinguished. The front departs already from the BA.

Anatomical features of AD

The basilar artery forms under the lower part of the medulla oblongata. This vessel releases its 2 most important branches - the midbrain. They branch off in the region of the upper edge of the pons, after a long and rectilinear rise of the BA upward along the cavity located between the pons and the base of the skull. Before the formation of these two branches, BA gives off one more branch - the superior cerebellar. At the confluence of 2 vertebrates, the main artery of the brain is formed.

A whole network of posteromedial arteries departs from the midbrain branches, which deliver blood to the midbrain tegmentum. The second network branches off from the midbrain trunk. They reach the roof of the midbrain, passing over its surface and giving off many branches along the way.

BA supplies blood to important structures such as the medulla oblongata, peduncles, occipital region, and basal temporal lobe. And also to the cerebellum, mastoid bodies, the upper plate of the roof and the roof of the 3rd ventricle, the visual tuberosity, the labyrinth of the inner ear, the corpus callosum, the geniculate bodies.

Vessels supplying blood to the brainstem are divided into 3 types:

1. paramedial - delivering blood to the area near the BA;
2. branches of one basilar and two vertebral arteries - part of the trunk cover;
3. posterior cerebral - some parts of the midbrain.

There is no doubt that if all these structures are not adequately supplied, there will be serious consequences. Any disturbances in the basin of the basilar vessel lead to the development of dangerous diseases accompanied by unpleasant symptoms.

Pathologies can develop not in the BA itself, but in the vertebrobasilar basin. Since BA is a place of intercourse of two vertebrates, keeping their way through a canal constructed by holes in the transverse processes of the cervical vertebrae and up to a hole in the skull.

The region of the vertebrae is subject to numerous diseases - from osteochondrosis to pathological tortuosity. And any of them can affect the blood flow of BA and its branches. If for some reason the lumen is narrowed in one of the vertebral arteries, the blood flow through the common BA will decrease significantly, and the brain will begin to starve. What pathologies can develop and for what reasons?

Vertebrobasilar insufficiency

With the development of pathological processes in the arteries of the vertebrobasilar basin, a person develops vertebrobasilar insufficiency. This is a syndrome accompanied by a whole group of symptoms and processes that occur against the background of insufficient blood supply to the brain. The result of the syndrome is often a stroke.

In simple words, vertebrobasilar insufficiency is a violation of the brain due to some pathologies in the spine. "Vertebro" - everything that is connected with the spine. "Basilar" - localization of the problem in the brain. Vertebrobasilar syndrome is not selective - even children can suffer from it.

Causes

Reasons for the development of the syndrome:

• osteochondrosis;
• excess cholesterol, provoking the development of atherosclerosis;
• congenital anomalies associated with arteries - non-vertebrogenic syndrome of vertebral arteries;
• anomalies in the region of the cervical vertebrae - vertebrogenic syndrome of the vertebral arteries;
• inflammatory processes in the arteries;
• hypertension;
• diabetes;
• cervical intervertebral hernia;
• thrombosis of any arteries of the vertebrobasilar basin;
• neck compression and effective vasoconstriction;

Symptoms

Whatever the cause of the development of vertebrobasilar syndrome, the general symptoms will be similar. The first attacks due to oxygen starvation of the brain occur unexpectedly (sudden attack) or slowly (permanent attack). The first is the so-called ischemic attacks. The patient experiences weakness, loses the ability to control his own limbs, does not feel them - numbness, cannot move, loses balance, feels dizzy, pain in the neck, inability to swallow and speak, feels nausea. Vomiting may not relieve nausea.

An ischemic attack can last from several minutes to several hours. And often leads to stroke and death.

Permanent seizures, which are chronic in nature, are characterized as giving a person constant discomfort. Suddenly, at any moment in time, a person begins to feel severe pain, starting from the back of the head and moving to the temporal region. May lose consciousness, suffer from forgetfulness, get tired quickly, feel constant physical weakness, experience irritability. Also characteristic are deterioration in hearing, vision, tinnitus, mood swings, depression, sweating, loss of balance.

It is not necessary that all of the above appear at once. Headaches or a few other symptoms alone are enough to go to the doctor. Let's take a closer look at some of the pathologies.

Atherosclerosis

This is the formation of cholesterol formations (plaques) in the vessel. Against the background of atherosclerosis of BA, a fusiform or saccular aneurysm develops. This occurs at the point where 2 parallel vertebral arteries merge. Or in the area of ​​​​brain separation from BA. With the development of pathology, the BA lumen narrows significantly, and local hemorrhages begin to occur in the brain. Often, with this course of the disease, the patient's eye functions are disturbed.

Atherosclerotic pathology develops along the entire length of the BA, but its embolism occurs only in the bifurcation zone.

Tortuosity of the vertebrobasilar arteries

Pathological tortuosity of the vertebral arteries is another reason for the reduction in blood flow through the basilar artery and, subsequently, branches that supply the brain from it. This pathology increases the risk of ischemic stroke by 30%.

As a rule, pathology develops due to hereditary factors. Namely, if the tissues that make up the blood vessels are dominated by elastic fibers instead of collagen ones. As a result, the walls of the arteries wear out quickly, decrease in diameter and deform (twist). An additional factor for the development of tortuosity is atherosclerosis.

Tortuous arteries do not bother the patient for a long time, since the disease is asymptomatic. In addition, if any symptoms appear, the patient quickly gets used to them. But as soon as noticeable circulatory disorders in the brain begin, a microstroke occurs.

Most often, pathology occurs in the region of the 1st or 2nd vertebra of the neck, loops, spurs of the artery walls, kinks and aneurysms - other anomalies of the arteries - can also form here.

Osteochondrosis of the cervical region

Cervical osteochondrosis is more common than in any other department. This is a progressive degenerative-dystrophic lesion of the discs located between the vertebrae. With such a pathology, the growth of the cervical vertebrae and the possible resulting muscle spasm put pressure on the vertebral artery. As a result, blood flow in one or two (rarely) channels is reduced, and the brain does not receive enough blood to perform its functions.

The person himself is to blame for the development of osteochondrosis. The main reason for the appearance of pathology is the wrong lifestyle - a violation of posture, limited mobility, long sitting at the computer without warming up the neck ... Osteochondrosis is one of the vertebrogenic causes of vertebrobasilar insufficiency.

Among others affecting the arteries from the outside, the most common are tumors, bone growths, congenital and acquired anomalies (rare), herniated discs and thrombosis.

Thrombosis of the arteries of the vertebrobasilar basin

Arterial thrombosis is the formation of a blood clot in a vessel. Thrombosis of BA is considered the most dangerous of all possible. Since the branches of the basilar artery are arteries that deliver 70% of all the blood it needs to the brain. With untimely treatment, the disease leads to cerebral edema. It is characterized by all the symptoms of vertebrobasilar insufficiency, as well as paralysis of half of the human body, pain in the face and its distortion.

Depending on which of the arteries extending from the basilar, thrombosis attacked, more pronounced symptoms develop. If the ophthalmic artery - there will be loss of vision, and then blindness. If the artery directed to the labyrinth of the inner ear - hearing loss, and then deafness.

The result of thrombosis in the region of the vertebrobasilar basin is a stroke. And often fatal.

Aneurysm in the vertebrobasilar system

One of the most dangerous diseases that cause pathological processes in the vertebrobasilar basin is an aneurysm. Therefore, it is worth considering in more detail.

Arterial aneurysm - expansion of the lumen and protrusion of part of the wall of the artery. In about 40% of cases, such a pathology is found in the anterior cerebral and communicating arteries. Among 30%, an aneurysm of the carotid artery, or rather its internal branch, is ascertained. And the middle brain. In the vertebrobasilar system, pathology is found in 15% of cases.

An ordinary saccular aneurysm has a small diameter, only up to 1 cm, but there are also giant species whose diameter exceeds 2.5 cm. Unlike a small one that has a clearly marked neck, bottom and body, giant ones do not have a neck at all.

Symptoms

It is impossible to identify an aneurysm on your own. According to their symptoms, aneurysms are similar to all major pathologies associated with insufficient blood supply to the brain. But the symptoms alone should be enough to call your doctor for help. And undergo an examination using magnetic resonance or computed tomography for the timely appointment of treatment - before the rupture of the pathological formation.

1. constant feeling of fatigue and muscle weakness;
2. feeling of nausea;
3. loss of vision, photophobia is possible;
4. dizziness;
5. unrelated speech;
6. poor hearing;
7. unilateral numbness of any part of the body or the whole body;
8. double vision, ripples in the eyes;
9. headache.

If the disease is not detected in time, the signs of its presence will become more pronounced. The main clinical manifestation of aneurysms is hemorrhages due to rupture of their walls, occurring inside the skull. Hemorrhages can occur several times (recurrent) and often lead to death - in 60% of cases immediately after the first.

Fortunately, ruptured aneurysms occur infrequently - 7-10 cases per year. They are detected at the earliest stages of development, but, as a rule, due to examinations for other diseases. These are the so-called "accidental" aneurysms.

Most often, pathological education develops in adulthood, starting from 30 years. This part of the population, which has undergone pathology, occupies 60%. Elderly people over the age of 50 suffer from the disease in 8% of cases. And children are even less - in only 3% of cases.

Treatment

The only effective and possible way to treat arterial aneurysms is surgery. Its main purpose is to protect aneurysms from the general blood flow, carried out to prevent the first or repeated hemorrhage. After the operation, the treatment does not end, the person has to undergo a long course of therapy.

Methods for excluding aneurysms from the general circulation are different - direct and endovasal. Which ones are suitable for a particular patient depends on the anatomical features of the pathology, including its size, as well as the state of blood flow, the time elapsed since the last rupture, and the general condition of the patient.

Treatment of vertebrobasilar insufficiency

All patients who have undergone this syndrome need urgent hospitalization and treatment under the supervision of a doctor. With the exception of chronic and vertebrogenic forms. They can be treated on an outpatient basis.

Basic treatment consists of the following activities:

• support for the work of the entire cardiovascular system;
• fight against cerebral edema;
• normalization of water and electrolyte metabolism;
• symptomatic remedies;

As soon as the cause of the development of the syndrome is established, a narrower treatment is prescribed. Individual for each patient, since the course of development of the pathology may be different.

After stabilization of the normal state of the patient, physiotherapy exercises are prescribed in all cases, for each individually. Manual therapy, physiotherapy and acupuncture are also available.

The arteries of the vertebrobasilar basin supply blood to the most important part of the human body - the brain. Therefore, you should not ignore the causelessly arising pains in the neck, neck and head. And ignore any other symptoms. Visit the doctor on time and be healthy!

Cerebral aneurysm: causes, signs, consequences, operation

Among diseases of the cerebral vessels, aneurysm can be attributed to the most dangerous. Due to a change in the structure of the vessel, it loses its elasticity, as a result of which a rupture may occur with hemorrhage in the subarachnoid region or brain substance. Cerebral aneurysm leads to serious circulatory disorders, death. The neoplasm in the vessel gradually fills with blood, increases in size. In addition to rupture of the aneurysm, the very fact of deformation of the vessel also poses a danger. A convex area can put pressure on brain tissue, nerves.

An aneurysm has a peculiar structure, which determines the high risk of its rupture. The natural three-layer structure of the artery is preserved only in the neck of the formation; this area is the most durable. In the walls of the formation body, the elastic membrane is already broken, there is a lack of a muscular layer. The thinnest part of the aneurysm is the dome formed by the intima of the vessel. Here it ruptures, causing a hemorrhage.

Brain aneurysm: types

Brain aneurysms differ in shape, size, type. Formations can be spindle-shaped, saccular, lateral, consist of several chambers and one. Fusiform aneurysm is formed after the expansion of a certain section of the vessel wall. A lateral aneurysm is characterized by its formation on the vessel wall.

Giant formations are usually located in the area of ​​bifurcation, in the carotid artery passing through the cavernous sinus, reach 25 mm. A small formation has a size of up to 3 mm. The risk of hemorrhage increases dramatically with the size of the aneurysm.

It is customary to distinguish two main types of formations in the vessels of the brain: arterial and arteriovenous.

arterial aneurysm

When the walls of the arterial vessels protrude like a sphere or sac, this is an arterial aneurysm. Most often, the location of these formations is the circle of Willis at the base of the skull. This is where the arteries branch the most. There are multiple, single, giant, small formations.

Arteriovenous aneurysm

When the venous vessels of the brain are dilated and form a tangle, the formation is an arteriovenous aneurysm. With the communication of venous and arterial vessels, this type of aneurysm can develop. There is less blood pressure in the veins than in the arteries. Arterial blood is ejected under high pressure into the veins, due to which the walls expand, deform, and aneurysms occur. Nervous tissue is subjected to compression, there is a violation of the blood supply to the brain.

Aneurysm of the vein of Galen

An aneurysm of the vein of Galen is rare. However, one third of arteriovenous malformations in infants and newborns is due to this anomaly. It is twice as common in boys. Forecasts for this disease are unfavorable - death occurs in 90% of cases in infancy, the neonatal period. With embolization, high mortality remains - up to 78%. Symptoms are absent in half of the affected children. Symptoms of heart failure may appear, hydrocephalus develops.

saccular aneurysm

A round blood sac visually resembles a saccular aneurysm. It is attached to the site of a branch of blood vessels, the main artery, with its neck. This type of aneurysm is the most common. It develops most often in the base of the brain. It usually occurs in adults. A typical formation is small in size, less than 1 cm. Structurally, the bottom, body and neck are distinguished in it.

Symptoms of the disease

The symptomatology of an aneurysm depends largely on the area of ​​the vessel where it is located. Aneurysm symptoms:

• Weakness;
• Nausea;
• visual impairment;
• Photophobia;
• Dizziness;
• Speech disorder;
• hearing problems;
• Numbness on one side of the body, face;
• Headache;
• Double vision.

It is easier to identify the formation at the stage of its rupture, when the signs are more obvious.

paroxysmal headache

Local pain in the head of varying intensity, which is repeated in one area, is characteristic of an aneurysm of cerebral vessels. With damage to the basilar artery, pain occurs in one half of the head, when the formation is located in the posterior cerebral artery, pain appears in the temple, occipital region. For aneurysms of the anterior connective and anterior cerebral arteries, severe pain in the fronto-orbital area is common.

Other signs of an aneurysm

Other signs of a brain aneurysm are also known. The following symptoms are possible:

1. A sharp whistling noise in the ear;
2. There is strabismus;
3. Hearing loss is unilateral;
4. The upper eyelid drops (the phenomenon of ptosis);
5. The pupil expands;
6. Double vision appears;
7. Sudden weakness in the legs;
8. Vision is disturbed: everything becomes cloudy, objects are distorted;
9. Paresis of the facial nerve of the peripheral type;
10. Fields of vision are distorted or drop out.

In general, the symptoms of an aneurysm may resemble signs of a stroke, circulatory disorders.

