Brain aneurysm – what is it and is it possible to avoid surgery
- 1 What is aneurysm
- 2 Classification
- 3 The reasons
- 4 Symptoms
- 5 Aneurysm rupture
- 6 Diagnostics
- 7 Treatment
- 8 Forecasts
This education is present in 5% of people, but in most cases it is not detected, that is, it is asymptomatic. When the aneurysm manifests itself, neurological disorders like tumor-like or stroke-like occur (at rupture). Pathology is detected during a specialized instrumental study. It is treated exclusively surgically.
What is aneurysm
Any artery, from the aorta to the smallest, is a three-layer tube. The inner layer, or intima, is the endothelium (epithelium cells), the middle one consists of elastic and muscle fibers. Outdoor is a mixture of collagen and connective fibers. If one of them becomes thinner or damaged, under the pressure of blood, the vascular wall bulges out. A bubble is formed – aneurysm – which poses a serious threat to health.
Most often, arterial wall defects appear in the place of their branches, where blood pressure is highest. Brain aneurysm consists of three structural elements: neck, body, dome. In the neck area, the protrusion has a three-layer structure, and its dome consists only of intima. This is where the break is most likely to occur. According to statistics, it occurs mainly in patients aged 30 to 50 years, accounting for more than 80% of all cases of hemorrhages in the brain.
Aneurysms are divided by structure into two groups. They can be spindly or sacculate. In the first case, they have the form of a uniform expansion of a portion of the vessel. In the second – they stick out on one side, forming a kind of bubble. Bagular may consist of one or several chambers and are much more common than spindles.
There is another classification – by the location of cerebral aneurysm. It can be localized in the vertebro-basilar system or on the following arteries: the anterior or middle cerebral, as well as the internal carotid. In more than one tenth of cases, multiple protrusions are diagnosed, on several vessels simultaneously. The size of the formation of miliary distinguish, the diameter of which does not exceed 3 mm, small – no more than 1 cm, medium – from 1 to 1.5 cm, large – up to 2.5 cm. If the size exceeds 25 mm, we are talking about the so-called giant aneurysm.
Pathology may be congenital or acquired. Defects of the vascular wall due to fetal abnormalities are often accompanied by other diseases. These include congenital coarctation of the aorta, multiple renal cysts, arteriovenous malformations, underdevelopment of the connective tissue.
Acquired changes are the result of various traumatic brain injuries or past diseases. Aneurysm of cerebral vessels often develops on the background of hypertension, atherosclerosis, and hyalinosis. If the protrusion is formed after an infectious embolus has entered the artery, it is called mycotic. In addition, aneurysms are formed due to uneven blood flow or arterial hypertension.
In most cases, a small expansion of the artery does not manifest itself. Such aneurysm is most often found by chance or during a routine examination. When clinical signs appear, they are divided by the flow into tumor-like or apoplexic. In the first case, the formation rapidly increases in size, as it grows, squeezing the nearby brain structures.
All symptoms add up to the standard clinical picture of the tumor and are directly dependent on the location of the protrusion. Usually, an aneurysm of a tumor-like type is localized in the cavernous sinus or in the area of chiasm, the junction of the optic nerves.
A defect in the artery wall located in the chiasmal region adversely affects the visual function: visual acuity decreases, its fields are disturbed. A long-existing and rather large brain aneurysm often leads to nerve atrophy followed by complete blindness. If it is deployed in the cavernous sinus, which is located at the base of the skull and regulates the venous outflow from the sockets and brain, paresis of the cranial nerves appears. When the 3rd, 4th and 6th couples are affected, oculomotor disturbances such as strabismus occur, it is impossible to focus on the subject.
The defeat of the branches of the trigeminal nerve is manifested characteristic symptoms of his neuralgia. In advanced cases, even the bone tissue of the skull is deformed, which is detected during the X-ray examination.
When the disease is of apoplexic type, any clinical signs are most often absent. Apoplexic aneurysm is detected only after its rupture and hemorrhage in the brain. Of the symptoms that may precede this, painful sensations in the orbits and the forehead are occasionally mentioned.
