Brain aneurysm

Brain aneurysm (cerebral aneurysm, intracranial aneurysm) is a protrusion of the artery wall. Aneurysm is characterized by bulging walls of the blood vessel: it lacks a muscle layer and a flexible membrane, as a result of which there is no counteraction to the expansion of the vascular wall. A ruptured cerebral aneurysm is extremely dangerous. According to statistics, the main cause of nontraumatic subarachnoid hemorrhage (when blood enters the subarachnoid space of the brain) is exactly the aneurysm rupture (over 50%).

Causes

There is no complete theory on the way the aneurysm develops, but the factors contributing to the disease have been studied quite thouroug.

These factors include:

• congenital defects of the muscular layer of the cerebral arteries (type III collagen deficiency), in most cases they develop at the junctions (bifurcations) of the arteries, with strong bends in the area where arteries have a complex shape. As a result, the condition is often accompanied by other pathologies: polycystic kidney disease, hypoplasia of the renal artery, coarctation of the aorta, etc. This factor is hereditary.
• artery damage
• bacterial, mycotic, tumor embolism
• effect of radioactive radiation
• atherosclerosis, hyalinosis of the vessel wall.

The development of brain aneurysm can be caused by hemodynamic disorders - high blood pressure, uneven blood flow (laminar flow changes into a turbulent one). This becomes most obvious in the areas where arteries are divided into smaller ones, when the disturbed blood flow has a constant or periodic effect on the already deformed vessel wall. A constant hemodynamic effect will eventually lead to the thinning of the vessel wall, aneurysm development and its rupture.

Ruptured aneurysm: effects

In ruptured brain aneurysms blood can flow into the membranous spaces of the brain (in fact, subarachnoid hemorrhage) and it can also flow into the brain tissues and/or into the ventricles of the brain. Thus, the ruptured brain aneurysm may proceed as a hemorrhagic stroke.

All anatomical forms of hemorrhage can cause occlusion of the CSF canals accompanied by acute occlusive hydrocephalus and brain dislocation. The intracerebral hemorrhage results in cerebral edema. The breakdown of blood and the reaction of brain tissue to the blood breakdown products leads to the inflammation and necrosis of brain tissue. Thus, the affected areas of the brain stop their functioning, and consequently the parts of the body regulated by this area of the brain will not function as well.

The subarachnoid hemorrhage developed in the ruptured aneurysm can cause a number of complications:

• Repeated aneurysm rupture
• Cerebral vasospasm
• More than half of all patients develop cerebral ischemia. In 15-17% of cases this condition leads to death.
• 1/4 of patients experience internal hydrocephalus due to the occlusion of the CSF canals.

After the ruptured brain aneurysm people can suffer from complications typical of both hemorrhagic and ischemic strokes:

• Motor disorders, weakness or paralysis, which can cause difficulty in moving, walking and loss of coordination. Hemiparesis or hemiplegia are the terms used to denote movement disorders affecting only one side of the body.
• Swallowing disorder. If the person develops impaired swallowing, both food and liquid can get into the respiratory tract or lungs but not into the esophagus. The person can therefore develop severe lung inflammation. Swallowing disorder can also cause constipation and dehydration.
• Speech disorder. Damage to the left hemisphere of the brain results in impaired speech production and understanding, including difficulty reading, writing and counting.
• Problems of perception. Even with normal vision, patient is unable to understand what he/she sees. Perceptual disorders make it difficult for the person to use everyday objects. For example, the person cannot take a glass and pour water into it and drink it.
• Cognitive disorders. In these disorders the person’s ability for mental perception and processing of external information becomes impaired. Patient lacks clear and logical thinking, memory gets worse, loses the ability to learn, make decisions and plan ahead.
• Behavioral disorders. The person can experience aggression, slow response, fearfulness, emotional instability and disorganization.
• Bowel and bladder problems. Stroke can cause a variety of different problems, resulting in either bowel or bladder dysfunction (fecal and urinary incontinence or retention).
• Psychological disorders. These include mood swings, depression, irritability, episodes of laughing or crying without an evident reason. Depression is a very common problem for people who have suffered stroke. It is often accompanied by loss of appetite, episodes of causeless laughing or crying, insomnia, low self-esteem and an increased sense of anxiety.
• Epilepsy The number of stroke patients who eventually develop epilepsy ranges from 7% to 20%.
• Pain syndrome. A small number of stroke patients can develop pain episodes manifested in burning, shooting and throbbing pain, which cannot be relieved with painkillers.

Brain aneurysm, treatment

Modern methods of treating cerebral aneurysms can be radically divided into two types of surgical procedures:

Surgery aimed at the opening of the cranial cavity (craniotomy). Aneurysm clipping. The procedure ranks among extremely complex intracranial interventions. The surgery aims to exclude aneurysm form the blood flow preserving patency of both carrier and surrounding blood vessels, as well as to remove blood from the subarachnoid space of the brain. To minimize the effects of the intervention, surgeons select an optimal surgical access, use a microsurgical technique and one-stage clipping of the aneurysm neck. When performing the surgical procedure, surgeons use an operating microscope and specially developed microsurgical instruments.

Endovascular interventions are surgical procedures that do not involve opening of the cranial cavity, but use puncture of the femoral artery. These interventions aim to close the lumen of the vessel formed as a result of aneurysm, thus excluding it from the circulation. Procedure is performed with the use of micro-spirals, balloons and other agents that are brought to the problem area and lead to thrombolysis of the vessel. This technique is minimally invasive and has fewer consequences, it is commonly used in Germany where in 90% of case for the treatment of aneurysm.

If hemorrhagic stroke was caused by ruptured brain aneurysm and doctors managed to diagnose this condition, a timely surgical treatment will return person a normal life.

Rehabilitation

Rehabilitation after the cerebral aneurysm is an integral and very important stage of treatment. Only with a professional approach to the recovery process, one can significantly multiply the result of complex treatment and return patient to a normal life. Such approach was developed by German specialists who have a unique experience of neurorehabilitation and provide their medical services to the patients from all over the world.

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