Aneurysm of cerebral vessels - Causes, symptoms and treatment. MF.

An aneurysm of the cerebral arteries is an expansion of the vessel as a result of a violation of the three-layer structure of the vascular wall.

The shape of an aneurysm can be various - single and multi-chambered, saccular, spindle-shaped.

There are small aneurysms up to 3 millimeters and giant ones - more than 25 millimeters. Giant aneurysms may be located in the part of the carotid artery that passes through the cavernous sinus, in the bifurcation area, in the vertebrobilar system.

In the structure of an aneurysm, a neck is distinguished, in which a three-layered structure of the artery is preserved and therefore it is the most durable part of an aneurysm;body, in the walls of which there is no muscle layer and the elastic membrane is broken and the dome is the thinnest place, consisting only of the intima of the vessel. This is where the aneurysm ruptures.

Causes of aneurysm

Congenital and acquired defects in the muscular layer, damage to collagen fibers, arteriosclerosis of the vessel, damage to the internal elastic membrane lead, with increasing blood pressure, to "overstretch" the portion of the vessel and form a "sac" - an aneurysm. Smoking, alcohol abuse, overweight, stress can provoke a rupture of the aneurysm.

More often aneurysms are a congenital pathology, often associated with malformations - coarctation of the aorta, polycystic kidney disease, connective tissue disease.

There is a genetic predisposition to aneurysms. Arterial hypertension as itself can cause the development of an aneurysm, and can lead to the rupture of an already existing aneurysm. Aneurysm can develop with head injuries, tumors, atherosclerosis, inflammatory diseases.

Symptoms of an aneurysm

An aneurysm is a "bomb" that tends to burst. An aneurysm of the cerebral vessels is a bomb that is in the head.

An aneurysm is a fairly rare lesion, it is believed that 5% of the world's population is an aneurysm.

Aneurysm rupture according to statistics occurs in 5-10 for 10,000 people. More often at people 30 - 50 years. You can live long enough to know about the presence of an aneurysm only if it is ruptured, which will come suddenly against a background of complete well-being, perhaps after emotional or physical exertion.

Symptom, suspicious for the presence of vascular malformation can be considered paroxysmal intense headache, repeated in the same location, the first time an epileptic attack occurred. Headaches in the fronto-orbital area can be with an aneurysm in the anterior-cerebral, antero-connective arteries, in the occipital region and temple - with an aneurysm of the posterior cerebral artery, in the half of the head - with an aneurysm in the basilar artery.

The appearance of ptosis( descent of the upper eyelid), doubling, strabismus, dilated pupil. An aneurysm of the posterior cerebral artery is characterized by transient visual disturbances - narrowing or falling out of the fields of vision, distortion of objects. When an aneurysm of the anterior connective artery of the anterior cerebral arteries is a temporary weakness in the legs. In the case of an aneurysm of the posterior cerebral artery and basilar, peripheral paresis of the facial nerve arises, a strong buzzing in the ear, one-sided hearing loss.

In the presence of an aneurysm, family members need to do a survey to exclude vascular malformations from close relatives of .

Diagnosis of aneurysm

Headache repeatedly repeated in the same place, with possible visual aural precursors, vomiting, convulsions, loss of consciousness and epipressure requires examination and for the presence of an aneurysm of the cerebral vessels. Differential diagnosis is performed with brain tumors.

The risk of hemorrhage from the detected aneurysm is high and depends on the size, location, state of the vessels and overall physical status. Repeated hemorrhages proceed more severely and increase the risk of death.

More often the detection of aneurysms occurs already at the rupture - that is, the development of subarachnoid hemorrhage from an aneurysm, hemorrhagic stroke. In 50% of cases of non-traumatic subarachnoid hemorrhage, the cause is an aneurysm of the cerebral vessel. Sudden headache, vomiting, loss of consciousness, hyperthermia, convulsions, cerebral and focal neurological symptoms, meningeal symptoms, anisocoria. Such a patient should be immediately delivered to a specialized department( neurosurgical).Naturally, there is no question of any self-treatment.

In the presence of an aneurysm, repeated bleeding, the development of vasospasm with an increase in the ischemia zone, the formation of an intracerebral hematoma, the breakthrough of blood into the ventricular system is possible.

Aneurysm suspected investigations: magnetic resonance imaging in angiography mode. In the future, even when an aneurysm is detected, angiography is used to determine the tactics of surgical treatment.

With subarachnoid hemorrhage in the first day of computed tomography will determine the outbreak of blood. With lumbar puncture, blood will be found in the cerebrospinal fluid.

Treatment of aneurysms

Surgical treatment - clipping of an aneurysm or an endovascular operation. The essence of the operation is to turn off the affected area of ​​the vessel( aneurysm) from the circulation and maintain the blood flow through the main vessel - the aneurysm is put on the clip, the blood drained out.

When endovascular intervention through the vessels through the femoral artery, special agents are injected into the aneurysm - micro-spirals, balloons closing the lumen and "turning off" the aneurysm from the circulatory system. Turning off an aneurysm with micro-vials or the newest drugs that glue together an aneurysm is by far the most progressive method of treating aneurysms.

Endovascular deactivation of aneurysm

Doctor's consultation on cerebral aneurysm

Question: Do multiple cerebral artery aneurysms operate?
Answer: The decision is made by a neurosurgeon - alternate endovascular shutdowns or craniotomy and clipping are possible.

Question: when do the shutdown operation?
Answer: if an aneurysm is found before the rupture - immediately after the examination and preparation for the prevention of rupture. If the gap has already occurred and the patient's general condition allows - in the first day or 10 to 14 days later. The question is solved individually, depending on the severity of the condition and the possible risk of surgical intervention.

Question: I'm 25 years old, my father had an aneurysm of the carotid artery, I have frequent headaches, I plan a pregnancy. Will I be able to give birth myself?
Answer: contact the neurologist for a checkup and make a magnetic resonance imaging in the angiography mode.

The doctor neurologist Kobzeva S.V.