Attention! If even individual symptoms of an aneurysm are observed, it is necessary to immediately consult a doctor. When the condition is severe, it is important to immediately call an ambulance. Timely treatment, surgery can cope with the disease.

Causes of brain aneurysms

At the moment, a complete theory of the occurrence of aneurysms is under development. However, the factors that contribute to the development of formations have been studied in sufficient detail.

The most serious cause of aneurysm development is birth defects present in the muscular layer of the cerebral arteries. They often appear in areas of strong bends of the arteries, their connection. There is a lack of collagen, which provokes abnormal formations. This factor is hereditary.

Cause the development of aneurysms and hemodynamic disorders: uneven blood flow, high blood pressure. With the greatest force, this manifests itself in areas where the arteries branch. The blood flow is disturbed, it puts pressure on the already deformed vessel wall, which leads to its thinning, rupture.

A genetic disorder that causes vascular damage is a pathological phenomenon when the veins and arteries of the brain are intertwined, disrupting blood circulation. Accompanying aneurysms and malignant neoplasms, when tumors of the neck and head metastasize. Some other causes of aneurysms should be noted:

All these factors jeopardize the circulatory system, blood vessels, contribute to the development of aneurysms.

Aneurysm rupture and its consequences

Rupture of an aneurysm in the thinnest place leads to hemorrhage of the subarachnoid type or intracerebral hematoma. Blood can enter the ventricles of the brain, brain tissue. Vascular spasm develops in 100% of cases. Acute occlusive hydrocephalus of the brain is likely when the cerebrospinal fluid pathways are closed by blood accumulated in the ventricles, cerebral edema. The brain tissue reacts to the products of blood decay, necrosis is characteristic, the cessation of the work of individual brain areas.

When an aneurysm ruptures, partial paralysis, severe nausea, headache, and vomiting occur. Consciousness is confused, the patient may fall into a coma. Convulsions appear, ptosis and various visual impairments are characteristic.

Complications after aneurysm rupture

Due to the hemorrhage provoked by the rupture of the aneurysm, a number of complications are observed. There is a cerebral angiospasm, a repeated rupture of the aneurysm is likely. Perhaps the development of cerebral ischemia, which leads to death in 17% of cases. Complications are similar to those in ischemic, hemorrhagic stroke. In some cases, after a rupture of the formation, a convulsive syndrome develops. The following complications are likely.

1. Pain syndrome. After a stroke, pain attacks of varying intensity and duration can develop. Pulsating and shooting pain, a feeling of heat is hardly removed by painkillers.
2. Cognitive impairment. Patients lose the ability to process external information, perceive it. The logic and clarity of thinking, memory are disturbed, the ability to plan, learn, and make decisions is lost.
3. Psychological disorders. Depressive states, abrupt mood swings, increased irritability, insomnia, and a sense of anxiety are characteristic.
4. Difficulty in defecation and urination. Patients experience difficulties with the bladder, intestines, and their emptying.
5. Visual disturbances. Carotid artery aneurysm is characterized by a decrease in visual acuity, loss of visual fields, double vision.
6. Difficulty or impaired swallowing. This complication can lead to food entering the trachea and bronchi, and not the esophagus. Dehydration and constipation are likely.
7. Behavioral disorders. Characterized by emotional lability, slow reaction, aggression or fearfulness.
8. Perceptual disturbances. The patient is not able to pick up an object, does not understand what he sees in front of him.
9. Problems with speech. Difficulty understanding and reproducing speech. Patients have difficulty counting, writing, reading. This complication is typical for damage to the left hemisphere of the brain (in right-handers).
10. Movement disorders. There is paralysis, weakness, patients move and walk with difficulty, coordination is disturbed. Sometimes there is hemiplegia - impaired movement of one side of the body.

After an aneurysm rupture, it is important to start treatment in a timely manner, to properly organize the subsequent rehabilitation of the patient.

Surgery

In most cases, surgery is considered the most effective treatment for an aneurysm. They make clipping, strengthen the walls of blood vessels, disrupt the patency of blood vessels at the site of the lesion with special microscopic spirals.

clipping

Clipping is performed with direct surgical intervention. The operation is open, intracranial. The aneurysm is switched off from the general blood flow, while maintaining the patency of the carrier and surrounding vessels. It is mandatory to remove blood in the entire subarachnoid space or drain an intracerebral hematoma.

This operation is recognized in neurosurgery as one of the most difficult. The neck of the aneurysm should be blocked immediately. The optimal surgical approach is selected, modern microsurgical equipment and an operating microscope are used.

Strengthening the walls of the vessel

Sometimes they resort to the method of strengthening the walls of the aneurysm. The affected area is wrapped with surgical gauze, which provokes the formation of a special capsule from the connective tissue. The disadvantage of the method is the high probability of bleeding in the postoperative period.

Endovascular operations

Now the method of purposeful violation of the patency of the aneurysm is popular. The desired part of the vessel is artificially blocked with the help of special microcoils. The patency of neighboring vessels is carefully examined, the operation is controlled by angiography. This method is minimally invasive and is widely used in Germany. The operation does not require opening the skull, it is less traumatic.

Aneurysm BEFORE and AFTER endovasal surgery

Postoperative complications

Often there are postoperative complications. Usually they are associated with the development of cerebral hypoxia, vasospasm, especially when the intervention was carried out in the acute period of cerebral hemorrhage. Complications are also observed when the walls of aneurysms are damaged. In some cases, the microspiral pierces the wall.

Oxygen starvation is characteristic of complete or partial obstruction of the vessel that carries the aneurysm. Now, thanks to modern techniques, the space of the vessel can be expanded and strengthened artificially in order to provide the necessary blood flow in strictly defined areas.

A fatal outcome is likely if the aneurysm is gigantic and is at a difficult stage of development. It is important to start treatment on time, to carry out surgery without starting the disease. Mortality is minimal, if the disease has not had time to go to the stage of exacerbation, the operation is direct. Individual deaths are likely due to the individual characteristics of the body, not directly related to the disease, the operation.

Non-surgical treatments

Despite the fact that the main and radical method to combat the disease is surgery, conservative treatment is also carried out. First of all, you must constantly be under the supervision of a doctor. Each patient needs an individual approach, it is necessary to take into account his condition as a whole, all the features of the body. This approach is also important when choosing surgical treatment. Various drugs are used to prevent aneurysm rupture and improve the general condition.

• Antiemetics and painkillers. They are necessary to alleviate the patient's condition.
• Drugs to stabilize blood pressure. The most important thing is to provide a certain fixed threshold, above which the pressure will not rise. An increase in blood pressure can lead to rupture of the aneurysm, hemorrhage.
• Anticonvulsants. These drugs are also commonly prescribed because seizures are likely to occur.
• Calcium channel blockers. The drugs prevent cerebral spasm, stabilize blood vessels. It is necessary to use medications so that blood access to those parts of the brain that have suffered due to the development of an aneurysm is not cut off.

It is optimal to combine conservative and surgical treatment, since a brain aneurysm needs surgical intervention to reduce the risk of its rupture and prevent death.

Prevention of cerebral aneurysms

First of all, it is necessary to pay attention to the factor of hereditary transmission of the disease, predisposition to it. Prevention of cerebral aneurysm is based on the timely diagnosis of the disease, the identification of symptoms, the passage of an examination, after which appropriate treatment is immediately prescribed. Sufficiently reliable results are obtained by magnetic resonance imaging, computed tomography of the brain. Angiography is also performed.

A person who already suspects the presence of this disease should maintain himself in a special state, not only physically, but also emotionally. It is important not to overexert yourself, to avoid overwork. It is necessary to make efforts to constantly stabilize the emotional background and not get overexcited. We must forget about stress, worries, vain insults and doubts, we must live in the present and enjoy every day.

It is important to minimize the risk of damage to blood vessels, head injuries. It is necessary to constantly monitor blood pressure. Timely detection of primary warning bleeding plays an important role. It is impossible to ignore the symptoms of a brain aneurysm - you should immediately contact a specialist.

Video: cerebral aneurysm in the program "Live healthy!"

Hello! Aneurysms are often asymptomatic, this is their insidiousness, since they can make themselves felt only after a rupture and hemorrhage in the brain. If you were offered an operation, then it was wrong to refuse it, the aneurysm can rupture at any time, and you may simply not have time to do anything. MRI is one of the most reliable methods for diagnosing vascular pathology of the brain. You can repeat the examination to make sure it is true, but the result will almost certainly be the same. Our advice to you is to go to the doctor to discuss the timing and options for surgical treatment.

Hello! Tell me, please, is it possible to wear an orthopedic collar (Schanz collar) in the presence of an aneurysm. I have two aneurysms of the c6 segment of the left ICA and the apex of the OA, there was also an aneurysm of the right ICA, but it was embolized. Now I was simply tormented by cervical osteochondrosis on the left and they told me that neither massage nor physiotherapy was allowed for me. Thanks in advance.

Hello! You can wear the collar, but you need to put it on correctly, without pinching the neck too much, following the instructions and recommendations of the doctor. You can additionally check with the neurologist for the duration of wearing it, which will be safe in your case.

Hello! Our opinion is that the problem is still neurological, so you need to consult a good doctor who will send you for examinations. It would be advisable to do at least an MRI to rule out brain pathology and identify indirect signs of increased intracranial pressure.

Hello. I'm 36 years old. Headaches have been bothering me for 1.5 years. Recently, in the temporal region, it is especially acute only on the left, the feeling of congestion in the left ear, as if something is pressing from the inside, everything is in order with vision, there is no nausea, vomiting and dizziness. When moving my jaw, I feel pain in the left temporal region, also when I tilt my head, when I touch the temporal region. The neurologist ordered a bunch of examinations. Everything went away, only MSCT of the cerebral veins with contrasting in a week remained. How dangerous is procrastination in this situation?

Hello! It is impossible to say unequivocally, because we do not know what the results of the surveys already passed and whether it is already possible to talk about the cause of your complaints. Descend or go to the neurologist with available inspections, he will give more exact information.

I am 34 years old, I plan to do IVF, prolactin is elevated, at a rate of 1-30, I have 67.54, they sent me for an MRI of the pituitary gland. Could you comment on the study protocol? How dangerous is it (no headaches, and no aneurysm symptoms described)?

Hello! In conclusion, everything is indicated: there is a suspicion of an aneurysm. You need to have a recommended angiogram to determine for sure if there is an aneurysm or not. In addition, such vascular changes are not always accompanied by any symptoms and can be detected by chance. If the diagnosis is confirmed, then you will be offered treatment, after which you can easily plan a pregnancy. Health to you!

Hello! This may be the result of an operation. Since your father is under the supervision of specialists, you need to wait for positive dynamics and clarify the condition of your father with the attending physician.

My father had an operation for an aneurysm on 11/16/15. The operation was successful, according to the doctors, but he was not moved to the ward, but left in intensive care. On 11/20/15 they had a second operation, as he had some kind of swelling. After the operation, he has not yet regained consciousness. Please tell me what are the risks and what are the chances of survival. Father is 53 years old.

Hello! Most likely, your father developed cerebral edema, this happens after such operations. The further course of events depends on the speed of elimination of edema, and it is not yet possible to predict in advance or make predictions. Wait and hope for a happy ending!

Hello! Rather, on the contrary - a migraine occurs due to an existing aneurysm, because aneurysm is most often a congenital phenomenon. Don't worry, it's very unlikely you'll have it, because the MRI didn't show it. An exacerbation of migraine before menstruation can be associated with fluid retention in the body and fluctuations in hormone levels, so do not burden yourself with excess drinking and get more rest.

Hello! Of course, without knowing exactly what the clip is made of, it is better to avoid an MRI, but a CT scan or contrast-enhanced angiography can be done. Try to find out from the doctor who operated on your husband what material the clip was made of, because in the future you may need an MRI.

Hello! If the hemostasiologist does not recommend continuing the drug, then you should listen, because the risk of bleeding can be high, and this is an unfavorable factor for the remaining aneurysms. Whenever possible, be sure to consult a neurosurgeon.

Hello! I would like to hear from you as an expert. I haven't taken any tests yet. I have a question for you. I am 46 years old and at any time of the day I have a flickering circle in front of my eyes, which then blurs in an arc either to the left or to the right, an unpleasant sensation. Where this flicker is located, nothing is visible behind it, only a flicker, and after this flicker goes away, a headache comes. Headache is accompanied by lethargy and malaise, but no nausea or dizziness. I don't feel numbness in my limbs either. Tell me, please, what could it be? I think it has to do with the vessels of the brain.

Hello! First, you need to go to an ophthalmologist to rule out glaucoma (increased intraocular pressure). Secondly, if the headache is intense, then the described symptoms may be a sign of an incipient migraine (aura), so you need to consult a neurologist. Start with this, and the doctors will direct you to the necessary examinations.

Hello! We do not provide information regarding the cost of treatment and examinations, but you can find out the approximate cost at the hospital where you are supposed to be operated on.

Hello, on June 17, I had an aneurysm clipped in my right temporal region. There is a pressing sensation in the head, as if something heavy had been placed on the head. As a result, the fear that something will happen again (there was a rupture of the aneurysm) In addition, another operation is due in two weeks, but only in gynecology, is it possible to do anesthesia again so soon? Could there be any consequences?

Hello! Before the next operation, you should consult with a vascular surgeon, as well as inform the anesthetist about your problem. If the vascular surgeon does not find pathology, then the next operation is not contraindicated.

Hello. Please answer how long can a person be in a state of stun after a ruptured carotid aneurysm

Hello! It is impossible to say exactly, it depends on the dynamics of the development of the disease, the stun can turn into someone else, the patient's condition will improve and consciousness will be restored, but the time frame is individual.

Hello. Mom is 60 years old? 4 days ago, she had an aneurysm rupture. She has edema, angiospasm, stunning, 3 foci. The condition is stable and heavy all the days, there is no dynamics. What could be the forecast?

Hello! The prognosis cannot be called favorable, given the impairment of consciousness and cerebral edema. Now we just need to wait for the further dynamics of the disease, the normalization of brain function, then we will talk about further recovery.

Hello! Tell me please, my husband recently died, age 22, the cause of death was basal subarachnoid hemorrhage, there was a disease of cerebral aneurysm, he did not know about the disease, they found out only after the autopsy. We have a daughter, she is 2 years old, tell me what is the probability that this disease will be inherited by her? And can we do an MRI of her brain right now? Thanks in advance.

Hello! An aneurysm is not inherited, so you should not worry in advance about its likelihood in your daughter. There is no need to do an MRI, and contrast is needed to study the vessels, so such a study may simply be contraindicated for a small child. Don't worry, your daughter is most likely healthy.

My mother (65 years old) has a similar situation. An aneurysm of the internal carotid artery ruptured on July 2 and was immediately taken to the hospital. Doctors did NOT operate, but only prescribed a bunch of drugs. We spent a lot of money on medicines. As a result, on Monday, July 6, we were told that the situation was hopeless and my mother was sent home ... How long will she last in an unconscious state?

