A Simple Guide to Cerebral Aneurysm, Diagnosis, Treatment and Related Conditions

This book describes Cerebral Aneurysm, Diagnosis and Treatment and Related Diseases

One of my patients had what he describes as the 'worst headache that he ever had followed by difficulty in swallowing'.

He was sent for brain scan which shows bleeding from a swollen blood vessel in the brain.

Because he was in China, his wife got hold of the SOS medical service which provided a private airplane.

He was then flown back to Singapore where I managed to get a neurosurgeon waiting to check on him on arrival.

Luckily for him his bleeding was mild and his operation to clip the aneurysm was successful.

Recently our Minister for Finance had a stroke due to the rupture of this brain aneurysm and has recovered from his illness after a brain surgery.

A cerebral aneurysm (termed a brain aneurysm) is a weak or thin spot on an artery in the brain that balloons or bulges out and becomes fill with blood.

The bulging aneurysm can press on the nerves or brain tissue.

It may also burst or rupture, spilling blood into the neighboring tissue (brain hemorrhage).

A ruptured aneurysm can produce serious health disorders such as hemorrhagic stroke, brain damage, coma and even death.

Some cerebral aneurysms, mostly those that are very small, may not bleed or cause other disorders.

These types of aneurysms are normally identified during imaging tests for other medical disorders.

Cerebral aneurysms can happen anywhere in the brain but most develop in the major arteries along the base of the skull.

Most are saccular (berry appearance) which is linked with a thin or absent tunica media and an absent or seriously fragmented internal elastic lamina.

Fusiform (circumferential) and mycotic (infectious) aneurysms are found in a small proportion.

Most cerebral aneurysms are silent and may be discovered incidentally on neuroimaging or upon autopsy.

About 85% of aneurysms are located in the anterior circulation, mainly at junctions along the circle of Willis.

Sub-arachnoid hemorrhage (SAH) normally happens with rupture and is linked with a high rate of morbidity and death.

Most cerebral aneurysms are acquired diseases with a higher incidence in patients with certain risk factors such as:
Advanced age,
Hypertension,
Smoking,
Alcohol abuse,
Atherosclerosis

Other causes are:
Cocaine use,
Tumors,
Trauma, and
Certain embolic-forming infections like endocarditis.

There is also a strong genetic factor with the incidence considerably increased in patients with a strong family history of aneurysms (in other words, more than one family member affected).

Un-ruptured cerebral aneurysms do not exhibit any symptoms and are therefore not detected based on history and physical exam alone.

When cerebral aneurysms are ruptured, they often present with a sudden onset of severe headache.

This is classically reported as a "thunderclap headache" or "worse headache of my life."

A headache may be followed by:
A brief loss of consciousness,
Neck stiffness
Nausea and vomiting.

Seizures are rare in less than 10% of patients.

Sudden death may also happen in 10 to 15% of patients.

CT scan is often the first test a doctor will order to determine if blood has leaked into the brain.

Small un-ruptured aneurysms may be safely left alone and monitored with CT scan

Surgical clipping or endovascular coiling or a flow diverter can be used to seal off a brain aneurysm and help prevent a future rupture.

Recovery from treatment or rupture may take weeks to months.

TABLE OF CONTENT
Introduction
Chapter 1 Cerebral Aneurysm
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Sub-Arachnoid Hemorrhage
Chapter 8

Dettagli