Aneurysm is a weak area in the wall of a blood vessel that causes it to enlarge or balloon, forming a thin-walled bubble or sac. Aneurysms can occur in any blood vessel in any part of the body. Cerebral aneurysms are aneurysms that form in blood vessels in the brain. Aneurysms sometimes have such weak spots that they rupture and bleed like a balloon bursting.
Aneurysm: A weakness in the vessel walls that causes a thin-walled bubble or ballooning to form in the blood vessels.
Cerebral: Relating to the brain
Stent: It is a specially designed, expandable tube placed into the vein. The stent forms a support to the vessel wall like a scaffold. In wide neck aneurysms, stents are placed on the neck of the aneurysm to keep the coil inside. They also allow blood to flow through and continue to flow in a vein in which a stent has been placed.
What Are the Risk Factors for an Aneurysm?
Aneurysms occur most often in people aged 35-60 years, but more often in women. Aneurysms are most often caused by infections, the use of drugs that damage cerebral vessels (amphetamine or cocaine), or an injury to the brain. In rare cases, aneurysms may also be due to certain vascular diseases, for example a condition called fibromuscular dysplasia. At the same time, a tendency to aneurysm formation may also run in the family.
What Are the Symptoms of an Aneurysm?
A small, unruptured aneurysm often also has no symptoms. Larger aneurysms begin to put pressure on the accompanying formations and regional pains and headaches occur. As the aneurysm grows, the pressure on the brain will increase and the patient may face vision problems, loss of feeling in the arms or legs, loss of strength, memory problems, speech problems or seizures.
Amphetamines: They are central nervous system stimulants. They increase energy and reduce appetite. They have been used in the treatment of narcolepsy and some forms of depression.
Cocaine: A potent stimulant produced from the leaves of the cocoa plant that quickly but briefly increases the activity of certain brain chemicals. Effects may include euphoria, restlessness, excitement, or feeling unwell.
Fibromuscular Dysplasia: Fibromuscular dysplasia, often known as FMD, causes abnormal cells to grow in the walls of one or more arteries. The result is narrowing (stenosis). If enough narrowing occurs in the artery to reduce blood flow, an aneurysm may develop.
Are All Aneurysms the Same?
Aneurysms can be of different sizes.
Aneurysms smaller than 10 mm are considered small.
Those between 10-20 mm are considered as large aneurysms
Aneurysms larger than 20 mm are called giant aneurysms.
Aneurysms also vary in shape. To give some examples:
-Saccular (purse-like) narrow neck aneurysms. These are also known as berry aneurysms because they look like cherries growing from the side of an artery; The narrow aneurysm neck looks like the stem of a cherry.
– Wide neck saccular aneurysms. In such aneurysms, the neck is at least 4 mm wide or at least half the length from the aneurysm origin to its apex.
– Fusiform (Spindle-shaped) aneurysms: They do not have a definite neck.
Finally, aneurysms can occur in different regions of the brain as localities. They mostly occur in the deep part of the brain, close to the center, sometimes slightly anterior to the eyes (anterior circulation) or slightly towards the back of the head (posterior circulation). In some people, more than one aneurysm can occur in different parts of the brain.
Aneurysms’ sizes, shapes and locations are influential in how prone they are to rupture and bleed. When aneurysms are smaller and more regular, they are less prone to bleeding.
What is Aneurysm Rupture?
When talking about aneurysms, you may hear the terms ruptured or not ruptured. Rupture is the rupture of the thin-walled part of the aneurysm, just as in the bursting of a balloon, and this causes blood to scatter into the adjacent nearby area. This type of bleeding is called hemorrhage.
– This distribution of blood from a cerebral aneurysm in the brain is called a hemorrhagic stroke. Signs of this extremely serious condition may include weakness or paralysis of the arms or legs, problems with speech or understanding, visual disturbances, or seizures.
– There is a risk of permanent brain damage or death following a hemorrhagic stroke, but some patients can still get through with very mild symptoms. If a ruptured aneurysm is not treated, there will always be an ongoing risk of rebleeding.
When an aneurysm bleeds, there is a risk of permanent neurological problems. Some people may have mild effects. If a ruptured aneurysm is not treated, there will always be a risk of continued rebleeding.
Hemorrhagic stroke: The passage of blood directly into the brain through a cerebral vessel.
Rupture: Rupture of a tissue
Some risk factors that can cause an aneurysm to rupture are as follows:
– Large aneurysm
– High blood pressure
– Smoking
– Excessive alcohol consumption
– Family History
– Substance abuse
What are the Symptoms of a Cerebral Aneurysm?
A small, unruptured aneurysm is usually asymptomatic.
As larger, unruptured aneurysms enlarge, they begin to place increasing pressure on nearby brain areas or nerves. This pressure causes local pains or headaches. Again, depending on where the aneurysm is in the brain and on which areas it starts to press, patients may experience vision problems, loss of sensation in the arms or legs, loss of strength, memory problems, speech problems or seizures.
If an aneurysm ruptures, the person is usually sudden, and what those who have experienced have described as “the worst headache of their life!” feels headache. Headache may be accompanied by nausea, vomiting, neck stiffness, blurred or double vision, sensitivity to light, or loss of sensation.