Hello! It's impossible to say for sure. In this condition, the risk of pneumonia, cerebral edema and other complications is high, so you need to ensure that your mother is adequately cared for and monitored at home.

Features of saccular aneurysm

Cerebral (cerebral) aneurysm - a protrusion (swelling) of a weak spot in a blood vessel due to damage to its walls. A saccular aneurysm is a sac-shaped intracranial aneurysm. Most often, a cerebral aneurysm does not show any symptoms and goes unnoticed until the examination. But sometimes it ruptures, releasing blood into the skull and causing unpleasant symptoms and consequences, including a stroke.

Types of aneurysms

Location and what vessels they affect

• Saccular (saccular) aneurysm is a fairly common type of aneurysm and accounts for about 80-90% of all intracranial aneurysms, it is the cause of subarachnoid hemorrhage (SAH). Such an aneurysm is shaped like a berry (often referred to as a "berry"), a glomerulus, or a sac that can form on arterial bifurcations and branches of large arteries at the base of the brain (circle of Willis);
• A fusiform aneurysm is a less common type. It looks like a bulge in the arterial wall on either side of an artery, or a blood vessel dilated in all directions. A fusiform aneurysm has no stalk and rarely ruptures.

The internal carotid arteries supply the anterior regions, and the vertebral arteries supply the posterior regions of the brain. After passing through the skull, the right and left vertebral arteries join together to form the basilar artery. The main and internal carotid arteries join each other in a ring at the base of the brain called the circle of Willis. Cerebral aneurysms occur at the branching points of large vessels, but can also develop on small septa, they are located both in the front of the brain (anterior circulation) and in the back (posterior circulation). The disease can affect any of the cerebral arteries:

Saccular aneurysms are divided into several types depending on location:

• Cerebral artery aneurysm - resembles a bulge or small ball in a blood vessel, looking like a berry or pouch hanging from a stem;
• Internal carotid artery - a weak area in the carotid artery provokes a bulging of a separate area;
• Anterior communicating artery - This type of saccular aneurysm is asymptomatic until it ruptures, sometimes causing memory problems or hypothalamic dysfunction.

Most intracranial saccular aneurysms are true (the inner wall protrudes outwards). They consist of a dense hyalized (hardening) fiber with a muscular wall. As the aneurysm grows, it can change its shape, and blood clots can develop inside it, in which case it ruptures.

Sizes of saccular aneurysms:

• Small - less than 5 mm;
• Medium - 6-15 mm;
• Large -mm;
• Giant (most often located in the internal carotid artery) - more than 25 mm.

Symptoms and signs

Saccular aneurysms are usually discovered during a patient's examination for another condition. Symptoms appear when the aneurysm ruptures, but sometimes they can be caused by pressure or growth of the aneurysm. The most common sign of a tear is a severe headache. The following is a list of possible symptoms:

• Visual defects (blurred blurred vision, double vision) are associated with the presence of an aneurysm of the internal carotid artery;
• Facial pain (in the region of the eyelids / forehead), severe pain is associated with the occurrence of the anterior communicating artery;
• Focal neurological symptoms;
• seizures;
• Insomnia (a common symptom on the background of an aneurysm of the carotid artery);
• Fainting or fainting;
• Weakness or numbness of a body part;
• Dizziness;
• convulsions;
• confusion or mental disturbances;
• Nausea and/or vomiting;
• Cardiac arrhythmia, tachycardia;
• Pain in the neck;
• Dilated pupils, involuntarily drooping eyelids;
• Light sensitivity;
• Labored breathing;
• Symptoms of a stroke (loss of speech, smell, paralysis of muscles on one side of the body, or other movement defects);
• Carotid aneurysms can cause changes in the bones of the skull, which are clearly visible during examination.

Many factors determine the likelihood of bleeding from a saccular aneurysm that has not yet ruptured, including size and location. Small saccular aneurysms, which are uniform in size, are less likely to bleed than large, irregularly shaped aneurysms - blood begins to seep through them into the subarachnoid space (a cavity between the membranes of the brain and spinal cord, filled with cerebrospinal fluid). This phenomenon is called "subarachnoid hemorrhage", its symptoms, depending on the volume of blood, are as follows:

• A sharp and severe headache, lasting from several hours to 2-3 days (acute, and then aching pain is accompanied by a rupture of the aneurysm of the anterior communicating artery);
• Vomiting, dizziness;
• Drowsiness, coma;
• Hemorrhage of aneurysms of the internal carotid and anterior communicating arteries is always accompanied by a decrease in vision.

This phenomenon is called "hemorrhagic stroke". Symptoms include:

• Weakness, numbness, paralysis of the lower extremities;
• problems speaking or understanding other people;
• Visual problems (in the presence of a saccular aneurysm of the internal carotid artery);
• Seizures, convulsive syndrome.

Diagnostics

• Angiography. A minimally invasive method that uses a special dye and X-rays to determine the degree of blockage of the arteries / vessels in the brain, detect pathologies in the carotid or anterior communicating arteries, and check blood flow for the presence of blood clots. Cerebral angiography is most commonly used to identify or confirm problems with blood vessels in the brain and to diagnose cerebral aneurysms, vasculitis, causes of stroke, vascular malformations;
• Analysis of cerebrospinal fluid. The test can be used to recognize a wide range of diseases and conditions affecting the brain: meningitis, encephalitis, bleeding (hemorrhage) in the brain, autoimmune disorders, tumors, if any type of aneurysm is suspected to rupture, including saccular ones. The analysis is carried out by spinal puncture. Less common sampling methods include: abdominal puncture, ventricular puncture, bypass;
• Computed tomography (CT) is a non-invasive method to detect saccular aneurysm and hemorrhage. X-ray images are formed in the form of a two-dimensional slice section of the brain. CT angiography is accompanied by the introduction of a contrast agent to the patient to obtain clear, detailed images of blood circulation in the arteries of the brain, where aneurysms are most common - the internal carotid and anterior connective;
• Transcranial Doppler Ultrasound - Sound waves are transmitted through the brain tissue, then they bounce off moving blood cells in the vessels, allowing the radiologist to calculate their speed. This method is widely used for a detailed study of blood circulation in the arteries (also during operations on the brain);
• Magnetic resonance imaging (MRI). The generated radio waves and magnetic field are used to take pictures of the brain. Magnetic resonance angiography (MRA) shows expanded images (2- and 3-dimensional) of transverse sections of the brain and blood vessels. Both methods are important for determining the type of aneurysm and detecting bleeding.

Treatment

• Surgical treatment of large/giant and symptomatic aneurysms includes endovascular intervention or aneurysm clipping (contraindicated in patients who may rupture during clip placement);
• The management of small aneurysms is a controversial issue. Saccular aneurysms less than 7 mm rarely rupture (most often as a result of a subarachnoid hemorrhage), in which case only a doctor can decide.

Preparing for the operation

Includes performing all of the above tests to diagnose an aneurysm and fasting for 12 hours before surgery (no water to drink). As well as:

• Before the operation, the doctor will check the level of intracranial and arterial pressure;
• Hypertension is a contraindication to surgery;
• It is forbidden to take diuretics.

Surgical intervention

Let's take a closer look at each method:

• Medical therapy/conservative treatment. Small, unruptured aneurysms that do not cause problems may not need treatment unless they grow and are asymptomatic. In this case, it is important to undergo a complete examination of the brain annually and constantly monitor blood pressure and cholesterol. The patient is prescribed antiemetics and pain medications (to relieve symptoms, if any), drugs to regulate blood pressure (if systolic pressure rises, there is a risk of rupture or growth of an aneurysm), antiepileptic drugs (if convulsive disorders are present), and calcium channel blockers (to regulate pressure , eliminating the risk of stroke);
• Neurosurgery. The patient may be recommended an open microsurgical operation. This is an invasive surgical method that is performed under general anesthesia. The surgeon performs a craniotomy, the meninges is opened and the aneurysm is gently dissected from nearby tissues, then the doctor places a surgical clamp (usually a titanium clip) around the base of the saccular aneurysm (aneurysm clipping). The clamp turns off the aneurysm, the surgeon punctures it and removes the blood. After the operation (which lasts 3-5 hours), the patient is shown to stay in the hospital for four to six days. Full recovery usually takes weeks to months;
• Endovasal surgery. Depending on the size and location of the saccular aneurysm and the age of the patient, this method may be chosen. This is a minimally invasive procedure that does not require opening the skull (lasts 1-1.5 hours), during which a catheter (previously inserted into the patient's femoral artery) is guided through the blood vessels to the aneurysm. The surgeon then carefully inserts (platinum or tungsten) microcoils (coils) into the catheter, which plug the cavity of the saccular aneurysm, the coils act as a mechanical barrier to blood flow, thus shutting down the aneurysm. The hospital stay after the procedure is one to two days. Recovery after surgery takes five to seven days. Against the background of the operation in the presence of bleeding, hospitalization can last from one to four weeks, depending on the state of health of the patient;
• Rarely use the method of strengthening the walls of the aneurysm. Its sections are treated with specialized gauze, which causes hardening of its shell. This method is rarely used due to frequent relapses in the form of hemorrhage.

Prognosis of the course of the disease

Rupture of a saccular aneurysm causes death, intracerebral hemorrhage, hydrocephalus, and can lead to short-term/permanent brain damage. The consequences for patients whose aneurysms have ruptured depend on general health, age, pre-existing neurological conditions (abscess, intracranial hypertension), location of the aneurysm, severity of bleeding, and time interval between rupture and referral to a physician. About 40% of people with a rupture die within 24 hours, another 25% die from complications within six months. Early diagnosis is of great importance. It is important to be vigilant when you discover the first signs of a break in yourself. People who seek medical help before an aneurysm ruptures have higher survival rates than those who ignore the symptoms of the disease. 40-50% of patients return to their normal activities after surgery.

Prevention

It consists in the early diagnosis of the disease, after which appropriate treatment is prescribed. In general, a patient who is aware of an aneurysm should:

• Avoid emotional stress, overexertion;
• Give up alcohol and smoking;
• Control blood pressure and cholesterol levels;
• Annually undergo a complete examination of the brain;
• Eat a healthy balanced diet (avoid spicy, fatty, fried foods, eat more fresh fruits and vegetables);
• Include in the daily diet vitamins that strengthen the walls of blood vessels.

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Sometimes a growth forms in the blood vessel of the brain - it quickly fills with blood and can burst, which will inevitably lead to death. This is an aneurysm of cerebral vessels - an extremely dangerous disease that requires urgent medical intervention.

Most often, an aneurysm affects the arteries located at the base of the brain - doctors call this area the circle of Willis. The area of ​​potential damage includes the carotid arteries and their key branches. Rupture of an aneurysm entails hemorrhage into the medulla or subarachnoid region.

The greatest danger is - the person with whom this happened lives a matter of hours.

Classification and development of the disease

Often, the disease goes unnoticed - the patient can live for several decades without realizing the terrible diagnosis. The scenario for the development of an aneurysm is as follows:

• pathologies of the muscular vascular layer are formed;
• the elastic inner membrane is damaged;
• tissues begin to grow and exfoliate (hyperplasia of the arterial trunk);
• arterial collagen fibers are deformed;
• rigidity (rigidity and excessive stress) increases, the walls become thinner.

The classification of cerebral aneurysms depends on a number of factors. With the defeat of various areas of the brain, doctors distinguish the following types of illness:

• aneurysm of the carotid artery (internal);
• cerebral middle artery;
• anterior connective or anterior cerebral;
• vessels of the vertebrobasilar system;
• multiple aneurysms (several vessels are affected simultaneously).

Accurate identification of the area of ​​the disease influences the treatment strategy. Therefore, the diagnosis of the type of aneurysm is extremely important. The structure of aneurysms also differs - fusiform and varieties are known. The latter are divided into multi-chamber and single-chamber. These formations are classified according to size:

• miliary (size up to 3 mm);
• ordinary (upper threshold - 15 mm);
• large (16-25 mm);
• giant (exceed 25 millimeters).

The size of an aneurysm affects the risk of rupture. The larger the formation, the higher the chance of a tragic outcome. A brain aneurysm has the following structure:

• neck;
• dome;
• body.

Formation types

The most durable (three-layer) part is the neck. The membrane shell of the body is underdeveloped - this area is less durable. The dome is the most fragile place (a thin layer, a breakthrough is inevitable).

Fatal changes appear over time, so the disease can "doze" for years.

Causes

The weakness of the vascular walls is always provoked by certain factors. The load on the arterial fibers increases - this leads to the formation of a build-up. The genetic aspect, as scientists suggest, plays a leading role. Hereditary pathologies that manifest themselves throughout life include:

• abnormal bends, tortuosity of vessels;
• congenital pathologies of muscle arterial cells (collagen deficiency is a typical example);
• connective tissue lesions;
• coarctation of the aorta;
• arteriovenous defects (venous and arterial plexuses).

Type III collagen deficiency leads to thinning of the arterial muscle layer - then aneurysms are formed in the zone of bifurcations (bifurcations). There are also non-hereditary diseases and traumatology:

• arterial hypertension;
• infectious lesions affecting the brain;
• (plaques form on the inner surface of the vessels - the arteries expand, deform and even collapse);
• radiation exposure (radioactive radiation affects the structure and functioning of blood vessels - this provokes pathological expansions);
• traumatic brain injury;
• hypertension and high blood pressure;
• impaired blood circulation (a blood clot can provoke this condition);
• brain cysts and tumors (arteries are compressed, which leads to impaired blood flow);
• connective tissue pathology;
• wounds;
• thromboembolism.

Risk factors

Some people have a predisposition to cerebral aneurysms. For example, in the United States, 27,000 patients have an aneurysm rupture every year. Women suffer from the disease much more often than men, and statistics also showed that patients aged 30-60 are at risk.

Other risk factors look like this:

• hypoplasia of the renal arteries;
• polycystic kidney disease;
• addiction;
• smoking;
• alcoholism;
• obesity;
• stress;
• taking oral contraceptives;
• living in radiation zones.

Aneurysm progresses with prolonged exposure to one (or several) of these factors. The wall of the artery gradually loses its mechanical strength and elasticity, it stretches and protrudes like a hernia, filling with blood.

Symptoms

Signs characteristic of an aneurysm are observed only in a quarter of patients. Among the symptoms, headaches of varying degrees of intensity are most common - migraine-like, twitching, aching. Symptoms may vary - it depends on the affected area of ​​the vessel. The basic symptoms are:

• nausea;
• weakness;
• blurred vision;
• dizziness;
• photophobia;
• hearing problems;
• speech disorders;
• headache;
• unilateral numbness of the face and body;
• double vision.

Frequent headaches

Paroxysmal migraine of varying intensity is the most characteristic symptom of a brain aneurysm (often the pain symptom is repeated in one area).

If the basilar artery is damaged, pain can flare up in half of the head, if the posterior artery is affected, the occipital region and temple suffer. There are more specific signs of an aneurysm:

• strabismus;
• whistling (and rather sharp) noise in the ear;
• unilateral hearing loss;
• pupil dilation;
• ptosis (upper eyelid drooping);
• weakness in the legs (appears suddenly);
• visual disturbances (objects are distorted, the environment is twitching with a muddy veil);
• peripheral paresis of the facial nerve.

