HYPERTENSION & CEREBRAL ANEURYSM FORMATION

As promised in our previous post Reason For Being Awayhere is our post about Cerebral Aneurysm.

It is said 1 in 50 people have a brain aneurysm. The annual rate of rupture is approximately 8 per 100,000 people or about 30,000 people in the United States suffer a ruptured brain aneurysm. There is a brain aneurysm rupturing every 18 minutes. Ruptured brain aneurysms are fatal in about 40% of cases. Of those who survive, about 66% will suffer some permanent deficit. There are almost 500,000 deaths worldwide due to ruptured brain aneurysms & half of the victims are younger than the age of 50.

So here we begin with the understanding of hypertension & cerebral aneurysms.

HYPERTENSION (BLOOD PRESSURE)

The pressure of the blood against the inner walls of the blood vessels, varying in different parts of the body during different phases of contraction of the heart & under different conditions of health, exertion, etc.

CEREBRAL ANEURYSM

Cerebral or brain aneurysm is a cerebra-vascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.

Hypertension is known to be a silent killer (by killing the person silently without any symptoms). Its silence can be very dangerous sometimes which can be fatal or can leave a serious morbidity behind. Hypertension may cause many health problems but this is article is written with the idea to provide you information about cerebral aneurysm.

The blood vessels are made up of three layers .i.e. tunica intima, media & adventitia.

When the Tunica Intima the inner most layer gets damaged usually due to high blood pressure or due to trauma, the vessel’s elasticity is compromised & the blood gets turbulence leading to the ballooning of vessel known as False Aneurysm formation. The True Aneurysm is said when all three layers of vessel is involved.

These Aneurysm can occur anywhere is the human body such as Abdominal Aorta or other blood vessels. If this aneurysm occurs with in the cranial cavity in the cerebral vessels it is known to be Cerebral Aneurysm.

HOW DO ANEURYSM FORM?
(PATHO-PHYSIOLOGY)

Aneurysm is a weak bulging spot on the wall of a brain artery very much like a thin balloon or weak spot on an inner tube. Over time, the blood flow within the artery pounds against the thinned portion of the wall & aneurysms form silently from wear & tear on the arteries. As the artery wall becomes gradually thinner from the dilation, the blood flow causes the weakened wall to swell outward. This pressure may cause the aneurysm to rupture & allow blood to escape into the space around the brain, which may be Fatal or can be a serious Complication.

TYPES OF ANEURYSMS

  1. SACCULAR ANEURYSM: It is a round shaped aneurysm that accounts for the vast majority of intracranial aneurysms. They are also the most common cause of non-traumatic subarachnoid haemorrhage.
  2. FUSIFORM ANEURYSM: Also known as Spindle Shaped Aneurysm. It is a variable in both diameter & length; their diameters can extend up to 20 cms.
  3. BERRY ANEURYSM: It is a small aneurysm that looks like a berry & classically occurs at the point at which a cerebral artery departs from the circular artery (the circle of Willis) at the base of the brain.
  4. MYCOTIC ANEURYSM: It is a localized, irreversible, atrial dilation due to destruction of the vessel wall due to infection.

ANEURYSM FORMATION

  1. Smoking
  2. High blood pressure or Hypertension
  3. Congenital resulting from inborn abnormality in artery wall
  4. Family history of brain aneurysms
  5. Age over 40
  6. Gender, women compared with men have an increased incidence of      aneurysms at a ratio of 3:2
  7. Other disorders like Ehlers-Danlos Syndrome, Polycystic Kidney Disease, Marfan Syndrome & Fibromuscular Dysplasia(FMD)
  8. Presence of an arteriovenous malformation (AVM),
  9. Drug use, particularly cocaine
  10. Infection
  11. Tumor
  12. Traumatic head injury
  13. Hardening of the arteries (arteriosclerosis)
  14. Heavy alcohol consumption
  15. Certain blood infections
  16. Lower estrogen levels after menopause



 

SIGN & SYMPTOMS OF HAVING AN ANEURYSM

Aneurysms are usually silent they will not let you know where and when you got the Aneurysm certain series of events & some features can let you know about an Aneurysm

UNRUPTURED ANEURYSM

  1. Pain above and behind an eye
  2. A dilated pupil
  3. Change in vision or double vision
  4. Numbness
  5. Weakness or paralysis of one side of the face
  6. A drooping eyelid.

LEAKING ANEURYSM

  • Sudden, extremely severe headache

RUPTURED ANEURYSM

It is usually known as Subarachnoid Hemorrhage (SAH). It is presented with the typical feature of worst pain ever as the patient complains of a severe headache that he/she had never experienced before. Other features may include:

  1. Nausea and vomiting
  2. Stiff neck
  3. Blurred or double vision
  4. Sensitivity to light
  5. Seizure
  6. A drooping eyelid
  7. Loss of consciousness
  8. Confusion

DIAGNOSIS OF AN ANEURYSM

Diagnosis is usually based on two things; a positive history with a positive series of events & radiological images.