What is a Wide Neck Aneurysm?
Wide-neck aneurysms (at the opening at the base of the aneurysm) are aneurysms with a neck that is at least 4mm wide or at least twice as wide as the highest apex of the aneurysm.
How Is An Aneurysm Diagnosed?
A test called computerized tomographic angiography is used in the diagnosis of cerebral aneurysms. This test reveals cerebral blood vessels within the brain. The patient lies on a sliding table and moves towards the computerized scanner, which looks like a large ring. A dye is given intravenously so that the veins can be seen better on the x-ray. A series of X-ray images of blood vessels are taken to reveal abnormalities, such as an aneurysm in a blood vessel.
A second imaging method is Magnetic Resonance Angiography. Patients lie on a table that moves into a magnetic resonance scanner and their blood vessels are imaged to look for the presence of an aneurysm. Both of these two screening tests are extremely helpful in recognizing most cerebral aneurysms larger than 3-5 mm.
The most reliable test is the diagnostic cerebral angiogram. This test allows the doctor to look directly at the vessels and blood flow within the brain. In this test, the patient lies on an x-ray table. A small vascular access catheter is inserted through a blood vessel in the leg and advanced to both neck veins in the neck leading to the brain. A contrast dye is injected through the catheter before X-rays are taken so that the veins can be seen well on the X-ray.
Computerized Tomographic Angiography: It is a diagnostic test that uses X-rays and transforms images of certain parts of the body from different angles and reconstructs them into cross-sectional images.
Magnetic Resonance Angiography: It is a procedure in which radio waves and magnetic field are used and the internal tissues of the body are reconstructed on the computer.
Since the dye is given through a catheter, this test is a little less comfortable and a little more invasive (interventional) compared to the others. However, it is the most reliable method for catching and identifying cerebral aneurysms of all sizes and types. Before any treatment is planned, a diagnostic cerebral angiogram will definitely be performed to prepare the roadmap to treatment.
If One Aneurysm Occurs, Will Others Occur?
Presence of an aneurysm increases the probability of having one or more aneurysms by 15-20%.
What Are the Symptoms of an Unruptured Aneurysm?
Small aneurysms usually have no symptoms. As the aneurysm grows, it causes headaches or localized pain. If an aneurysm becomes too large, it can press on normal brain tissue or adjacent nerves. This pressure can lead to difficulty seeing, loss of sensation and strength in the arms or legs, memory and speech problems, or seizures.
What Treatments Are There?
Currently, there are basically three types of treatment for cerebral brain aneurysms: drugs, neurosurgery or neurovascular intervention. The treatment method that will be recommended for each person depends on many factors. These include the size, structure and location of the aneurysm, whether the aneurysm is ruptured or not, and the patient’s own condition.
Contrast Paint (X-ray Paint): A substance that is opaque under X-rays (X-ray) and allows the internal structures of the body to be seen.
Diagnostic Cerebral Angiogram: It is a test performed to reveal abnormalities related to brain vessels. It is also used to reveal the presence of aneurysm. This test is performed by applying contrast (dye) to the neck veins under the guidance of a tube (catheter) inserted into the vein from the groin and observing the blood flow.
Medical Treatment:
Not all aneurysms require interventional treatment. If an aneurysm is small, unruptured and asymptomatic, the physician may prescribe medication to reduce risk factors such as high blood pressure instead of intervention. Regular checkups will be necessary to control blood pressure and other medical conditions.
Neurosurgery:
Neurosurgery to repair an aneurysm consists of creating an opening in the skull, gently opening the tissues of the brain to expose the aneurysm, and placing a clip on the neck of the aneurysm. The clip compresses the aneurysm neck and closes it, preventing blood flow from entering the aneurysm.
General anesthesia is applied to the patient during surgery. If there are no complications during or after surgery, most patients stay in the hospital for 4-6 days and recover completely within a few weeks or months.
Neurovascular Intervention:
Neurovascular intervention refers to filling the aneurysm with a material in order to reach the aneurysm through a vessel in the body and prevent blood from entering it.
During neurovascular intervention, the patient lies on an x-ray table and images are taken with a machine called a fluoroscope. A special dye is given through the micro-catheters in the vessel, allowing the doctor to see the aneurysm and medical instruments are directed to this aneurysm without opening the skull.
If there are no side effects or complications after the procedure, the patients stay in the hospital for a day or two and are fully recovered within a week.
Coil Embolization Procedure
This method is a kind of neurovascular intervention application. There are different materials used to fill the aneurysm. The most commonly used are coils – long, very thin, coiled beams of wire, similar to guitar wire but flexible like telephone wires.
In a coil embolization procedure, the physician places several of these into an aneurysm until they are filled. These coils remain in the aneurysm and the blood clots around them and fills the inside so that no more blood can enter the aneurysm. As embolism occurs around these coils due to a natural reaction of the body, the process is called coil embolization.
In this procedure, the physician inserts a tube (catheter) into the large vein that goes to the leg through a tiny incision or needle intervention in the patient’s inner thigh. This tube is a catheter sheath. A thin guide wire is then advanced through this sheath. Since this wire is metal, the physician can see this wire on the x-ray screen (fluoroscopy) and direct it to the brain and the aneurysm there.