During the formation of an aneurysm, intracranial pressure causes discomfort and leads to the effect of "bursting". Cases of tingling in the affected area are known - they cause slight concern, but at the same time they should be alarming. An aneurysm rupture causes severe pain syndrome, which, according to the surviving patients, cannot be tolerated.

Cases of loss of consciousness or its temporary clouding have been recorded - the patient loses spatial orientation and does not understand the essence of what is happening. In some patients, signal pains are traced - they flare up a few days before the rupture. But in most cases, the gap occurs suddenly - the patient does not have time to be transported to the clinic, death comes so quickly.

The conclusion is simple: if you find at least one of the symptoms listed above, you should immediately go to the doctor. Timely diagnosis, competent treatment and surgical intervention can save your life.

Diagnostics

The most popular method for detecting aneurysms is angiography. Unfortunately, not all patients receive a timely diagnosis - this leads to disastrous consequences. Cerebral aneurysm is also detected by other instrumental methods. Let's try to briefly describe them.

• Angiography. X-ray examination, carried out after special formulations are injected into the artery. The procedure allows you to assess the condition of the vessels, detect pathologies, narrowing and expansion. Substances that "illuminate" the artery are injected through a special catheter.
• CT scan. This painless method does not require interventions in the body. The X-ray pictures taken are loaded into a computer - after electronic processing of information, arterial problems are revealed. With a CT scan, doctors can detect hemorrhages, blockages, and narrowing. CT information combined with angiographic examination gives a larger picture of what is happening.
• Magnetic resonance imaging. The patient is irradiated with special waves, after which a three-dimensional image of the cerebral arteries is displayed on a computer screen. MRI is an indispensable tool in the diagnosis of suspicious neoplasms and various pathologies. The MRI process takes a long time and for some patients is associated with emotional discomfort, as they are forced to remain motionless in a limited space.
• Puncture of cerebrospinal fluid. This diagnostic method is recommended for patients with suspected rupture that has already occurred. The spinal column is pierced with a special needle. The extracted liquid is examined for the presence of blood impurities - they could get into the column cavity after a hemorrhage.

Consequences

Intracerebral hemorrhage leads to swelling of the brain. The tissue reacts to the breakdown of blood, necrosis develops, the damaged areas cease to function. Parts of the body that were previously controlled by the affected areas gradually fail.

Other complications include:

• cerebral angiospasm;
• re-rupture of the aneurysm;
• cerebral ischemia (deaths have been registered);
• internal hydrocephalus;
• paralysis, weakness and movement disorders;
• problems with swallowing;
• speech dysfunction;
• behavioral disorders;
• psychological and cognitive impairments;
• problems with urination and defecation;
• pain syndrome;
• distorted perception of reality;
• epilepsy;
• irreversible brain damage;
• coma.

Vasospasm is an extremely dangerous complication. This phenomenon narrows the blood vessels, which leads to a cerebral stroke. The risk of vasospasm increases many times over in the three-week period that replaces the hemorrhage.

Timely diagnosis allows you to restore control over the narrowing of the arteries.

Treatment

The choice of therapeutic strategy depends on the "behavioral" features of the aneurysm and the affected area, as well as on the age and general condition of the patient. If the brain aneurysm has a high density and small size, and there are no complications, the case may be limited to conservative treatment:

• therapy of vascular atherosclerosis;
• correction of arterial hypertension;
• the use of calcium channel blockers (diltiazem, verapamil);
• bed rest.

An aneurysm detected at an early stage implies stable therapeutic observation and emergency intervention in case of rupture. The state of the pathology should be assessed in dynamics. Some patients spend their whole lives under the close supervision of doctors, and a fatal gap never occurs.

Surgery

Surgery is still the most effective treatment option. In some cases, the vascular walls are strengthened, in others, clipping is recommended. Let's take a look at the types of these surgical interventions in turn.

• clipping . This is an open intracranial operation, which involves isolating the aneurysm from the bloodstream. Also, during the operation, the intracerebral hematoma is drained and blood is removed within the subarachnoid space. A successful operation requires an operating microscope and microsurgical equipment. This type of intervention is recognized as the most difficult.
• Strengthening the walls of the artery. Surgical gauze is wrapped around the damaged area. The disadvantage of this method is the increased chances of bleeding predicted in the postoperative period.
• Endovascular operations. The affected area is artificially blocked by means of microcoils. The patency of the nearest vessels is scrupulously examined - the angiography method allows you to control the course of the operation. The method does not involve opening the skull, is considered the safest and is used by German surgeons.

Postoperative complications should not be ruled out - they occur quite often. Unpleasant consequences are associated with the development of cerebral hypoxia. With obstruction of the vessel (complete or partial), oxygen starvation may occur.

A lethal outcome can occur in the case of a gigantic aneurysm. If the stage of exacerbation has not come, mortality is minimal.

Non-surgical methods

We mentioned conservative treatment, but did not dwell on it in detail. The key to the effectiveness of such therapy is constant medical supervision and a strictly individual approach. Drugs used to combat the disease can be divided into the following groups:

1. blood pressure stabilizers. An increase in pressure provokes a rupture of the aneurysm, so fixing it at a certain level is necessary.
2. Painkillers and antiemetics (significantly alleviate the patient's condition).
3. Calcium channel blockers. Stabilize the functioning of the circulatory system and prevent the occurrence of cerebral spasm.
4. Anticonvulsants (as we remember, convulsions are also dangerous).

Prevention

It is impossible to completely exclude the possibility of the disease. But you can reduce the risk to a minimum, thereby raising your chances. The prophylactic complex looks like this:

• active lifestyle;
• refusal of addictions (alcohol, smoking, alcohol);
• balanced diet;
• scheduled medical examinations;
• absence of head injuries (they should be carefully avoided).

The cornerstone of prevention is timely diagnosis. This primarily applies to patients with a hereditary predisposition. At the slightest suspicion of an aneurysm, you should immediately go to the clinic.

Throw away doubts, vain resentments and worries, enjoy today and stop conflicting with loved ones. Check your blood pressure regularly. Do not ignore suspicious symptoms - an additional examination has not harmed anyone yet. Early diagnosis and timely assistance is the key to your health.

Doctor-therapist, candidate of medical sciences, practicing doctor.

Let the doctors read it (I'm talking about prevention). And then, no matter how you come to them, so anything, just not to help the patient. In our country it is easier to die than to prevent death.

Headaches, dizziness, weakness - so common symptoms. They are present and I went to the doctors. They sent me for an MRI. For my funds. But it turns out that the vessels should be looked at separately on another MRI procedure. Again, this is a cost. The research itself is not really pleasant. It took me longer to come to my senses than it was during the procedure.

Arterial aneurysms of the brain- one of the frequent causes of life-threatening, often fatal intracranial hemorrhages. Arterial aneurysms are limited or diffuse expansion of the lumen of the artery or protrusion of its wall.

The most common types of aneurysms are:

• so called saccular aneurysms, having the appearance of a small thin-walled bag in which you can distinguish the bottom, middle part (body) and neck;
• rarer forms are spherical,
• fusiform (fusiform) or S-shaped.

The wall of the aneurysm, as a rule, is a plate of scar connective tissue of various thicknesses. In the cavity of the aneurysm, there may be blood clots of various prescriptions.

localization of the aneurysm.

The most common localization of arterial aneurysms is the arteries of the base of the brain, usually at the sites of their division and anastomosis. Especially often, aneurysms are localized on the anterior communicating artery, near the origin of the posterior communicating artery, or in the region of the branches of the middle cerebral artery. In 80-85% of cases, aneurysms are located in the system of internal carotid arteries, in 15% - in the system of vertebral and basilar arteries.

Causes.

The cause of the formation of arterial aneurysms is established only in a small number of patients. About 4-5% of aneurysms develop due to the entry into the arteries of the brain of infected emboli. These are the so-called mycotic aneurysms. In the origin of large spherical and S-shaped aneurysms, an undoubted role is played by the emergence of saccular aneurysms associated with congenital inferiority of the arterial system of the brain. Atherosclerosis and trauma also play a significant role.

Aneurysms can be:

• single or
• multiple.

clinical picture.

There are two forms of clinical manifestation of arterial aneurysms - apoplexy and tumor-like. The most common form of apoplexy occurs with the sudden development of subarachnoid hemorrhage, usually without precursors. Sometimes patients before hemorrhage are concerned about limited pain in the fronto-orbital region, paresis of the cranial nerves is observed.

The first and main symptom of an aneurysm rupture is sudden severe headache.
Initially, it may have a local character in accordance with the localization of the aneurysm, then it becomes spilled, diffuse. Almost simultaneously with the headache, nausea, repeated vomiting, and loss of consciousness of varying duration occur. The meningeal syndrome develops rapidly! epileptiform seizures are sometimes observed. Often there are mental disorders - from a slight confusion and disorientation to severe psychosis. In the acute period - an increase in temperature, a change in blood (moderate leukocytosis and a shift of the leukocyte formula to the left), in the cerebrospinal fluid - an admixture of blood.

When a basal aneurysm ruptures, the cranial nerves, most often the oculomotor, are affected. When an aneurysm ruptures, in addition to subarachnoid hemorrhage, hemorrhage into the substance of the brain (subarachnoid-parenchymal hemorrhage) can occur. The clinical picture in such cases is supplemented by symptoms of focal brain damage, the identification of which is sometimes difficult due to the severity of cerebral symptoms.

In the case of a breakthrough of blood into the ventricles of the brain (subarachnoid-parenchymal-ventricular hemorrhage), the disease is very difficult and quickly ends in death.

Symptoms of brain damage in aneurysm ruptures are caused not only by cerebral hemorrhage, but also by cerebral ischemia, which occurs as a result of a prolonged arterial spasm characteristic of subarachnoid hemorrhage, both near the ruptured aneurysm and at a distance. The local neurological symptoms revealed at the same time often render essential help in establishment of localization of an aneurysm. A rarer complication is the development of normotensive hydrocephalus due to the blockade of the basal sections of the brain membranes that resorb the cerebrospinal fluid with the outflow of blood.

In some cases, arterial aneurysms, slowly increasing, cause damage to the brain and contribute to the appearance of symptoms characteristic of benign tumors of the basal brain. Their symptoms vary depending on the location. Most often, aneurysms with a tumor-like course are localized in cavernous sinus and chiasmal region.

Aneurysms of the internal carotid artery are divided into the following groups:

1. aneurysms in the cavernous sinus (infraclinoid - located below the sphenoid processes of the Turkish saddle),
2. aneurysms of the supraclinoid artery,
3. aneurysms near the bifurcation of the carotid artery.

Aneurysms within the cavernous sinus .
Depending on the different localization, there are three syndromes of the cavernous sinus

• posterior, which is characterized by damage to all branches of the trigeminal nerve in combination with oculomotor disorders;
• medium - damage to the I and II branches of the trigeminal nerve and oculomotor disorders; anterior - pain and impaired sensitivity in the zone of innervation of the I branch of the trigeminal nerve and paralysis of the III, IV and VI nerves.

Large and long-standing carotid aneurysms in the cavernous sinus can cause destructive changes in the bones of the skull, visible on the radiograph. When an aneurysm ruptures in the cavernous sinus, there is no hemorrhage into the cranial cavity due to their extradural location.

Aneurysms of the supraclinoid part of the internal carotid artery.
They are located near the origin of the posterior communicating artery and are characterized, in addition to the symptoms of subarachnoid hemorrhage typical of all aneurysms, by a selective lesion of the oculomotor nerve in combination with local pain in the fronto-orbital region.

Carotid bifurcation aneurysms often cause visual impairment due to their location in the outer corner of the chiasm.

Aneurysms of the anterior cerebral artery are characterized by mental disorders, paresis of the legs, hemiparesis with extrapyramidal changes in tone in the arm, which is explained by spasm of the anterior cerebral arteries and their branches.

Aneurysms of the middle cerebral artery when ruptured, they cause the development of paresis of opposite limbs, speech disorders, less often sensitivity disorders.

Aneurysms of the vertebrobasilar system usually occur with symptoms of damage to the formations of the posterior cranial fossa (dysarthria, dysphagia, nystagmus, ataxia, paresis of the VII and V nerves, alternating syndromes).

Multiple aneurysms account for about 15% of all aneurysms. Features of the clinical course are determined by the localization of the aneurysm from which the hemorrhage occurred.

Arteriovenous aneurysms (arteriovenous angiomas, vascular malformations, or malformations) can also cause intracranial hemorrhage. These are vascular tangles of various sizes, formed by a random interweaving of tortuous and dilated veins and arteries. Their size ranges from a few millimeters to giant formations that occupy most of the cerebral hemisphere. Most often they are localized in the fronto-parietal regions.

Diagnostics.

Diagnosis of both arterial and arteriovenous aneurysms presents certain difficulties. When recognizing them, anamnestic indications of past subarachnoid hemorrhages, transient hemianopsia, ophthalmoplegic migraine, and epileptic seizures are taken into account. Of great importance is craniography, which reveals characteristic thin annular shadows that look like petrified aneurysms on the pictures.
Some large aneurysms can cause destruction of the skull base bones. EEG has a certain value.

The final diagnosis of an aneurysm of the arteries of the brain, determining its localization, size and shape is possible only with the help of angiography, which is performed even in the acute period of a stroke. In some cases, computed tomography of the head with contrast enhancement is informative.

TREATMENT OF ANEURYSM OF BRAIN VESSELS.

Conservative treatment for ruptured aneurysm is the same as for hemorrhage in the brain(). It is necessary to observe strict bed rest for 6-8 weeks.

Repeated lumbar punctures with a therapeutic purpose are justified only for the relief of severe headaches, in which medications are ineffective. Spasm of the intracranial arteries, which often leads to extensive softening, including the brain stem sections, has not yet been relieved by conservative measures.

The only radical method of treatment of saccular aneurysms is surgical intervention - clipping of the aneurysm neck. Sometimes the wall of the aneurysm is strengthened by “wrapping” it with muscle or gauze.

In recent years, a number of improvements and new methods of surgical treatment of aneurysms have been proposed: microsurgical, artificial thrombosis aneurysms using coagulants or a suspension of powdered iron in a magnetic field, stereotactic electrocoagulation, thrombosis using a disposable balloon catheter, stereotactic clipping.

In arteriovenous malformations, the most radical extirpation of the entire vascular tangle after clipping of adducting and draining vessels.

Forecast.

The prognosis for aneurysm rupture is often unfavorable, especially for subarachnoid-parenchymal hemorrhages: 30-50% of patients die. There is a constant risk of rebleeding, which is more often observed in the 2nd week of illness. The prognosis is most unfavorable for multiple arterial and large arteriovenous aneurysms that cannot be surgically removed. With hemorrhages caused by angiomas (malformations), the prognosis is somewhat better.

