The brain aneurysm or intracranial is the dilation of an arterial vessel within the brain, which can break and cause asubarachnoid hemorrhageIt is useful to analyze the structure in which this can occur.
What does the central nervous system look like?
Il central nervous system (CNS) It is composed of these elements:
- brain, in turn made up of white matter (nerve fibers) and gray matter (neuronal cells)
- spinal cord
They surround them meninges, membranes whose layers are thus distinguished (from outside to inside):
- dura mater, where blood vessels supply the skull
- arachnoid
- pious mother, inside which the vessels nourish the surface of the system
There are four arteries that supply blood to the brain: two internal carotid arteries and two posterior vertebral arteries. They join in thebasilar artery, which supplies blood to various elements: cerebellum, pons, inner ear, thalamus, hypothalamus.
Cerebral aneurysm: causes, risk factors, and development
Typically, cerebral aneurysm develops in the subarachnoid space, that is, the one between the pia mater and the arachnoid, where the blood flows cerebrospinal fluidIts size can range from 0,5 cm to 2,5 cmWhen this size limit is exceeded, we speak of giant aneurysms, particularly risky and difficult to treat. Cerebral aneurysms form, grow and eventually rupture for reasons that are not yet known, but these can be considered risk factors, especially in subjects of female sex:
- hypertension
- smoking and alcohol abuse
- genetic predisposition
- vascular trauma
- blood infections
It is cerebral aneurysms that cause 90% of subarachnoid hemorrhagesThese are caused by the rupture of the aneurysm sac, and the larger the opening, the greater the hemorrhage. The risk of rupture increases as the aneurysm size increases. Generally, a very low risk is considered when the size is less than 0,7 cm, although hemorrhages have been observed even in these cases.
Cerebral aneurysm: symptoms
Very often the cerebral aneurysm it gives no warning symptomsConversely, since the dilation increases slowly, it doesn't cause any particular symptoms and can be discovered incidentally during routine examinations. This is especially true for unruptured aneurysms, which can remain silent for a long time. Subarachnoid hemorrhage from a cerebral aneurysm may present with symptoms such as:
- headache, the most common symptom that alarms the patient, sometimes accompanied by vomiting
- Seizures
- photophobia and visual difficulties
- stiff neck
- neurological deficits
It is used Hunt-Hess scale to classify cerebral aneurysm according to the severity of its manifestations:
- asymptomatic, mild headache and mild neck stiffness
- moderate or severe headache, neck stiffness, cranial nerve palsies
- drowsiness or confusion, minimal neurological deficits
- drowsiness, hemiparesis
- coma
Cerebral aneurysm: the diagnosis
As mentioned, an unruptured brain aneurysm may also be detected during a magnetic resonance performed for other investigations. If the patient complains of symptoms related to the aneurysm, the doctor proceeds with a physical examination, aimed at understanding the patient's lifestyle and family history. Subsequently, instrumental tests are performed, which allow the presence of a cerebral aneurysm to be ruled out or confirmed. In addition to MRI, the following may be performed:
- CT angiography, or the investigation of blood vessels with computerized axial tomography (through ionizing radiation with which three-dimensional images are obtained)
- angio MRI, which allows you to analyze the blood vessels of a specific part of the body
- cerebral angiography, a type of angiography dedicated exclusively to the blood vessels in and around the brain. It is performed with contrast fluid administered through the arterial system.
If there is a family history of cerebral aneurysm, screening is recommended.
Cerebral aneurysm and possible consequences
If the brain aneurysm causes a subarachnoid hemorrhage, the consequences may include:
- ictus
- coma
- death
A particularly feared complication of subarachnoid hemorrhage is thehydrocephalus acute (rapid accumulation of cerebrospinal fluid) and rather common is thechronic hydrocephalus (slow accumulation).
Treatment of cerebral aneurysm
At the time of rupture of a cerebral aneurysm, the patient must immediately seek medical attention.surgery, to be evaluated based on the situation, can include various options:
- clipping, the application of a clip to the neck of the aneurysm following a craniotomy. This procedure obstructs blood flow to the aneurysm and thus prevents a second rupture.
- endovascular coiling, which involves placing platinum coils inside the aneurysm itself. The opening is thus blocked and blood can no longer flow through it.
Furthermore, there are also plans adjustment therapies, such as taking analgesics, calcium channel blockers, or antihypertensives and antiepileptics. To prevent hydrocephalus, cerebrospinal fluid drainage is performed. If the hemorrhage has affected certain functions, such as speech and movement, the choice is made. rehabilitation with speech therapy or physiotherapy.
In some cases, even a subject with unruptured aneurysm may require prompt intervention, precisely to prevent rupture and hemorrhage. If the risk appears minimal, treatment consists of periodic monitoringMuch depends on the age, size, and location of the aneurysm, as well as, of course, the patient's general health and family history.
