Cerebral aneurysm

At a cerebral aneurysm is a protuberance in the wall of a blood vessel in the brain. Such changes in the vessels have a disease value. Basically, cerebral aneurysms belong to the so-called cerebral angiodysplasias. Cavernomas and angiomas are also included in this category. In numerous cases, the cerebral aneurysm occurs in areas where the main arteries in the brain branch.

What is a cerebral aneurysm?

In principle, aneurysms are vascular bulges. They arise primarily in places where blood vessels divide. A distinction is made between different types, depending on the shape of the aneurysms. On the one hand, there are sac-shaped aneurysms and irregularly shaped ones. Aneurysms also differ considerably in terms of their size. The extent varies from a few millimeters to aneurysms in the centimeter range.

If the aneurysm is larger than two centimeters, it is called a giant aneurysm. The rupture of cerebral aneurysms. Such ruptures occur with a probability of about 10: 100,000 cases annually. This shows that female patients suffer more ruptures than men. The structure of aneurysms is divided into a neck and a sac area.

In the majority of cases, a rupture occurs at the thinnest point within the sac. For many people, the rupture is not heralded by prior signs, so that it usually occurs suddenly and in anticipation. Sometimes, however, the rupture is favored by physical exertion or pressing. Sac-shaped aneurysms often occur at the base of the brain. Because there the four most important arteries of the brain connect in a circle.

causes

The development of a cerebral aneurysm is usually promoted by various factors. On the one hand, disturbances or damage to the walls of the blood vessels are a possible development factor. In some cases, there are also genetic dispositions for the formation of aneurysms in the brain.

In addition, some factors make cerebral aneurysms easier to develop. These include, for example, a weakness of the connective tissue, certain malformations in the arteriovenous area and diseases of the kidney. Another crucial risk factor for the development of cerebral aneurysms is high blood pressure (medical term hypertension).

Smokers are also more at risk than non-smokers. Special mechanical forces act in the area of ​​the division of blood vessels in the brain. These are believed to be involved in the formation of aneurysms. This explains why numerous cerebral aneurysms develop at branch points of vessels.

The so-called tunica media is often thinned. In the majority of cases, cerebral aneurysms develop in the course of life. The lesser part of the aneurysms is congenital or inherited.

Symptoms, ailments & signs

The possible symptoms of cerebral aneurysms are different. In many cases, however, an aneurysm does not cause any discomfort for a long time and therefore remains undetected. In many cases, cerebral aneurysms are found and diagnosed by chance during other medical examinations.

This is often possible, for example, in connection with MRI or computed tomographic examinations. You may also experience additional symptoms. These are closely related to where the cerebral aneurysm is located and how big it is. Particularly extensive vascular bulges take up a certain amount of space in the brain, so that other tissue is displaced.

As a result, neurological disorders such as failures of cerebral nerves are possible. Some patients also have seizures. In particularly severe cases, the cerebral aneurysm leads to compression of the brain stem. In the event of a rupture of a cerebral aneurysm, a so-called subarachnoid hemorrhage occurs, which represents an acute threat to the patient's life. The symptoms that accompany the bleeding are similar to those of a stroke.

Diagnosis & course of disease

Basically, cerebral aneurysms can be diagnosed using imaging examination methods. For example, a CT or MRT examination can be considered here. Angiography also provides particularly precise results. Since cerebral aneurysms remain symptom-free in numerous cases, they are usually not discovered or only discovered by chance.

Complications

The greatest danger with a cerebral aneurysm is that the enlarged blood vessel bursts and leads to what is known as subarachnoid hemorrhage in the brain. Subarachnoid hemorrhage is a life-threatening condition that requires immediate medical attention. This is a hemorrhagic stroke that is fatal in 50 percent of cases.

A third of the patients die on the way to the clinic and another third can no longer be saved despite treatment in the hospital or they retain neurological damage. Often those affected are mentally retarded after a subarachnoid hemorrhage. However, about a third of the patients have good to very good chances of recovery.

The cerebral aneurysm is often an incidental finding because there are usually no symptoms. Sometimes, however, the finding is only made when the cerebral hemorrhage has already occurred. The bleeding manifests itself in the form of sudden violent annihilation headaches, drop in blood pressure, vomiting, difficulty breathing and unconsciousness. Depending on the extent of the cerebral haemorrhage, death can sometimes occur suddenly from seemingly full health.

