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.

Atherosclerosis

Atherosclerosis

Atherosclerosis is a disorder in which arterial wall stiffens and loses its elasticity caused by the formation of thickening (atherosclerotic plaque) in its inner layers, which can reduce or obstruct blood flow. Although it is more common in the male population, its prevalence increases in women after the menopause and equalizes with the prevalence of the men of the same age.

Atherosclerosis affects heart, brain, kidneys and other vital organs and extremities and thus represents the leading cause of illness and mortality in the US and most Western countries. Mortality due to coronary heart disease among white males between the age of 55 and 65 is 1 in 100.

How does it happen?

An atherosclerotic plaque is forming after the large amount of “bad cholesterol” LDL-c accumulates in arteries where they get oxidized, causing inflammation. In order to defend itself, the organism sends macrophages, a form of white blood cells to capture the cholesterol.

They transform the oxidized cholesterol into large foam cells which cause even more inflammation. As a consequence of that, arterial smooth muscle cells activate, migrate and proliferate forming a “cap” above the inflamed area.

This doesn’t represent good protection because lipid part beneath can be dangerous if it gets torn out, potentially causing a heart attack or stroke. Over time the organism forms a thick layer thus narrowing the space for blood flow even more.

Signs and symptoms

Since the atherosclerosis is a slowly developing disorder, at first it shows no symptoms that will warn you about it. The first symptoms are seen when the artery gets obstructed. Signs and symptoms depend on the body part where an arterial obstruction occurred.

Atherosclerosis in heart arteries will be expressed via chest pain, feeling a pressure or discomfort (angina) which may progress into arms, legs or neck.

Atherosclerosis in brain arteries can cause difficulty speaking, blurred vision, loss of coordination or balance, numbness, weakness or paralysis in one side of the face, arm or leg, etc (TIA signs and symptoms).

Atherosclerosis in leg arteries will manifest itself in leg pain, difficulty walking or intermittent claudication.

Atherosclerosis in kidney arteries can cause hypertension or kidney failure.

Some of the most dangerous consequences of atherosclerosis are a heart attack and stroke as it could cause both these health emergencies.

Atherosclerosis - risk factors

Risk factors for atherosclerosis

There are some risk factors for atherosclerosis on which we can’t influence such as family history, genetic abnormalities, advanced age, and male gender but many other risk factors are modifiable. You can find some of them in the text below.

Unhealthy diet – It is known that nutrition rich in saturated animal fats and carbohydrates is correlated to atherosclerosis development. Moreover, people who have a diet poor with vitamins, minerals, amino acids, and essential fatty acids have an even larger chance of atherosclerosis.

Obesity – Obesity is associated with high cholesterol levels, hypertension, diabetes, poor physical activity which all may potentially lead to various cardiovascular diseases, as well as atherosclerosis.

Lack of physical activity – People who are physically inactive have a greater chance to develop atherosclerosis.

DyslipidemiaHigh concentrations of LDL-c and low concentrations of “good cholesterol” HDL-c favors atherosclerosis.

Diabetes – Diabetes can cause many metabolic disorders which can affect change on arteries which supply different organs.

Hypertension – High blood pressure increases atherosclerotic changes significantly.

Smoking – Nicotine from tobacco smoke cause constriction of blood vessels increasing the atherosclerotic changes.

Atherosclerosis - prevention

Prevention

Primary prevention involves fighting risk factors in people who have no expressed symptoms and signs. First of all, it is necessary to carry out proper nutrition, reduce body weight and exercise adequately.

If the patient’s health condition is good but he/she has elevated cholesterol or triglycerides in the blood, stated preventive measures are recommended for 3 – 6 months. There is evidence that people with these conditions may benefit from Omega 3 unsaturated fatty acids.

Pharmacological treatment

If primary prevention does not help the usage of medications is needed. Here are some of the most used drug classes.

First line drugs are statins, lipid-lowering medications which can stop, reduce, or even reverse the atherosclerotic plaque (other lipid-lowering medications may be used). Likewise, a good antiplatelet drug that may prevent thrombotic complications of atherosclerosis is aspirin (100 mg) or some other medication from this class. Various other cardiovascular medication such as beta blockers, calcium channel blockers, ACE inhibitors or diuretics may also be introduced into therapy. Furthermore, control and treatment of hypertension and diabetes are part of the recommendations for the prevention of cardiovascular diseases.