  • MAGNETIC RESONANCE IMAGING (MRI): MRI uses a magnetic field & radio waves to create detailed images of the brain, either 2-D slices or 3-D images. A type of MRI that assesses the arteries in detail (MRI angiography) may detect the site of a ruptured aneurysm.
  • COMPUTERIZED TOMOGRAPHY (CT): A CT scan, a specialized X-ray exam, is usually the first test used to determine if you have bleeding in the brain. The test produces images that are 2-D “slices” of the brain. With this test, you may also receive an injection of a dye that makes it easier to observe blood flow in the brain and may indicate the site of a ruptured aneurysm. This variation of the test is called CT angiography.
  • CEREBROSPINAL FLUID TEST: If you have had a subarachnoid hemorrhage, there will most likely be red blood cells in the fluid surrounding your brain and spine (cerebrospinal fluid). Your doctor will order a test of the cerebrospinal fluid if you have symptoms of a ruptured aneurysm but a CT scan has not shown evidence of bleeding. The procedure to draw cerebrospinal fluid from your back with a needle is called a Lumbar Puncture or Spinal Tap.
  • CEREBRAL ANGIOGRAM: During this procedure, your doctor inserts a thin, flexible tube (catheter) into a large artery — usually in your groin — & threads it past your heart to the arteries in your brain. A special dye injected into the catheter travels to arteries throughout your brain.
  • X-RAY IMAGES: They can then reveal details about the conditions of your arteries and the site of a ruptured aneurysm. This test is more invasive than others and is usually used when other diagnostic tests don’t provide enough information.

TREATMENT IF TESTS ARE POSITIVE

Treatment of depends upon the condition, size & location of aneurysm.

TREATMENT FOR UNRUPTURED ANEURYSMS

  • MEDICAL THERAPY: Small, unruptured aneurysms that are not creating any symptoms may not need treatment unless they grow, trigger symptoms or rupture. It is very important to have annual checkups to monitor blood pressure, cholesterol & other medical conditions. Small, unruptured aneurysms require regular imaging examinations to make sure that they have not grown or changed significantly.
  • NEUROSURGERY: Depending upon the person’s risk factors, open surgery may be recommended. Patients are placed under general anesthesia, an opening is made in the skull, the brain tissue is spread apart & the aneurysm is surgically exposed. Then the neurosurgeon places a surgical clip around its base. The clip seals off the aneurysm in a way that blood can not enter. For an uncomplicated surgical clipping procedure, the hospital stay is usually 4-6 days. Full recovery usually takes several weeks to months.
  • NEUROINTERVENTIONS / NEURORADIOLOGY: Depending on the aneurysm’s size, location & shape, it may be treatable from inside the blood vessel. This minimally invasive procedure is similar to the cerebral angiogram. However, in addition to taking pictures, a catheter is directed through the blood vessels into the aneurysm itself. Then, using X-ray guidance, the endovascular surgeon carefully places soft platinum micro-coils into the aneurysm and detaches them. The coils stay within the aneurysm and act as a mechanical barrier to blood flow, thus sealing it off. For an uncomplicated procedure, the hospital stay is usually 1-2 days. Recovery after the operation usually takes 5-7 days. For a complicated surgery or endovascular treatment, or if an aneurysm has bled into the brain, hospitalization may last from 1-4 weeks, depending on the patient’s medical condition & any complications caused by the hemorrhage.

TRETAMENT FOR RUPTURED ANEURYSMS

  • SURGICAL CLIPPING: It is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm & locates the blood vessel that feeds the aneurysm. Then he/she places a tiny metal clip on the neck of the aneurysm to stop blood flow towards it.




 

  • ENDOVASCULAR COILING: It is a less invasive procedure than surgical clipping. The surgeon inserts a hollow plastic tube (catheter) into an artery, usually in your groin & threads it through your body to the aneurysm.


OTHER TREATMENTS

Other treatments for ruptured brain aneurysms are aimed at relieving symptoms & managing complications, which include:

  1. Pain relievers
  2. Calcium channel blockers
  3. Interventions to prevent stroke from insufficient blood flow
  4. Anti-seizure medications
  5. Ventricular or lumbar draining catheters & shunt surgery

WHAT IF I AM AFRAID OR NEUROSURGERY & CARRY ON WITH MY ANEURYSM?

Living with an aneurysm is like living with a tiny time bomb constantly ticking in your head. The worst thing is not knowing that you have a aneurysm.

  • RE-BLEEDING: It occurs in nearly 19% of SAH patients. SAH patients who experience re-bleeding at any time, approximately 70% will die. Re-bleeding is most likely to occur within the first 2 weeks of the SAH. Peak times within this time frame are within the first 24-48 hours & between 7-10 days.
  • VASOSPASM: It is the narrowing of a cerebral blood vessel due to irritation. Vasospasm results in reduced cerebral perfusion, cerebral ischemia, potential infarction & deterioration of neurological function. The mortality rate from vasospasm is between 40-50%.
  • HYDOCEPHALUS: It is a condition that occurs when fluid builds up in the skull & causes the brain to swell. The name means “water on the brain.”

    Brain damage can occur as a result of the fluid buildup. This can lead to developmental, physical & intellectual impairments. It requires treatment to prevent serious complications.

  • HYPONATREMIA: Subarachnoid hemorrhage from a ruptured brain aneurysm can disrupt the balance of sodium in the blood supply. This may occur from damage to the hypothalamus, an area near the base of the brain. A drop in blood sodium levels (hyponatremia) can lead to swelling of brain cells & permanent damage.

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