Even after immediate medical or surgical therapy, further complications are possible, such as secondary bleeding, vasospasms with the risk of ischemic strokes, CSF outflow disorders due to clogging of the CSF passages, cerebral edema or cerebral seizures. Since the surgical removal of cerebral aneurysms is associated with risks, an operation is only recommended if the patient is over seven millimeters in size.

When should you go to the doctor?

If there is a sudden rise in blood pressure, there is an acute cause for concern. A doctor must be consulted or an emergency service must be alerted in acute cases. If the patient's health deteriorates to an immense extent within a short period of time, he urgently needs medical help. In the event of seizures, symptoms of paralysis or a rapid decline in physical performance, a doctor's visit is necessary. Functional disorders are warning signals from the organism. You should be presented to a doctor so that a diagnosis can be made and a treatment plan can be established.

A medical examination is indicated in the event of irregular breathing, vomiting, nausea or dizziness. Since a cerebral aneurysm can be fatal without treatment, a doctor should be consulted immediately in the event of acute malaise or severe illness. Headaches, unsteady gait, discoloration of the skin or memory impairments are the first signs of a health problem. You should be examined and treated by a doctor as soon as possible.

A feeling of pressure inside the head, disturbances of the blood circulation and a weakening of the connective tissue are considered warning signs of the organism. To avoid complications and secondary disorders, a doctor should clarify the symptoms. If there is a tingling sensation in the organism or other sensitivity disorders on the skin, action is also required.

Treatment & Therapy

The treatment of cerebral aneurysms is primarily based on the individual case and, above all, on the location and the form of the aneurysm. The shape of the vascular bulge also plays a role in the choice of therapeutic methods. For example, if it is a smaller aneurysm less than seven millimeters in size that is located in the anterior circulatory sphere, no treatment is usually required.

This is especially true if the patient concerned has not had a subarachnoid hemorrhage in the past. If the aneurysms are cerebral aneurysms larger than seven millimeters, therapy should be considered. The patient's age, state of health and neurological factors are weighed up in order to keep the risk of complications as low as possible.

As long as the cerebral aneurysms are not causing any discomfort, possible therapeutic interventions should be thoroughly reconsidered. The cerebral aneurysm is surgically separated from the blood flow with a clip.

prevention

Although numerous cerebral aneurysms are acquired, prevention is difficult. Avoid risk factors such as smoking.

Aftercare

The actual treatment of the cerebral aneurysm is followed by the rehabilitation phase. This is a neurological rehabilitation therapy. How much time this follow-up treatment takes depends on the extent of the disease. It is important to initiate the rehabilitation phase as early as possible, especially in patients who are severely affected by the aneurysm.

In the transitional phase, however, the patient often needs to be looked after by neurosurgery. It is not uncommon for there to be close cooperation with different neurological specialist hospitals. Once the rehabilitation phase is over, further follow-up care is considered useful. As part of this, control examinations using angiography take place.

The first examination is done after one to six months. The next check-up takes place one year after the first examination, another after three years. If the angiography reveals abnormalities that do not need to be treated immediately, an annual check-up is recommended. If a surgical closure has been performed, the time frame is similar.

In addition to an imaging follow-up, follow-up care for a cerebral aneurysm also includes advising the patient about his or her everyday processes. Their relatives can also obtain information from the doctor.

Thanks to modern therapy methods, the follow-up treatment rate for a cerebral aneurysm has been reduced considerably. In addition to high-resolution vascular imaging, magnetic resonance imaging (MRT) is also one of the most important methods of control examinations.

You can do that yourself

In most cases, the person affected by this disease can no longer cope with everyday life themselves and in many cases is dependent on the help and support of carers. Above all, help from one's own family has a very positive effect on the further course of the disease. Psychological help is also necessary to prevent depression and other psychological upsets.

With the various types of paralysis, it is not uncommon for patients to rely on physical therapy or physiotherapy. Some of the exercises from these therapies can also be repeated at home so that the symptoms continue to be alleviated. Cold hands and feet should be avoided as far as possible, whereby the blood circulation should be increased.

Many of those affected also show reduced alertness with this disease and need special support in everyday life. This support cannot be provided exclusively by one's own family; professional support is often very important so that relatives do not suffer psychological damage. Since the risk of falling is significantly increased with this disease, the living situation must be adapted accordingly.