When the protrusion ruptures, a very severe headache appears first. At first, it can be felt locally, where the damage is located. Then gradually, the painful sensations become diffuse, covering the whole head. The following signs of hemorrhage are added:
- Nausea with repeated vomiting.
- Increased sensitivity and tone of the occipital muscles.
- Kernig’s symptom is the inability to straighten a raised, bent knee (while lying).
- Symptom complex of Brudzinsky, when with pressure on different points of the body limbs involuntarily move.
- Loss of consciousness for various periods of time.
- Mental disorders (from minor to severe), epileptic seizures.
The hemorrhage between the meninges – the subarachnoid – causes a long spasm of nearby arteries. In most cases, it leads to the defeat of the medulla, as in ischemic stroke.
If, when a cerebral vascular aneurysm is ruptured, blood enters its ventricles or substance, focal is added to the common symptoms. Specific symptoms depend directly on the location of the damage. When it is located in the area of the carotid bifurcation, visual function suffers. The defeat of the anterior cerebral artery leads to mental disorders with simultaneous paresis of the legs, and the middle – to speech disorders and paralysis of the opposite side of the body. Aneurysm, located in the vertebro-basilar system, as a result of the rupture, causes a lack of coordination, dysphagia, frequent eye oscillations, paresis of the trigeminal and facial nerves.
The frequency of subarachnoid hemorrhage is about 80% of the total. Intracerebral hematomas are less common, but have more pronounced negative effects. The outbreak of blood in the ventricles is most dangerous, since the result is often fatal. With hemorrhage into the cavernous sinus, outside the hard shells, the medulla is not damaged.
Detect aneurysm of cerebral vessels, if it is small and does not manifest clinically, can only be random. Asymptomatic disease in most cases is detected on special examinations, which are conducted on another occasion. If there are pathological symptoms, you need to contact a neurologist.
Diagnosis begins with anamnesis based on patient complaints. Then a neurological examination is performed, during which the localization of the aneurysm is determined on the basis of specific tests.
The next diagnostic step is an instrumental examination. It includes the following manipulations:
- X-ray, with which it is possible to detect the characteristic deformation of the bones of the skull at its base. Petrified protrusions in which calcium salts are deposited are also visible on the x-ray.
- Magnetic resonance imaging and computed tomography are more informative methods of examining the brain, but they may not be enough to confirm the diagnosis.
- Angiography gives the most complete picture of the state of the vessels without the introduction of contrast agents into them. With its help, a three-dimensional image of the damaged artery is obtained, which makes it possible to judge the variety, size and shape of the protrusion.
If it is not possible to use high-precision equipment, a lumbar puncture is performed (cerebrospinal fluid sampling). According to the presence of blood in the cerebrospinal fluid, a conclusion is made about intracerebral or subarachnoid hemorrhage.
Special attention is paid to the differential diagnosis, since the brain aneurysm symptoms may be similar to other diseases. These include tumors, abscesses or cysts, if the pathology proceeds in a tumor-like type. In the case of apoplexic signs, differentiation is carried out from ischemic stroke, epilepsy, meningitis, transient ischemic attacks (spasm).
The aneurysm is treated mainly surgically, since such an formation requires removal. However, if the protrusion of small size does not manifest clinically, then the neurologist is limited to systematic observation. A patient with such a diagnosis is registered, regularly examined. Additionally, measures are being taken to eliminate the causes of the pathology. If there is an increase in cerebral aneurysm with an increasing simultaneously risk of its rupture, an operation is performed using one of the modern techniques.
The leading causes of this disease are atherosclerosis, hypertension, and diabetes. If there are chronic pathologies, it is necessary to treat them, as well as adjust their lifestyle. First of all, you should stop smoking and reduce alcohol consumption. These bad habits are extremely negative for the state of the vessels with all the diagnoses listed.
The transition to a healthy diet is one of the most important conditions for the stabilization of the state and effectiveness of drug therapy of major diseases. It is necessary to eliminate harmful fatty foods from the diet, minimize sugar consumption, eat more fresh vegetables with fruits, lean meat, dairy products. Heat treatment also matters: it is desirable to boil, simmer or bake dishes, and refuse from roast.