Cerebral aneurysm is an extremely dangerous pathology, which, in conditions of late diagnosis or incorrect treatment, is associated with a rather high level of mortality and disability. Aneurysm is a focus of pathological expansion of one or more blood vessels in the brain. In other words, it is a kind of protrusion of the vessel wall, which can be located in any part of the brain and can be both congenital and acquired. Since during the formation of an aneurysm, a defect in the wall of a blood vessel is formed ( usually arteries), then there is a risk of rupture with the subsequent formation of intracranial bleeding, which can cause many severe neurological disorders and even death.

The frequency with which cerebral aneurysms occur in the general population is quite difficult to track. This is due to the difficulties in diagnosing this pathology and the peculiarities of its clinical course. However, according to various clinical data, the average incidence of cerebral aneurysms is about 10-12 cases per hundred thousand of the population. According to the morphopathological examination ( autopsy), nearly 50% of unruptured aneurysms are found incidentally.

The main danger of cerebral aneurysms is due to the high risk of rupture with the development of intracranial bleeding ( subarachnoid hemorrhage or subarachnoid bleeding), which is a condition requiring immediate medical attention. According to the statistics of Western clinics, 10% of patients with subarachnoid bleeding die almost instantly before the possibility of providing any medical care, 25% - during the first day, 40 - 49% - within three months. Thus, the mortality from a ruptured aneurysm is about 65%, with a large proportion of deaths in the first few hours and days after the accident.

To date, the only effective method of treating cerebral aneurysms is surgical intervention, which, however, even with the current level of development of medicine and neurosurgery, does not guarantee 100% survival. However, it should be understood that the risk of dying from a suddenly ruptured aneurysm is almost two to two and a half times higher than the risks associated with surgery.

Interesting Facts

• The highest frequency of cerebral aneurysms is about 20 cases per 100,000 population, which is typical for Finland and Japan.
• Cerebral hemorrhage caused by aneurysm rupture is one of the main causes of maternal mortality during pregnancy, accounting for about 35%.
• Cerebral aneurysms are almost one and a half times more common among the female population.
• Giant aneurysms are 3 times more common among women.
• Survival among women with a ruptured aneurysm is lower than among men of the same age.

The structure of the vessels of the brain

The brain is one of the most important organs in the human body, since it regulates the functioning of most of the internal organs, and, in addition, it provides higher nervous and mental activity. The performance of these functions is possible due to the abundant and developed blood supply to the brain, since the blood provides the inflow and outflow of regulatory hormones and other biological substances, and also implements the delivery of nutrients and oxygen. It should be noted that brain tissue is extremely sensitive to oxygen starvation. In addition, the brain consumes a huge amount of energy - almost 20 times more than an equivalent mass of muscle tissue.

The blood supply to the brain is provided by two large blood vessels - the paired internal carotid artery and the unpaired basilar artery. These vessels give many branches that provide blood circulation to other organs of the neck and head, as well as the upper parts of the spinal cord and cerebellum. At the level of the brainstem, these arteries form the so-called circle of Willis - the place where all these vessels unite into a common formation, from which three pairs of the main arteries of the brain depart. Such an organization of blood vessels avoids a decrease in blood circulation in the brain during blockage ( thrombosis) basilar or carotid artery.

On the surface of the cerebral hemispheres are the following arteries:

• Anterior cerebral artery provides blood to the lateral surface of the cerebral hemisphere, part of the frontal and parietal lobes.
• Middle cerebral artery provides blood circulation at the level of the frontal lobe, parietal lobe and part of the temporal lobe of the brain.
• Posterior cerebral artery Supplies blood to the lower surface of the temporal and occipital lobes.

The cerebral arteries form an extensive branched vascular network, which, by forming a number of small arterial trunks, provides blood circulation throughout the entire thickness of the medulla.

The outflow of venous blood occurs through the superficial and deep veins of the brain, which flow into special sinuses formed by the dura mater. These sinuses are formed by rigid structures and therefore do not collapse when damaged. For this reason, open skull injuries are often accompanied by profuse venous bleeding.

It should be noted that almost all types of vessels are interconnected in one way or another, that is, they form anastomoses ( intervascular connections). In most cases, these anastomoses play an important physiological role by adapting the circulation to changing conditions and requirements. However, in some cases, the junctions of the vessels can become the site of the occurrence of aneurysms, since these formations are exposed to fairly high pressure.

The following types of intervascular connections are distinguished:

• Arterio-arterial anastomoses unite arteries of various sizes and origins. These compounds form an extensive network of bypass pathways for blood, so that blood circulation can be maintained even if some vessels are blocked. However, if key arteries are damaged or blocked, these anastomoses may not be effective.
• Arteriovenular anastomoses formed between arterioles the smallest arteries) and veins of various diameters. Provide redistribution of blood, if necessary, by diverting blood flow directly into the venous bed. It should be noted that when forming an anastomosis between a large artery and a vein, the risk of aneurysm formation is high ( pressure in the arterial system significantly exceeds that in the venous network).
• Venous anastomoses are a developed venous network with a large number of connections between veins of different diameters. This type of intervascular connections allows the venous system to receive a fairly large volume of blood without changing the functional state of the body.

In the microscopic structure of the arteries of the brain, 3 membranes are distinguished, each of which performs a specific function. The three-layer structure provides greater strength and allows the vessels to adapt to changing conditions of the internal environment.

The arterial wall consists of the following layers:

• Inner shell vessel or intima is represented by one row of small endothelial cells that come into direct contact with the blood. This layer is quite thin and vulnerable to a number of adverse factors. In addition, it is quite fragile and easily damaged by mechanical factors. This is due to the small number of connective tissue fibers in the structure of the inner shell. On the surface of endothelial cells are special substances that prevent blood clotting and prevent the formation of blood clots. It should be noted that the cells of the inner lining receive nutrients and oxygen directly from the blood flowing in the vessel. A similar phenomenon becomes possible due to the slowing down of blood flow near the vessel wall.
• Middle shell arteries consists of a layer of elastic connective tissue fibers that form an elastic frame, and a layer of muscle cells that provide rigidity and participate in adaptive reactions ( constriction and dilation of blood vessels to regulate pressure and blood circulation velocity).
• Outer shell ( adventitia) It is represented by a network of connective tissue fibers that significantly strengthen the vascular wall. In addition, this layer contains blood vessels that feed the arteries and veins, as well as nerve fibers.

It must be understood that most aneurysms are formed as a result of protrusion of the inner choroid through a defect in the middle and outer membranes. As a result, a kind of thin-walled volumetric cavity is formed, which at any time can burst and cause hemorrhagic stroke, intracranial bleeding and a number of other complications. In addition, in the aneurysm area, the speed and type of blood flow change significantly, eddies appear, and blood stasis appears. All this significantly increases the risk of thrombus formation, the detachment and migration of which can provoke ischemia ( oxygen starvation) part of the brain or other organ ( depending on the location of the aneurysm).

Meninges

For a better understanding of the pathological processes that occur in the cranium during the formation of an aneurysm and during its rupture, it is necessary to understand the structure of the meninges and their function.

The brain is located in the cranium, which is represented by a bone structure that is not capable of changing volume or shape. Between the medulla and the inner wall of the skull there are 3 membranes that protect the brain from a number of adverse factors, and also ensure its nutrition and functioning.

The following meninges are distinguished:

• Dura mater ( dura mater) located most superficially above the other two. Consists of a strong and solid connective tissue, which is fused with the bones of the skull on the outer surface. The inner surface is smooth. In the area of ​​​​the furrows of the brain, the dura mater forms special outgrowths in which the venous sinuses are located, as well as processes ( greater and lesser falciform, cerebellar tenteum, sella turcica diaphragm) that separate some parts of the brain.
• Arachnoid meninges ( arachnoidea) is located directly under the dura mater, from which it is separated by a narrow space filled with fatty tissue and capillaries. It is formed by a network of connective tissue fibers that are intertwined with each other and with small blood vessels. In the region of the base of the brain, the arachnoid membrane forms a series of cisterns - special cavities in which cerebrospinal fluid accumulates.
• pia mater directly adjacent to the medulla, repeating all the bends and convolutions of the cerebral hemispheres. In some places between the pia mater and the arachnoid there is a narrow gap filled with cerebrospinal fluid. In the thickness of this shell are blood vessels.

Thus, the brain is located in a limited "closed" cavity, so any changes in volume are immediately reflected in the state of the medulla and its function, since an elevated state occurs. This occurs with the development of any tumors in the cranial cavity, with cerebral edema, with excessive production of cerebrospinal fluid. In addition, intracranial pressure increases with subarachnoid bleeding, that is, with bleeding from a vessel located under the arachnoid meninges. In most cases, such bleeding is the result of an aneurysm rupture or injury.

Causes of cerebral aneurysms

The occurrence of aneurysms of cerebral vessels is associated, first of all, with violations of the structure of the vascular wall, and the reasons for this can be varied, and it is far from always possible to determine them. Under the influence of pathological factors, the internal elastic layer is destroyed, which, in combination with a defect in the elastic structures of the middle and outer shell of the vessel, creates the prerequisites for a bag-like protrusion of the intima. Violation of the integrity of the muscle fibers of the middle shell and the weak resistance of the outer shell create conditions under which the vessel is not able to compensate for the effects of chronic hemodynamic stress ( high pressure inside the vessel). Local eddies of blood flow in the area of ​​vascular bifurcation ( site of bifurcation of an artery) can create enough pressure to form an aneurysm at the site.

Distal aneurysms, that is, bulges located in more distant parts of the vessels, are usually smaller in size than aneurysms located in more proximal regions. However, the risk of rupture of these distant aneurysms is higher, which is associated with a thinner vascular wall. In addition, surgical access to such aneurysms is often difficult, which increases the risk of adverse complications.

The role of various factors in the development of aneurysm is still not well understood. Most scientists propose a theory of multiple causes, since it is based on the interaction between factors of the internal and external environment, such as, for example, atherosclerosis and high blood pressure, combined with congenital predisposition and various vascular anomalies.

In clinical practice, the following causes of damage to the vascular wall are distinguished:

• Congenital. Congenital vascular defects include various genetic pathologies in which the structure of connective tissue fibers is disturbed or arteriovenous anastomoses are formed between large arteries and veins. In addition, as a result of congenital defects, other vascular anomalies can also form, which, to one degree or another, weaken the vascular wall and contribute to the formation of aneurysms.
• Acquired. Acquired defects of the vascular wall are extremely diverse and can occur under the influence of a huge number of adverse factors. In most cases, these are some kind of degenerative diseases, connective tissue diseases, arterial hypertension and infections. These pathologies in most cases cause changes in the structure of blood vessels.

Genetic anomalies

Genetic predisposition is one of the main risk factors for the development of both congenital and acquired cerebral aneurysms. In most cases, the occurrence of this disease is associated with various pathologies of the synthesis of collagen or other types of connective fibers. This is explained by the fact that with an abnormal structure of the proteins that make up the connective tissue framework of the vascular wall, the risk of defects increases and resistance to mechanical stress is significantly reduced.

The following pathologies are most often combined with cerebral aneurysms:

• autosomal dominant congenital polycystic kidney disease;
• fibromuscular dysplasia;
• arteriovenous malformations;
• Osler-Randu syndrome;
• Moyamoya disease;
• Marfan syndrome;
• Ehlers-Danlos syndrome;
• violation of the synthesis of collagen of the third type;
• elastic pseudoxanthoma;
• alpha-1 antitrypsin deficiency;
• neurofibromatosis type 1;
• tuberous sclerosis;
• arterial hypertension.

Separately, it is necessary to single out such a pathology as coarctation of the aorta, which is a congenital defect of the main artery of the body - the aorta. This disease occurs in almost 8% of newborns with heart defects and is a significant narrowing of the aortic lumen ( often associated with other congenital heart defects). To date, it is assumed that there is a relationship between some genetic and chromosomal diseases and this pathology. In the presence of this anomaly, the risk of an aneurysm of cerebral vessels increases significantly.

Most of these diseases are quite rare. The presence of these pathologies is not a mandatory sign of a brain aneurysm. It should be understood that these diseases in most cases only increase the likelihood of developing an aneurysm due to a direct or indirect effect on the vessels of the brain.

Arterial hypertension

Arterial hypertension is a chronic disease that can occur due to a fairly large number of different causes. The main manifestation of this pathology is a significant and persistent increase in blood pressure in the vasculature ( greater than 140 mmHg for systolic and greater than 90 mmHg for diastolic).

An increase in blood pressure for a rather long time is effectively compensated by a number of physiological mechanisms, however, with a long course of the disease, as well as in the absence of proper drug treatment, this pathology causes a number of changes in the vessels and internal organs.

With an increase in pressure in the cerebral arteries, the hemodynamic stress on the vascular wall increases significantly, which, subject to the presence of individual characteristics ( genetic predisposition, trauma, degenerative vascular disease, inflammatory vascular disease) can lead to aneurysms.

It should be noted that arterial hypertension is often combined with atherosclerosis, a disease in which the metabolism of a number of lipid substances is disturbed ( fats and cholesterol), which are deposited in the walls of blood vessels. This significantly increases the risk of developing complications such as myocardial infarction, hemorrhagic and ischemic stroke. In addition, atherosclerosis itself can provoke the occurrence of aneurysms in the vessels of the brain, since atherosclerotic plaques quite strongly weaken the vascular wall.

infections

A fairly common cause of cerebral aneurysms are various infections. This is due to the fact that an inflammatory reaction occurs in the foci of infection with the production of a large number of various pro-inflammatory substances that, to one degree or another, change the properties of the vascular wall and cause degenerative damage. In addition, diffuse infiltration of the vascular wall by bacteria, their metabolic products, as well as the above-mentioned pro-inflammatory substances often occurs. As a result, all three shells of the vessel lose their elasticity and strength, and prerequisites are created for the occurrence of various protrusions of the intima of the vessels. It should be noted that in this case, the inner lining of the artery is also significantly weakened, and therefore the risk of its rupture is extremely high.

The risk of cerebral aneurysm increases with the following infectious diseases:

• Bacterial endocarditis. In the vast majority of cases, infectious aneurysms are located in distant branches of the middle cerebral artery ( 75 - 80% of cases), which indicates the embolic nature of these lesions. Emboli are small fragments of blood clots or, in this case, pus, which, with the blood flow, have entered a place remote from the primary focus. Bacterial endocarditis is a serious and dangerous disease in which infectious agents attack the inside of the heart. At the same time, gradual damage to the valvular apparatus of the heart develops, the work of the heart muscle is disrupted. In most cases, the left atrium and ventricle are damaged, that is, that part of the heart that is directly involved in pumping blood into the arterial bed. As a result, infectious agents, together with the blood flow, can freely enter the systemic circulation and affect distant organs. Damage to the vessels of the brain is observed in almost 4 cases out of 100. With a similar nature of the development of an aneurysm, the risk of bleeding is extremely high.
• Fungal infections. In some systemic fungal infections, brain damage occurs with vascular involvement. This significantly increases the risk of an aneurysm.
• Meningitis. Meningitis is an infectious and inflammatory lesion of the meninges. At the same time, infectious agents also affect blood vessels, infiltrating them in the direction from the outer vascular layer to the inner one, thereby gradually weakening them and creating the prerequisites for the occurrence of aneurysms or other pathologies.

