Brain aneurysm

Brain aneurysm

A brain aneurysm is an abnormal enlargement of a blood vessel in the brain. Arteries that supply the brain are branched out from the set of arteries that is located at the base of the brain. Those branching sites are the most common locations where brain aneurysms occur. Brain aneurysms can affect anyone, including children, but the are more commonly seen in adults 35 to 60-year-old, slightly more common in women.

How does it happen?

The wall of the artery becomes weaker in some places over time and due to long-lasting pressure, an enlargement (bulge) occur. That bulge may be in the form of a sac (balloon-like) and then it is called a saccular aneurysm, which represents the most common form of this condition. The other form of brain aneurysm represents a spindle and then it‘s called a fusiform aneurysm.

As the enlargement grows, the sack expands and creates a neck that makes a connection to the artery. When the brain aneurysm is small it doesn‘t pose a greater danger, but as it grows larger it gets prone to a rupture which causes the leakage of blood into the area between the brain and the lining that separates it from the skull, called subarachnoid hemorrhage.

Signs and symptoms

In some cases, people with an aneurysm do not have any symptoms at all. Because the growth of the aneurysm can pressure the surrounding tissue, symptoms such as headache, diplopia (double images), lower eyelid, pain behind or above the eye, trigeminal neuralgia, or uneven pupils may occur.

Symptoms of aneurysm rupture: sudden, extremely (as never before) severe headache, nausea, vomiting, neck stiffness, changes in consciousness to coma.

Massive intraventricular hemorrhage usually gives a very difficult clinical picture: deep coma, hyperpyrexia, decerebrate rigidity. It almost always ends in death.

brain

Brain aneurysm rupture

The rupture of brain aneurysms involves the breaking of blood vessels in the brain. This leads to hemorrhage in the area of the brain membranes, sometimes leading to hematoma or penetration of blood into the ventricular system. All of this together causes brain damage. In 40 percent of cases of a brain aneurysm that suddenly cracks can be the cause of death, and if the patient survives, each new rupture in the next 15 days increases the mortality rate by up to 70 percent.

Risk factors for brain aneurysm rupture

The most common risk factors for brain aneurysm rupture are hypertension, smoking, patient age (ruptures are more common after 40 years), atherosclerosis, use of medications such as aspirin or anticoagulant therapy, cocaine use, alcohol consumption, head injury, and low doses of estrogen after menopause. Brain aneurysms are more common in women after menopause. A family history of aneurysms is another risk. It should also be noted that certain diseases, such as polycystic disease and AV brain malformations, formerly associated with aneurysms.

Brain aneurysm rupture vs stroke

The concepts of brain aneurysm rupture and stroke should be separated. In the case of a rupture, bleeding occurs in the brain, which gives a clinical picture of a sudden headache, unlike a stroke, where the clinical picture is followed by a sudden resulting half-body paralysis and loss of speech. However, after a rupture, there may be a stroke as a result of the blood vessel spasm. The classic cause of brain infarction is the closure of a blood vessel by a thrombus, most often scattered from the heart during arrhythmia, or stenosis of the blood vessels of the neck and brain.

brain aneurysm

Treatment

In cases of aneurysm rupture or significant enlargement, treatment is always surgical. Before surgery, it is necessary to determine the condition of the cardiovascular system of the patient, since atherosclerosis is also present in a large number of patients.

Whether it is an aneurysm rupture or not, therapy is surgical, in the domain of a neurosurgery specialist.

Surgical clipping on the neck of the aneurysm involves a neurosurgical procedure in which a thin metal clip is placed in a place of the neck of the aneurysm, which presses the neck of the sacral aneurysm and prevents blood supply to it.

Endovascular coiling is a procedure similar to angiography when an aneurysm catheter is placed and a small metal coil or balloon is placed in it to stop the blood flow to the aneurysm.

In cases where a person is found to have a small, asymptomatic aneurysm, depending on the size, location, growth of the aneurysm, and on the age of the patient, it depends on whether one of these methods is immediately followed, or whether the patient will be monitored.

Osteoporosis

Osteoporosis

Osteoporosis is a systematic bone disease that is characterized by a decrease in bone mass, changed bone structure, and increased risk of fracture.

It is most commonly found in postmenopausal women due to the decrease of estrogen in the blood. Osteoporosis is an asymptomatic disease that often goes unnoticed until the bone fracture happens. Fractures lead to pain, impaired movement or immobilization and hospitalisation, comorbidities and increased mortality rates.

Increased mortality is most prominent in hip fractures in older women. Hip fractures always require hospitalization. Rehabilitation is slow and incomplete, so many people need constant medical care, Fractures are commonly sudden, without any warning signs and symptoms.

Epidemiology

It is the most common metabolical bone disease. Its prevalence is quite high, as approximately 8-10 of the world‘s population is affected by osteoporosis. This number will be even higher due to the increase in the elderly population and the modern way of living. Around 21% of women in menopause and 6% of men older than 50 years develop this condition/

Risk factors on which you can affect

Nutrition

Too little calcium in your diet can increase your chances of getting osteoporosis. Recent research shows that vitamins K2 and D3 play a big important role in the process of calcium use in the body.

Physical activity

Prolonged physical Inactivity over a long time increases the chances of developing osteoporosis. Regular physical activity makes and keeps the bones stronger.

Medications

Some medications such as corticosteroids have an adverse effect that causes bone loss. Some drugs that are used to treat epilepsy and depression, also may express this effect and cause osteoporosis. Other drugs may include drugs used for the treatment of endometriosis or uterus cancer.

Smoking

Smoking cigarettes can significantly affect the quantity of calcium in the human body. Besides that, female smokers go through the menopause sooner compared to nonsmoking women, which additionally increases the risk of osteoporosis.

Weight

People whose weight is below average have a greater chance to develop this disorder.

Alcohol

People who consume alcoholic beverages regurarly have a greater chance to develop osteoporosis

Osteoporosis

Risk factors on which you can‘t affect

Sex

Women have less body mass than men, and they are losing it faster due to hormonal changes due to menopause thus have increased the risk of developing osteoporosis.

Age

Older people have an increased risk of bone problems.

Ethnicity

People of African and Hispanic origin have significantly less risk of developing osteoporosis as opposed to People of Caucasian and Asian origins.

Family history

People whose close family members happen to have osteoporosis fractures, also have a greater risk for those occurrences.

medications

Therapeutic recommendations

It is advised to follow calcium and vitamin D substitution in recommended doses. First-line medications that are used are bisphosphonates. The most commonly used drug from this group is alendronate due to high efficiency and low-cost. If alendronate is contraindicated or shows side effects, alternatives are risedronate, ibandronate, and zoledronic acid.

The next drugs that might be used are monoclonal antibody medications such as denosumab; selective estrogen receptor modulators including raloxifene and bazedoxifene.

Anabolic, bone-building medications can help in bone growth. The most commonly used drug of this type is teriparatide, while strontium ranelate is sometimes used.

Other possibilities include hormone replacement therapy.