Required moderate exercise. If sport is contraindicated, you need to move more, walk along the street, climb stairs without an elevator. Effective special gymnastics, normalizing blood circulation, restoring muscle and vascular tone. In addition, when a brain aneurysm is very important to maintain a stable emotional background, less nervous, to avoid stress.
It is impossible to cure the pathology itself with pills or injections, but in most cases, drug therapy is necessary. Medicines are prescribed in accordance with the established cause of the aneurysm:
- If the vascular wall becomes thinner due to atherosclerosis, special preparations are used to lower cholesterol. These include nicotinic acid, statins, bile acid sequestrants. Due to the normalization of lipid metabolism, the process of cholesterol plaque deposition and arterial deformation is slowed down.
- In the presence of hypertension, medication that lowers blood pressure is mandatory. They reduce the risk of rupture of the existing brain aneurysm and the formation of new ones.
- Antibiotics are used if the cause of the pathology becomes an infectious embolus. Antibiotic therapy is intended for the treatment of infectious-inflammatory process that caused the pathological changes of blood vessels.
In case of rupture with hemorrhage, drug therapy is carried out as in hemorrhagic stroke. Intravenous drugs are used to stabilize intracranial pressure, arterial pressure, reduce vascular permeability, as well as hemostatics, barbiturates. In parallel, the question of the feasibility of surgical treatment. Doctors, on the basis of information on the location, volume of hemorrhage, prescribe surgery or continue to be treated with medicines.
The most effective method of treating brain aneurysm is microsurgical surgery to remove it. The following methods are used with varying degrees of invasiveness. Neck clipping is performed by microsurgical method after craniotomy. The brain membranes are opened through a hole with a diameter of not more than 4 cm, the aneurysm stands out, and a special clip is placed on its neck. Thus, the lumen of the protrusion overlaps.
Endovascular occlusion is a less traumatic operation, shown to elderly patients, as well as in the presence of somatic diseases or deep location of the aneurysm in the brain tissues, its spindle-shaped form. Through an incision in the femoral artery, a micro-coil is inserted into the cavity of the aneurysm, thrombusting it, or a balloon catheter covering the lumen.
If there are malformations, methods of transcranial, radiosurgical removal are shown. Stereotactic thermocoagulation, artificial thrombosis of the protrusion using coagulants are also used. If the aneurysm ruptures, surgical removal of the hematoma may be necessary. It is performed through stereotactic aspiration or endoscopic evacuation. In the case of ventricular hemorrhage, ventricular drainage is done.
The use of alternative medicine recipes to get rid of cerebral aneurysm will not help. However, it is possible to stabilize blood flow and pressure, reduce the concentration of sugar, cholesterol in the blood by folk remedies. The following are considered the safest and most effective:
- To reduce the level of sugar, a decoction of oats or flax seeds, a mixture of ground buckwheat with kefir, lemon juice with chicken eggs are used. Herbs are also useful – St. John’s wort, wormwood, immortelle and others.
- Herbal medicine is also used to reduce cholesterol concentration (golden mustache, bearberry, ginseng, dandelion are effective). Especially effective are honey, bee products, linseed oil, garlic, and lemons.
- Ginger, milk-garlic drink, herbal teas with the addition of honey will help to stabilize the pressure.
It is important to remember that folk recipes are only an addition to the main treatment. In addition, all methods of therapy at home must be coordinated with the doctor.
Perspectives of an aneurysm patient are evaluated in many ways. Size, localization and character of protrusion, its tendency to increase matter. If the education is small, does not grow and does not manifest in any way, you can live your whole life without a break or operation. The presence of chronic diseases that adversely affect the state of the vascular wall, predictions worsens. In this case, the risk of rupture or the formation of a new aneurysm increases many times.
According to statistics, a ruptured protrusion leads to death in the range from 30 to 50% of all cases. Among the survivors, about a third acquire persistent disability, and a quarter of hemorrhages occur again. In this case, the second gap leads to death even more often – in 70% of cases.