Closed traumatic brain injury

Aneurysms resulting from a closed craniocerebral injury are usually localized in the region of the peripheral cortical branches of the arteries. They arise due to the contact of the surface of the brain and, accordingly, the cerebral arteries with the edge of the falciform process of the dura mater.

Often, after a strong mechanical impact, traumatic dissecting aneurysms are formed, which in their structure differ somewhat from a true aneurysm in that they are formed not due to protrusion of the intima through the other two vessel membranes, but due to blood seepage between these membranes. Thus, a pathological cavity is formed in the vessel, which gradually exfoliates its membranes. In addition to the fact that it threatens with rupture and bleeding, the place of detachment gradually narrows the lumen of the artery, thereby reducing blood flow in the corresponding parts of the brain. The constantly growing cavity of the false aneurysm gradually compresses the surrounding nervous tissue and nerves, causing severe discomfort and neurological deficits of varying severity. It should also be understood that at the site of the formation of this traumatic aneurysm, prerequisites are created for the formation of blood clots. Basically, these dissecting aneurysms are localized at the base of the skull, at the level of large vascular trunks.

How can a cerebral aneurysm manifest itself?

Most aneurysms do not manifest themselves until the moment of rupture, which is associated with a high degree of morbidity and mortality. Some aneurysms show only mild symptoms, which are often ignored, so it is not uncommon to diagnose this pathology after the development of intracranial bleeding. For this reason, it is extremely important to contact a competent specialist in a timely manner and undergo all the necessary examinations.

However, in some cases, cerebral aneurysms can have certain symptoms. In most cases, clinical manifestations occur with a fairly large aneurysm, but often small aneurysms are symptomatic. This is due to the fact that the basis of the clinical picture is neurological signs that appear as a result of compression of the medulla by a volumetric formation - a vascular aneurysm.

An unruptured cerebral aneurysm may present with the following symptoms:

• Violation of vision. The close location of the aneurysm to the optic nerves ( nerves that transmit visual impulses from the retina to the occipital regions of the brain) can cause partial compression of these nerves with impaired vision. At the same time, depending on the location of the aneurysm, these disorders can manifest themselves in different ways. With a close location to the optic chiasm, partial or complete loss of vision may occur.
• Seizures. Some aneurysms, especially large ones ( diameter over 25 mm), can compress the motor sections of the cerebral cortex, thereby provoking uncontrolled muscle contractions - convulsions. At the same time, these convulsions differ from epilepsy, however, differential diagnosis can only be made on the basis of a detailed examination.
• Headache. Headache is a fairly common symptom of a cerebral aneurysm. Usually, pain sensation occurs due to compression of the pia mater and arachnoid, in which a fairly large number of pain receptors and nerve fibers are located. When the aneurysm is located deep in the medulla, such symptoms develop extremely rarely, since the brain itself is devoid of pain receptors. Usually the headache is unilateral, subacute, with predominant localization in the area behind the eyes, quite often the pain is throbbing.
• Transient ischemic attack. A transient ischemic attack is an incoming attack of acute cerebrovascular accident lasting up to 24 hours. Manifestations depend on the affected arteries and, accordingly, areas of the brain prone to oxygen starvation. The most typical symptoms are dizziness, loss of consciousness, nausea, vomiting, temporary loss of orientation in time and space, memory loss, impaired sensitivity with complete or partial loss of certain sensations, various paralysis, speech impairment.
• Dysfunction of the cranial nerves. The cranial nerves are nerve fibers that provide motor and sensory innervation to the head, neck and some other parts of the body. When they are compressed, various neurological disorders can occur, such as paralysis of facial muscles, taste disturbance, the inability to turn the head in the direction opposite to the damage, partial or complete drooping of the upper eyelid, hearing loss with tinnitus, or even auditory hallucinations.
• Pain in the face. Quite often, aneurysms originating from the branches of the internal carotid artery compress the branches of the facial nerve, causing periodic pain in the face.

In addition to the symptoms listed above, many patients who have had an aneurysm rupture describe a number of signs that appeared 2 to 3 weeks before the development of subarachnoid bleeding. In most cases, these symptoms can be considered late, as they appear shortly before the rupture, but if you notice them in time and seek medical help, you can significantly increase your chances.

The following symptoms often precede an aneurysm rupture:

• double vision ( diplopia);
• dizziness;
• pain in the area behind the eyes;
• convulsions;
• drooping of the upper eyelid;
• noise in ears;
• deficiency of the sensitive or motor sphere;
• speech disorders.

The occurrence of these signs preceding the rupture of the aneurysm is explained by the fact that the gradually thinning wall of the aneurysm becomes more permeable to blood, which leads to minor pinpoint bruising. This has an irritating effect on the nervous tissue, resulting in the corresponding neurological signs.

It should be understood that in most cases these symptoms occur quite rarely and are usually mild. Diagnosing or even suggesting a cerebral aneurysm based on these manifestations alone is extremely difficult.

Rupture of a cerebral aneurysm

Unfortunately, quite often an aneurysm of a cerebral vessel does not manifest itself in any way until a rupture occurs with the development of subarachnoid bleeding ( hemorrhage under the arachnoid membrane of the brain). This variant of evolution is the most unfavorable and is associated with high mortality.

According to statistics, almost 90% of cases of non-traumatic subarachnoid hemorrhage are caused by ruptured intracranial aneurysms. This condition refers to pathologies in which emergency medical care is needed, since without proper treatment the prognosis is extremely unfavorable.

Subarachnoid bleeding in the vast majority of cases has a pronounced clinical picture, manifested by severe headaches and other neurological symptoms. For this reason, most of the patients, one way or another, seek medical help.

Symptoms of a ruptured cerebral aneurysm include:

• Strong headache. Intracranial bleeding is characterized by an extremely severe headache, which many patients describe as the most severe headache attack they have ever experienced. This symptom occurs due to the irritating effect of spilled blood on the meninges, in which, as mentioned above, a large number of nerve endings are located. The absence of this symptom is extremely rare and often indicates an attack of amnesia in the patient.
• Signs of irritation of the meninges. The spilled blood has a pronounced irritating effect on the meninges, and in addition, under the influence of a growing hematoma, their gradual compression occurs. The main manifestations of this process are the headache described above, photophobia, as well as stiffness and pain in the neck muscles, muscles of the back and legs. The last symptom is the inability to touch the chest with the chin, that is, the limited mobility of the neck, as well as the inability to bend the legs at the hip joint. This is explained by the fact that when bending the head and moving the legs, some stretching of the meninges occurs, which causes a reflex contraction of the muscles that block these movements.
• Nausea and vomiting. Nausea and vomiting unrelated to food intake are common but uncommon symptoms of subarachnoid bleeding. Occur due to irritation of the meninges and medulla.
• Sudden loss of consciousness. Almost half of patients with a ruptured cerebral aneurysm lose consciousness. This happens because, due to the growing hematoma, there is a gradual increase in intracranial pressure, which, in the end, becomes higher than the pressure at which adequate blood circulation occurs in the brain. As a result, acute oxygen starvation occurs with the loss of some neurological functions.

Diagnosis of cerebral aneurysm

Diagnosis of cerebral aneurysm is a complex process, the purpose of which is not only to identify the aneurysm as such, but also to determine the general state of health and the presence of comorbidities. This tactic is necessary both to identify possible causes of the aneurysm and to prepare for surgical intervention.

To detect cerebral aneurysms and determine other important indicators, the following research methods are used:

• physical examination of the patient;
• medical imaging methods;
• electrocardiography ( ECG);
• complete blood count and biochemical blood test.

In addition to these research methods, it is important to collect an anamnesis, that is, a conversation with the patient or his relatives in order to determine the history of the disease.

During a conversation with a patient, the following indicators are determined:

• main disturbing symptoms;
• the onset of the manifestation of the disease;
• the presence of other systemic or other pathologies;
• treatment taken at home;
• the presence of injuries;
• allergic reactions;
• family medical history ( allows you to identify or suggest genetic diseases).

Physical examination of the patient

A physical examination is a set of procedures during which the doctor performs a general examination, as well as a specific neurological examination.

The physical examination of the patient includes the following procedures:

• Palpation. Palpation is a method of physical examination, during which the doctor, by pressing on various parts of the body, reveals painful areas, determines areas of swelling, and feels skin formations. With aneurysm of cerebral vessels, palpation is usually of little information, but it can help in identifying other concomitant diseases. A particularly important indicator in this case is the condition of the skin, since many systemic diseases of the connective tissue, in which there are prerequisites for the development of an aneurysm, are reflected in the skin ( excessive extensibility of the skin occurs, various growths and volumetric formations appear).
• Percussion. Percussion is the tapping of individual parts of the body in order to identify areas with increased or decreased acoustic resonance. With cerebral aneurysm, this examination is rarely used, but it helps to identify some concomitant pathologies from other organs - the heart and lungs.
• Auscultation. Auscultation is a method of physical examination in which the doctor uses a stethophonendoscope to listen to various body noises. In cerebral aneurysms, auscultation may reveal abnormal murmurs at the level of the heart and aorta ( that occur with bacterial endocarditis, coarctation of the aorta), as well as at the level of the carotid arteries.
• Measurement of blood pressure. Measurement of blood pressure is a routine method of examining patients. Allows you to determine the general condition of the body at the current moment ( reduced blood pressure may indicate massive blood loss or damage to the vasomotor center of the brain), as well as to suggest a possible cause of aneurysm formation. In addition, elevated blood pressure in patients with an unruptured aneurysm is a definite risk factor that greatly increases the chances of rupture and hemorrhage.
• Measurement of heart rate and respiratory movements. The heart rate and respiratory movements can change under the influence of many factors, among which a special place belongs to systemic connective tissue diseases and infections.
• Neurological examination. Neurological examination is the most important and informative when examining patients with cerebral aneurysm. During this procedure, the doctor evaluates the tendon-muscle and skin reflexes, determines the presence of pathological reflexes ( that appear only in certain diseases and damage to the central nervous system). In addition, motor activity is checked, a deficiency of the sensitive sphere is revealed. If necessary, signs of irritation of the meninges are determined. However, it should be understood that in most cases the data obtained are not enough to determine the aneurysm of the brain, and for a more accurate diagnosis, an instrumental examination is necessary.

Medical Imaging Methods

Medical imaging is a set of activities that are aimed at obtaining an image of the internal organs of a person without surgical intervention, by using various physical phenomena ( x-rays, ultrasonic waves, magnetic resonance, etc.).

This examination method is the most informative for cerebral aneurysms and is the basis for diagnosing this pathology. In addition to identifying aneurysms as such, medical imaging allows you to determine their number, location, size, relationship with brain regions and other vessels.

The following medical imaging techniques are used to detect cerebral aneurysms

Method name	Method principle	Detectable signs
CT scan (CT)	It is based on the use of X-rays, but unlike conventional X-rays, this method uses a special matrix connected to a computer as a sensor. By combining the rotation of the sensor and the radiation source, it is possible to obtain images of a certain depth - the so-called slices. As a result, after processing by a number of programs, the image is clearer and more contrast. In addition, CT allows you to detect even small formations, accurately determine their location and compare their density with surrounding tissues.	bag-like dilated vessels; zones of compression and changes in the position of the medulla; destruction of bone tissue due to the pressure exerted by the aneurysm); signs of intracranial bleeding; the presence of thrombi in the cavity of the aneurysm.
Magnetic resonance imaging (MRI)	It is based on the registration by special sensors of the degree of deviation of hydrogen protons in the tissues of the human body under the action of a strong magnetic field. As with CT, MRI allows you to obtain high-resolution layered images. With this method of examination, the tissue image is the more intense, the more hydrogen atoms it contains ( water). For this reason, MRI provides detailed images of the brain and blood vessels ( which are poorly visible on CT). In addition, this method can be used for 3D computer reconstruction of blood vessels with further detailed study of aneurysms.	protrusion of the vascular wall; pulsating cavities in the lumen of the vessels; signs of cerebral hemorrhage; compression of the medulla; compression of nerve trunks.
Angiography	It is a minimally invasive research method, in which the vascular bed ( through the femoral artery or vein) a special contrast agent is introduced, which can be easily seen with other research methods ( CT, MRI, plain radiography) Allows you to accurately localize vascular aneurysms, to identify the degree of blockage of the arteries.	allows you to accurately trace the trajectory of blood vessels, identify the places of their expansion or narrowing; detects blood clots; reveals areas of the brain with impaired blood circulation.
Transcranial Doppler Ultrasound	It is a method of ultrasound diagnostics, in which a sensor for examining intracranial vessels is applied to the surface of the head in certain places. Due to the physical Doppler effect ( change in wavelength depending on the speed and direction of the object under study) allows you to study in detail the blood circulation in the system of cerebral arteries.	spasm of cerebral vessels; areas with impaired blood flow; zones with eddy current of blood; sharply dilated blood vessels.
Positron emission tomography (PAT)	It is based on the registration of a special type of radiation that occurs under the influence of an administered labeled drug.	ischemic zones ( reduced circulation); areas with increased blood circulation.
Plain radiography of the cervical spine	X-rays are unevenly absorbed by different tissues in the human body. As a result, the formed image is determined by the degree of absorption and radiological density of the tissues through which the wave beam has passed. It is uninformative in the detection of aneurysms of cerebral vessels, but is widely used for differential diagnosis.	Allows to detect signs of traumatism of the cervical spine in patients in a coma or unconscious and, thereby, exclude the diagnosis of subarachnoid bleeding and aneurysm.

Electrocardiography ( ECG)

Electrocardiography is a method of graphic recording of the electrical activity of the heart muscle. It is a fairly sensitive method for determining cardiac pathologies. With cerebral aneurysm, it is an uninformative method, which, however, allows you to determine a number of changes that have arisen with concomitant or predisposing pathologies. In addition, the ECG in most hospitals is included in the list of mandatory studies in preparation for surgery.

Lumbar puncture

Lumbar ( lumbar) puncture is a puncture of all three meninges at the level of the lumbar spine in order to obtain cerebrospinal fluid. This procedure is carried out under sterile conditions by highly qualified personnel. Usually the puncture is carried out at the level between the second and third or third and fourth lumbar vertebrae, that is, where the spinal cord no longer exists. The risk of complications with a properly performed procedure is minimal.

A lumbar puncture is used to detect subarachnoid bleeding when medical imaging is not available or is ineffective. At the same time, in the analysis of liquor ( cerebrospinal fluid) showed traces of blood.

Electroencephalogram ( EEG)

An electroencephalogram is a method of graphic recording of the electrical activity of the brain, which is recorded through electrodes applied to the surface of the head.

