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Tuesday, March 18, 2014

Cerebral Aneurysm






Brain aneurysm



Normal

Abnormal
  • The brain has many arterial blood vessels that supply blood pumped by the heart. When the wall of a blood vessel becomes weak and/or thin, it forms a bulge or a bubble. This bulge or bubble is called an aneurysm.
  • An aneurysm may press on areas of the brain and cause various symptoms (below). Aneurysms may also rupture, causing bleeding in the brain. This bleeding results in Subarachnoid Hemorrhage (bleeding into the subarachnoid space of the brain).

  • Often asymptomatic
  • Focal neurological deficits depending on location; for example, if the aneurysm compresses the area of brain controlling the left leg, then left leg weakness will occur.
  • Mild headaches
  • Nausea
  • Neck stiffness
  • Severe "thunderclap" headaches if the aneurysm ruptures (Subarachnoid Hemorrhage)

  • Genetic predisposition in persons withPolycystic Kidney Disease or coarctation of the aorta
  • Cause often unknown

  • Examination:
  1. Focal neurological deficits (explained above)
  2. Neck stiffness if aneurysm has ruptured
  • Imaging:
  1. Cerebral Angiography (dye is injected into the eye to get an image of the blood vessels)
  2. CT scan will usually show bleeding after an aneurysmal rupture
  3. MRI
  • Laboratories:
- Lumbar puncture (spinal tap)-cerebrospinal fluid will show blood if there is aneurysm rupture.
  • Electrocardiogram (EKG) may be abnormal (it is thought that excess adrenaline during aSubarachnoid Hemorrhage may cause heart abnormalities).

  • Unruptured aneurysms:
  1. Large Aneurysms are surgically clipped at their base to prevent rupture.
  2. Small (less than 1/2 centimeter) ones without symptoms are usually followed with repeated cerebral angiographies.
  • Ruptured aneurysms:
  1. Surgical clip placed at the base of the aneurysm
  2. Aminocarproic acid may be considered, but has complications
  3. Calcium channel blockers such as Nimodipine may prevent spasm of the artery where the aneurysm ruptured.

  • Subarachnoid Hemorrhage
  • Intracerebral Hemorrhage
  • Stroke
  • Transient Ischemic Attack
  • Arteriovenous malformations

  • Point of Clarification
- As stated above, a Subarachnoid Hemorrhage is bleeding into a space in the brain, generally causing significant and dangerous symptoms (see Subarachnoid Hemorrhage). A ruptured Cerebral Aneurysm is just one cause of Subarachnoid Hemorrhage

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