EEG makes it possible to identify various neurological disorders, determine areas of brain damage or ischemia, and make a differential diagnosis of certain diseases with symptoms similar to aneurysms. However, this method is most valuable during surgery, as it allows you to evaluate brain activity during surgery.

General and biochemical blood test

A laboratory blood test is necessary to determine comorbidities, as well as to determine the degree of risk during the operation.

When an aneurysm is detected, the following laboratory tests are indicated:

• Complete blood count with platelet count. Allows you to recognize some infections, determine the degree of anemia, recognize the risk of bleeding during surgery.
• prothrombin time. Prothrombin time, or prothrombin index, is an indicator of the state of the blood coagulation system. Allows you to identify problems with clotting and suggest the risk of intraoperative bleeding.
• blood electrolytes. Necessary to determine the initial level, on which it will be possible to base the correction during the operation.
• Functional liver tests. Allow to identify pathologies of the liver, on the normal operation of which many other indicators of the body depend. In the presence of serious anomalies, a certain correction is required.
• Other analyses. Other laboratory tests may be required depending on hospital standards and the specific clinical situation.

Treatment of cerebral aneurysm

To date, the only effective treatment for cerebral aneurysms is surgery. Drug treatment is used only to stabilize patients or in cases where surgery is impossible or contraindicated.

It should be understood that pharmacological drugs prescribed for treatment do not eliminate the aneurysm, but only reduce the risk of its rupture by eliminating a number of adverse factors. In addition, some drugs are used as a symptomatic treatment, that is, a set of therapeutic measures aimed at alleviating certain manifestations of the initial pathology.

Drugs used in the treatment of cerebral aneurysms

Pharmacological group	Representatives	Mechanism of therapeutic action	Application methods
Calcium channel blockers	Nimodipine	It blocks calcium channels in the muscle cells of the vascular wall, thereby expanding the vessels and improving blood circulation at the level of the cerebral arteries. They are mainly used to prevent spasm of the arteries.	Inside on an empty stomach, one capsule ( 30 mg) every 6 hours.
Anticonvulsants	fosphenytoin	Stabilizes the membrane of nerve cells, thereby slowing down and reducing the spread of pathological nerve impulses.	It is administered intravenously at a dose of 15-20 mg per kilogram of the patient's weight.
Antihypertensive drugs	Labetalol Hydralazine Captopril	Reduce the tone of the arteries by acting on various receptors and enzymes. Reduce mechanical stress on the aneurysm wall, thereby reducing the risk of its rupture.	The dosage and mode of administration depend on the initial level of blood pressure, as well as on the desired effect. In some cases, with increased intracranial pressure, these drugs are not prescribed, as they can reduce blood circulation in the vessels of the brain.
Painkillers	Morphine	It acts on specific opioid receptors, reducing the level of pain and changing its color.	It is prescribed intravenously, under the control of vital functions in intensive care units. The dosage is selected individually, depending on the effect obtained.
Antiemetics	Prochlorperazine	It blocks postsynaptic dopamine receptors in the mesolimbic zone of the brain, thereby reducing the activity of the vomiting center.	It is prescribed orally, in the initial daily dose of 25 mg. Gradually, the dosage can be increased to 300 mg.
Antacids	Ranitidine	Blocks H2 histamine receptors of the stomach, thereby reducing the secretion of gastric juice and reducing its acidity.	It is used orally, 150 mg once a day.

Surgery

Surgical treatment is aimed at isolating the cavity of the aneurysm and removing it from the cerebral circulation. This reduces the risk of rupture and eliminates the effect of squeezing adjacent tissues.

To date, several types of operations have been developed, each of which has strictly defined indications. The effectiveness of surgical treatment, unfortunately, is not one hundred percent, however, the risks of surgical intervention are many times overridden by the likely risks of rupture of an aneurysm of a cerebral vessel.

There are the following methods of surgical treatment of aneurysm:

• Craniotomy and clipping of the aneurysm. This method is based on the opening of the cranium ( craniotomy) and placing a special metal clip directly on the neck of the aneurysm while preserving the maternal vessel. As a result, gradual necrosis of the aneurysm cavity occurs, followed by its replacement with connective tissue. A significant disadvantage of this method is the impossibility of gaining access to vessels located close to the vital centers or in the depths of the brain.
• Endovascular aneurysm repair. Endovascular method ( translated from Latin - intravascular) is a minimally invasive and highly effective method for repairing aneurysms. With this method, a special flexible catheter is inserted through one of the distant vessels into the bloodstream and gradually, under constant X-ray control, moves up to the aneurysm. Then a special metal coil is inserted from this catheter into the cavity of the aneurysm, which causes a gradual blockage and death of the aneurysm. The advantage of this method is the ability to access deep-seated cerebral vessels. The endovascular method can be used even after the rupture of the aneurysm and the onset of subarachnoid bleeding, as it allows you to eliminate the vascular defect.

Is treatment always necessary when an aneurysm is identified?

To date, the frequency of detection of unruptured aneurysms is gradually increasing, which is associated with the increasing use of various methods of medical imaging. After identifying this pathology in many patients, the question arises whether it is necessary to treat it. It should be noted right away that this issue is relevant only for an unruptured aneurysm, since in the event of a rupture, surgical treatment is the only available method of saving life and preventing re-rupture.

In conditions of an unruptured aneurysm, the decision on treatment should be made by the patient, carefully understanding this issue, consulting with qualified specialists and evaluating all possible risks.

It should be understood that today the only effective method of preventing aneurysm rupture is surgical intervention, which is the only method of treatment. The risks of this procedure depend on many indicators, among which are the general condition of the patient, the location and structure of the aneurysm, and its size. Whatever the case, the 10-year survival rate for people who repair an aneurysm is significantly higher than for those who don't. Of course, there are exceptions, however, given the rapid development of safer endovascular techniques, this figure may increase even more.

Prevention of stroke in cerebral aneurysms

The only effective prevention of hemorrhagic stroke in cerebral aneurysm is timely surgical treatment. However, in addition to this radical method of solving the problem, the risk of aneurysm rupture can be reduced by changing lifestyle and eliminating risk factors.

The following activities slightly reduce the risk of subarachnoid hemorrhage:

• quitting smoking and alcohol;
• control of blood pressure with the help of drugs prescribed by a doctor;
• a balanced diet with a reduced content of animal fats and cholesterol;
• low physical activity;
• refusal of traumatic sports;
• periodic monitoring by a specialist;
• regular intake of medicines prescribed by a doctor.

It should be noted that in the presence of an aneurysm of a cerebral vessel, self-treatment is categorically contraindicated. This is due to the fact that some medications can provoke an adverse reaction of the body, which can cause aneurysm rupture. Before taking any medications ( even aspirin, which reduces the viscosity of the blood and thereby increases the risk of bleeding) you should consult your doctor.

Is it possible to treat a brain aneurysm with folk remedies?

Cerebral aneurysms are a wall defect that cannot be completely corrected by medication or by the use of traditional medicine. All these treatments can only affect the blood flow in the arteries of the brain. However, even this influence is sometimes enough to reduce the risk of dangerous complications ( in the first place - aneurysm rupture and hemorrhagic stroke). Of course, due to the high risk of complications, preference should be given to pharmacological drugs, the effect of which is stronger and narrower than that of folk remedies. However, with the consent of the attending physician, some folk recipes can also be included in the course of treatment.

First of all, we are talking about those means that stabilize blood pressure and prevent its increase. It is sharp pressure surges that usually cause aneurysm ruptures. In this case, folk remedies are used more to prevent complications, rather than treat the disease. In addition, many medicinal plants used in traditional medicine contain a large amount of vitamins, minerals and other beneficial substances. This strengthens the body as a whole and improves the well-being of people who, for one reason or another, cannot have an aneurysm removed surgically. Finally, some medicinal plants contain substances that strengthen the vascular wall. This directly reduces the risk of aneurysm rupture.

The most effective in the fight against cerebral aneurysms are the following folk remedies:

• beetroot juice. Freshly squeezed beetroot juice with honey is considered an effective way to lower blood pressure. The effect occurs 1-2 weeks after the start of the course. The juice is mixed in equal proportions with flower honey and drunk 3-4 tablespoons three times a day.
• Honeysuckle. The berries of this plant are extremely effective. They have a general strengthening effect, which is especially noticeable in old age. Their main action is also to lower blood pressure.
• potato peel. It is used for the prevention of hypertensive crises. You can drink a decoction ( potatoes are boiled with peel for 10 - 15 minutes, and then they drink expressed water) or just eat potatoes in their skins with their skins on.
• Infusion of cornmeal. For one cup of boiling water, you need 1 full tablespoon of cornmeal. It is stirred and left overnight. In the morning on an empty stomach, you need to drink only liquid ( decant without stirring the sediment).
• Decoction of black currant. Dried blackcurrant berries are poured with boiling water ( per 100 g of fruit 1 liter of water) and keep on low heat for 8 - 10 minutes. Then, for several hours, the broth cools down and infuses. It is filtered and drunk 50 g three times a day. Vitamins and trace elements will strengthen the vascular wall and reduce the likelihood of a stroke.
• Valerian root. For 10 g of dry crushed root, 1 cup of boiling water is needed. The mixture is boiled for 20-25 minutes and allowed to cool to room temperature ( 1 – 2 hours). The decoction is drunk 1 tablespoon 2-3 times a day. It reduces the likelihood of high blood pressure due to stress.
• motherwort tincture. For a tablespoon of motherwort, 1 cup of boiling water is needed. The glass is covered with a saucer to reduce the evaporation of liquid ( you can use a sealed bottle), and leave for 3-4 hours. After that, the infusion is taken 1 teaspoon three times a day ( preferably 30-60 minutes before meals).
• Decoction of immortelle. For 25 g of dried flowers, 1 liter of boiling water is needed. The mixture is continued to boil until about half of the water has boiled away. After that, the broth is cooled to room temperature and taken 20-30 ml three times a day. The therapeutic effect is felt 5-7 days after the start of treatment.

It should be noted that some plants have a very noticeable hypotonic effect ( reduce pressure well). Their use at the same time with certain drugs of similar action can cause dizziness, tinnitus, darkening of the eyes and other manifestations of low blood pressure. If such symptoms appear, treatment with folk remedies should be temporarily stopped and seek the advice of a doctor.

The above folk remedies are relevant for all patients with cerebral aneurysm. However, they can be used prophylactically and in the postoperative period, when the aneurysm itself has already been surgically removed. This will speed up the recovery.

It is strictly forbidden to give folk remedies a dominant place in the course of aneurysm treatment. This disease should always be treated with highly effective pharmacological agents ( before surgical removal of the problem), since it is about the life of the patient. Self-medication without consulting a doctor greatly increases the risk of various complications. The fact is that artificial pressure reduction in some cases can only worsen the patient's condition ( for example, in patients with anemia or other comorbidities). Therefore, traditional medicine begins to be taken only after a full comprehensive examination of the patient.

Can a cerebral aneurysm develop again?

Cerebral aneurysm is a rather rare but formidable pathology that can develop due to many external and internal factors. Treatment of aneurysm today is exclusively surgical, which is a radical solution to the problem. However, even after surgery, there is a risk of re-development of this disease.

A true cerebral aneurysm is a sac-like protrusion of the inner layer of the vessel through the middle and outer shells. This pathology develops in various categories of patients, but most often occurs in the elderly. To date, no single clearly defined cause of this pathology has been identified, however, there is a whole range of diseases in which the risk of developing intracranial aneurysm is highest. Among these diseases, a separate role belongs to genetic abnormalities and diseases of the connective tissue.

With acquired or congenital diseases of the connective tissue, the structure of the supporting framework of internal organs and vessels changes significantly. As a result, the walls of arteries and veins become less resistant to hemodynamic stress, that is, they are unable to withstand high blood pressure. As a result, under the action of blood flow in the weakest places of the vessels, peculiar defects are formed, through which the inner shell of the vascular wall protrudes - an aneurysm cavity is formed.

Thus, based on the mechanism described above, it becomes clear that even with the radical elimination of one of the aneurysms, the internal and external factors that caused the primary pathology do not disappear anywhere. As a result, over a fairly long period of time, the likelihood of re-formation of the aneurysm remains.

In order to prevent recurrence of an aneurysm, the following recommendations should be followed:

• Control blood pressure. High blood pressure is one of the main factors that can trigger the development of intracranial vascular aneurysm. In order to reduce the negative impact of hypertension on the vascular wall, you should regularly take the drugs prescribed by your doctor, as well as periodically undergo medical examinations.
• Follow a diet. A healthy and balanced diet can stabilize the general condition of the body, normalize the work of many organs and systems. It is extremely important to control the intake of animal fats, as they are the main source of cholesterol, the excess of which can be deposited in the vessel wall, weakening it ( atherosclerosis). To prevent this, you should consume mainly vegetable fats, as well as a large amount of fresh vegetables and fruits.
• Take prescribed medications regularly. In most cases, after the operation to eliminate the aneurysm, the attending physician prescribes a long course of treatment, which is aimed at normalizing the general condition, controlling internal and external negative factors, as well as reducing the likelihood of relapse.
• Avoid high physical activity. High physical activity in most cases increases the pressure in the system of cerebral arteries, which significantly increases the risk of aneurysm recurrence.
• Periodically undergo medical supervision. Even if all the rules and recommendations of the doctor are followed, the risk of re-formation of the aneurysm remains. In order to reduce the likelihood of its rupture and subarachnoid bleeding ( which is a very severe complication.), you should regularly, especially during the first year after surgery, undergo a medical examination, as this allows you to identify relapses at an early stage and conduct adequate treatment.

Which doctor treats and diagnoses cerebral aneurysms?

A neurosurgeon is involved in the diagnosis and treatment of cerebral aneurysms. However, it should be understood that other doctors are actively involved in this process.

Any adequate medical intervention is based on a comprehensive multidisciplinary approach. In the majority of both domestic and Western clinics, doctors of different specialties are constantly working together in order to increase the productivity and efficiency of certain methods of medical treatment and diagnostics, which significantly increases the patient's chances for a full recovery.

In the vast majority of cases, before undergoing surgery, patients go through a number of specialists who help identify aneurysms, diagnose concomitant diseases, and prepare the patient for surgery.

The following specialists are involved in the treatment and diagnosis of patients with intracranial aneurysm:

• Family doctor. Despite the fact that the family doctor does not treat cerebral aneurysms, in most cases he is the specialist that the patient encounters in the first place. The further fate of the patient depends on the correct tactics and clinical thinking of the family doctor. In most cases, these doctors, based on the data obtained during the examination and conversation with patients, refer them for further examination and appoint a consultation with a neurologist, who will continue to guide this patient.
• Neurologist. Neurologists are specialists who deal with diseases of the central nervous system. It is they who most often prescribe computed tomography or magnetic resonance imaging, with the help of which an aneurysm is detected.
• Radiologist. The field of work of a radiologist is a variety of medical imaging methods, with the help of which an aneurysm can be detected, its position, structure and size are determined. This specialist provides the surgeon with the most valuable data, without which no surgical intervention is possible.
• Anesthesiologist. Anesthesiologists are specialists who deal not only with anesthesia of the patient during surgery ( anesthesia), but also prepare him for the upcoming surgical intervention, together with the neurosurgeon, determine the most optimal and safe methods of treatment.
• Neurosurgeon. It is the neurosurgeon who is the specialist who performs the surgical intervention and eliminates the aneurysm. However, his work is not limited to the operation. In addition, he plans and develops the safest and most rational therapeutic tactics, prescribes the necessary examinations, and guides the patient in the postoperative period.

Thus, despite the fact that the treatment of cerebral aneurysm is the prerogative of the neurosurgeon alone, in no case should we forget about the rest of the team of doctors who are equally striving to help the patient.

What to do after surgery for a cerebral aneurysm?

Operations to remove brain aneurysms can be of several types. It depends on the size of the aneurysm, its type, and the location of the affected vessel in the brain. By and large, all operations are divided into two large types - open and minimally invasive. In the first case, we are talking about access to the aneurysm through the cranium, and in the second case, it is about strengthening the vascular wall in the area of ​​the aneurysm through the vessel. Of course, open surgery is more difficult to tolerate and the postoperative period after it will be longer than with minimally invasive intervention.

However, in both cases, after aneurysm removal or vessel strengthening, patients should follow a number of rules that will prevent the development of various complications. In general, they represent a certain regimen that the patient adheres to. This mode is discussed individually with the attending physician, since only such an approach allows taking into account the condition of a particular patient, concomitant diseases and individual wishes. But in any case, there are a number of basic principles that are relevant for all patients.

In the postoperative period, it is necessary to pay attention to the following points:

• Nutrition. Usually, nutrition does not play a key role in the postoperative period during surgical interventions on the vessels of the brain. However, if the aneurysm was acquired against the background of atherosclerosis, diabetes mellitus or other metabolic diseases, it is the diet that becomes the key component of prevention. You should not overeat, eat a lot of sweets, and also eat too fatty foods. Alcohol, salty and spicy foods can lead to reflex vasodilation. In the first weeks after surgery ( especially with open interventions) this can cause a stroke or recurrence of the aneurysm. An important factor that can be affected by diet is blood pressure. To curb its growth, you need to limit the use of strong tea, coffee, and salt ( including as part of other dishes). Useful dairy products, lean meats ( boiled or steamed), cereals, vegetables and fruits.
• Limitation of physical activity. Physical activity is limited after any intervention on the vessels. The fact is that when lifting weights, walking fast or running, the heart rate quickens, and the pressure begins to rise. Because of this, a rupture may occur in the operated vessel. Physical activity after open surgery is limited to such an extent that in the first days after surgery, the patient is not recommended to get out of bed. Then it is gradually allowed to walk, slowly climb the stairs, lift a load of several kilograms. With time ( in a few weeks or months) this restriction can be removed if the results of preventive examinations do not reveal the threat of rupture or recurrent aneurysm.
• Blood pressure measurement. After surgery, the patient needs to regularly measure blood pressure. In the hospital, this is done by the medical staff on a fixed schedule. However, at home, you should not stop this procedure. Normal blood pressure ( 120/80 mmHg) is a guarantee that the rehabilitation is successful. As a rule, patients after surgery take certain drugs to normalize blood pressure. Daily measurement ( it is important to do it at about the same time of day) will help evaluate the effectiveness of the prescribed treatment. If the pressure varies greatly throughout the day, or there is a tendency to a significant increase ( systolic pressure 140 mm Hg. Art. and more), this should be reported to the attending physician.
• Periodic consultations with a doctor. Even if after discharge from the hospital all the symptoms and manifestations of the disease have disappeared, this does not mean that you need to stop seeing a specialist. Usually, the schedule of visits is negotiated with the attending physician after the operation. It depends on the condition of the patient, the type of surgery and the presence of concomitant diseases. At first, after discharge, the doctor is visited every few days, then once a week or two. A month after the operation, they switch to a monthly visit ( or less often if the doctor does not see a danger to the patient). If necessary, additional instrumental examinations may be scheduled during these visits. If any neurological symptoms appear in the postoperative period, you should contact a specialist immediately, regardless of when the next consultation is scheduled.

Compliance with these measures will help the patient recover faster after surgery and return to normal life. Neglect of the doctor's prescriptions is fraught with the development of serious complications, which often pose a danger to the life and health of the patient.

Are any physical therapy procedures used to prevent or treat cerebral aneurysms?

Actually, an aneurysm of the cerebral artery cannot be eliminated with the help of physiotherapy procedures. The fact is that with this disease there are structural changes in the wall of the vessel. Physiotherapy by means of electric, laser or electromagnetic influence can to a certain extent influence the cellular structure of tissues. However, this effect is not enough to eliminate the cavity of the aneurysm. Moreover, some physiotherapy can, on the contrary, weaken the already stretched wall of the aneurysm, or provoke an increase in blood circulation in a particular place. Because of this, the risk of aneurysm rupture, the most severe complication, which poses the greatest danger to the patient's life, will increase. In this regard, physiotherapy is not included in the complex course of treatment of cerebral aneurysms.

However, this method of treatment can be successfully used in hemorrhagic stroke, which occurs after the rupture of the aneurysm. At the same time, blood accumulates in the medulla. If the patient does not die directly from the hemorrhage, many brain functions are often impaired. Specific symptoms depend on the location of the damaged vessel. A long period of rehabilitation is required to restore normal brain function. This is where physiotherapeutic methods of treatment can be successfully applied.

During the rehabilitation period, physiotherapy procedures have the following goals:

• anti-inflammatory effect - reduces damage to brain tissue;
• absorbable action - prevents the accumulation of fluid and compression of nerve fibers;
• improved blood flow to surrounding healthy areas of the brain ( this partly compensates for the lost functions);
• restoration of movements in the limbs with movement disorders.

All physiotherapy procedures can be divided into two large groups. The first includes massage and gymnastics. Here there is an effect not on the area affected by a stroke, but on the muscles and blood vessels of the body, which have lost their functions due to hemorrhage in the brain.

The main principles of such treatment are:

• Passive movements in the limbs. They begin to be done 1 to 2 weeks after a hemorrhagic stroke. The patient does not try to strain the muscles. At first, the movements in the joints themselves are important. Alternate flexion, extension, rotation and other types of movements. The doctor tries to capture all the joints of the affected limb. A change in the position of the limb is done every 1 to 2 hours. For such a time, an arm or leg is fixed in a certain position. Gradually, this time is reduced, and the patient tries to help the doctor by conscious muscle contraction.
• active movements. The patient performs such movements himself, without the help of a doctor, when motor functions begin to return to him. The duration of active movements should be at first no more than a few minutes. Gradually the time increases.
• Collar area massage recommended to improve cerebral circulation. It should be done in a comfortable position for the patient at a comfortable temperature. The movements of the masseur's hands are smooth. Muscles should not be stimulated like sports massage), and slightly knead.
• Therapeutic massage of the limbs. The masseur determines the condition of certain muscle groups in the affected limb. Those groups that are in a tense state ( hypertonicity) should be relaxed. The movements here are slower and smoother. Antagonist group ( moving in the opposite direction), usually relaxed ( hypotonicity). In this area, a stimulating massage is done with patting, sharper movements and stronger pressure. This restores muscle tone and helps restore conscious control over movements.

In addition to massage and gymnastics, a number of procedures are used to stimulate tissues in the area of ​​hemorrhagic stroke. This contributes to the speedy restoration of normal connections between neurons and normalizes the passage of nerve impulses. Some electrophysical procedures can also be applied to the affected muscles.

For the speedy rehabilitation, the following methods of physical and chemical effects can be used:

• electrophoresis. The procedure consists in introducing certain medicines into the affected area under the influence of electromagnetic waves. With the help of a special device, you can enter ( according to indications) aminofillin, papaverine, iodine preparations. Insertion site ( electrode placement) is selected according to the site of the ruptured aneurysm. The current strength should not exceed 3 - 4 amperes. A course of 15-20 sessions is recommended ( daily) lasting 15-20 minutes. If necessary, the course of electrophoresis can be repeated after 1 - 2 months.
• Muscle electrical stimulation. The procedure consists in applying current to the spastic ( tense) muscle groups. The variable operating mode of the apparatus is set with a frequency of 100 - 150 Hz. The current strength is selected in the range of 25 - 45 amperes until a normal physiological muscle contraction is obtained ( the appearance of a reflex). Each of the selected fields is affected 2-3 times for 2 minutes with short breaks ( 45 - 60 seconds). Procedures are carried out daily for 20-30 days. The interval between courses of treatment should be at least 3 weeks.

Somewhat less often, ultrasonic waves are used to stimulate muscles and dissolve blood in the area of ​​a stroke. Their effect on the nervous system is somewhat more aggressive, so they are resorted to in cases where other methods do not give tangible results or the patient has specific contraindications.

In addition to all of the above procedures, physiotherapy also includes the use of various therapeutic baths. They speed up rehabilitation not only after a hemorrhagic stroke, but also after an operation to remove a cerebral aneurysm.

The most commonly prescribed types of baths are:

• coniferous baths - 10 minutes each, 8 - 10 procedures every other day;
• sulfide baths ( optimal concentration - about 100 mg / l) - 5 - 10 minutes, 12 - 14 procedures every other day;
• iodine-bromine baths - 10 minutes each, 10 - 15 procedures every other day;
• coniferous baths - 10 minutes each, 10 - 12 procedures every other day;
• oxygen baths - 10 - 20 minutes, 10 - 15 procedures daily.

Heat and cold treatments can also be applied locally to specific muscle groups. In the first case, paraffin applications are used, and in the second, ice bags. The combination of all these methods allows you to quickly restore lost motor and sensory functions. However, the appointment of methods should be done only by the attending physician. In the postoperative period, they are used only in cases where the operation was completed with complications and the patient has residual neurological disorders. Before surgery or aneurysm rupture, none of the above methods is recommended. Moreover, when relaxing in resorts and sanatoriums, patients with cerebral aneurysm should refrain from these procedures ( they are often recommended to vacationers as a tonic).

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What is a brain aneurysm

An aneurysm, most commonly a saccular aneurysm, is a globular or similar mass in an artery in the brain. Aneurysm, as I have already noted, is saccular and fusiform. Aneurysm consists of three parts neck, body and bottom or top. Unlike the normal vascular wall, the apex of the aneurysm is not three-layered, but single-layered and most vulnerable to rupture, especially since a shock blood stream rushes to this place. Most often, the aneurysm is located in the anterior parts of the circle of Willis - in descending order - the aneurysm of the anterior communicating artery of the PCA, then the aneurysm of the internal carotid artery of the ICA, . Less common are aneurysms of the vertebrobasilar basin - aneurysms of the bifurcation of the basilar artery OA, the mouth of the posterior inferior cerebellar artery PICA. Aneurysms of the pericallosal artery and other distal parts of the anterior cerebral and middle cerebral arteries are also quite rare.

Classification of aneurysms by size

• Milliary aneurysms - up to 3 mm;
• Small aneurysms - 3 mm - 5 mm;
• Ordinary - 5 mm-1.5 cm;
• Large aneurysms - 1.5 cm - 2.5 cm;
• Giant aneurysms - more than 2.5 cm in largest size.

Cerebral aneurysm photo

I present to your attention a photo of 2 aneurysms - the basilar artery and the bifurcation of the middle cerebral artery, which we had to deal with in our clinic over the past 2 weeks.

Saccular aneurysm of the bifurcation of the basilar artery

Saccular aneurysm of the bifurcation of the left middle cerebral artery. The aneurysm and branches of M2 are outlined with a ballpoint pen.

The aneurysm of the bifurcation of the basilar artery had to be transferred to another facility for endovascular exclusion (filling with coils), and the MCA aneurysm was operated in our clinic.

Cerebral aneurysm causes

Finally, the genesis of arterial aneurysm is not clear. Some argue that this is a congenital phenomenon - an undeveloped, blindly ending short vessel. Others say it's an acquired condition - a bulge in a weak spot hemangiona- the structural unit of the vessel, between the circular areas of smooth muscles. As a result of the impact of the shock wave, this protrusion gradually grows. De-novo aneurysm formation confirms the presence of new aneurysms on follow-up angiographies in already operated patients. There is also an autoimmune inflammatory theory of the occurrence of arterial aneurysms, which is being actively developed at the University of Helsinki with the participation of Professor J. Hernisniemi. Thus, he believes that in time a drug will be developed that can treat and prevent aneurysmal disease (he considers himself the last of the Mohicans - i.e. "aneurysmal" surgeons).

Cerebral aneurysm - symptoms

Most often, an aneurysm debuts as a rupture, the most formidable, often fatal complication. Hemorrhage may be subarachnoid, parenchymal and ventricular, as well as all sorts of combinations of this trinity.

Of the atypical manifestations - pseudotumor, with a gigantic aneurysm, it can behave like a tumor and compress the brain and nerves, causing focal neurological symptoms.

Migraine-like the course is manifested by hemicranialgia.

Pseudoradicular mimics sciatica - pain in the legs, which is caused by the flow of blood into the terminal cistern of the spinal cord.

meningitis-like- in this case, patients with suspected bacterial meningitis can end up in an infectious disease hospital, where only with a lumbar puncture is diagnosed SAH and suspected aneurysm rupture.

psychotic- the name speaks for itself.

Methods of treatment of brain aneurysm

Surgical

Aneurysm is treated only surgically - by direct intervention, exclusion by clipping, wrapping with various materials (rarely) or endovascular method. Only miliary aneurysms may be seen in patients without risk factors for rupture. Aneurysms without previous hemorrhages are also subject to surgical treatment. A rupture is easier to prevent than to treat its fatal consequences - angiospasm and clip the aneurysm in the most acute period.

Intraoperative photo of a clipped aneurysm of the left middle cerebral artery.

CT angiography the next day after surgery. The aneurysm is off. M2 segments of the left MCA are contrasted.

The red circle marks the area of ​​intervention, where 2 clips are installed. There are signs of angiospasm.

In the area of ​​operation on native CT of the brain, a small amount of blood is impregnated with surgicell.

On CT in bone mode, the clip is clearly visible.

Cerebral aneurysm - consequences after surgery

The consequences of the operation, as well as the natural course of the disease itself, are very often cerebral angiospasm, which leads to unsatisfactory results of treatment - death or severe neurological deficit in the form of paresis and paralysis, aphasia, mental disorders (which is typical for aneurysms of the anterior communicating artery). Meningitis can be a complication of the operation itself, which is associated with the presence of blood - a rich nutrient medium in the subarachnoid space, in the basal cisterns, cerebral ischemia, and a rather long operation time.

Thus, the treatment of arterial aneurysms is a very urgent and difficult problem in neurosurgery, especially in the most acute and acute periods of hemorrhage.

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