Aneurisms of vessels of a brain
Aneurisms of vessels of a brain are pathological local protrusions of walls of arterial vessels of a brain. At an opukholepodobny current of an aneurysm of vessels of a brain imitates clinic of volume education with defeat visual, trigeminal and glazodvigatelny nerves. At an apoplectic current of an aneurysm of vessels of a brain it is shown by the symptoms of subarakhnoidalny or intracerebral hemorrhage which are suddenly resulting from its gap. Aneurism of vessels of a brain is diagnosed on the basis of data of the anamnesis, neurologic survey, a X-ray analysis of a skull, a research of tserebrospinalny liquid, brain KT, MPT and MPA. In the presence of indications of an aneurysm of vessels of a brain is subject to surgical treatment: to endovascular occlusion or clipping.
Aneurisms of vessels of a brain
Aneurism of vessels of a brain is a consequence of change in a structure of a vascular wall which normal has 3 layers: internal — to intim, a muscular layer and external — an adventition. Degenerate changes, an underdevelopment or damage of one or several layers of a vascular wall lead to thinning and loss of elasticity of an affected area of a wall of a vessel. In the weakened place under pressure of current of blood protrusion of a vascular wall results. Aneurism of vessels of a brain is so formed. Most often aneurism of vessels of a brain is localized in places of a branching of arteries as there pressure put upon a vessel wall is highest.
According to some information aneurism of vessels of a brain is available for 5% of the population. However often it proceeds asymptomatically. Increase in anevrizmatichesky expansion is followed by thinning of its walls and can lead to a rupture of aneurism and a hemorrhagic stroke. Aneurism of vessels of a brain has a neck, a body and a dome. The aneurism neck like a wall of a vessel is characterized by a three-layer structure. The dome consists only from intims and is the weakest point in which aneurism of vessels of a brain can become torn. Most often the gap is observed at patients at the age of 30-50 years. On statistical data become torn aneurism of vessels of a brain causes up to 85% of not traumatic subarakhnoidalny hemorrhages (SAKY).
Reasons of aneurism of vessels of a brain
Congenital aneurism of vessels of a brain is a consequence of the anomalies of development leading to violation of a normal anatomic structure of their wall. It is often combined with other congenital pathology: polikistozy kidneys, koarktatsiy aorta, dysplasia of connecting fabric, arteriovenozny malformation of a brain, etc.
The acquired aneurism of vessels of a brain can develop as a result of the changes happening in a vessel wall after the postponed craniocereberal trauma against the background of a hypertension, at atherosclerosis and a gialinoza of vessels. In some cases it is caused by a drift in brain arteries of infectious embol. Such aneurism of vessels of a brain in neurology carries the name of mikotichesky. Formation of aneurism of vessels of a brain is promoted by such haemo dynamic factors as unevenness of a blood-groove and arterial hypertension.
Classification of aneurism of vessels of a brain
In the form aneurism of vessels of a brain happens meshotchaty and spindle-shaped. And the first meet much more more often, in the ratio about 50:1. In turn meshotchaty aneurism of vessels of a brain can be one - or multichamber.
By localization of an aneurysm of vessels of a brain it is classified on aneurism of a forward brain artery, average brain artery, internal carotid and vertebro-bazilyarny system. In 13% cases the multiple aneurisms which are settling down on several arteries are observed.
There is also a classification of aneurism of vessels of a brain by size according to which allocate miliarny aneurisms up to 3 mm in size, small — to 10 mm, averages — 11-15 mm, big — 16-25 mm and huge — more than 25 mm.
Symptoms of aneurism of vessels of a brain
On the clinical manifestations aneurism of vessels of a brain can have an opukholepodobny or apoplectic current. At opukholepodobny option of an aneurysm of vessels of a brain progressively increases and, reaching the considerable sizes, begins to squeeze anatomic formations of a brain, close to it, that leads to emergence of the corresponding clinical symptoms. Opukholepodobny aneurism of vessels of a brain is characterized by a clinical picture of an intra cranial tumor. Its symptoms depend on the location. The most often opukholepodobny aneurism of vessels of a brain comes to light in the field of a visual recross (hiazma) and in a kavernozny sine.
Aneurism of hiazmalny area is followed by violations of sharpness and fields of vision; at long existence can lead to an atrophy of an optic nerve. The aneurism of vessels of a brain which is settling down in a kavernozny sine can be followed by one of three syndromes of a kavernozny sine representing a paresis combination III, IV and VI couples of ChMN with defeat of various branches of a trigeminal nerve. Paresis III, IV and VI couples is clinically shown by glazodvigatelny violations (easing or impossibility of convergence, development of squint); damage of a trigeminal nerve — symptoms of trigeminal neuralgia. It is long the existing aneurism of vessels of a brain can be followed by the destruction of bones of a skull revealed when carrying out a X-ray analysis.
Often aneurism of vessels of a brain has an apoplectic current with sudden emergence of clinical symptoms as a result of a rupture of aneurism. Only occasionally the rupture of aneurism is preceded by headaches in frontal and orbital area.
Rupture of aneurism of vessels of a brain
The first symptom of a rupture of aneurism is sudden very intensive headache. In the beginning it can have the local character corresponding to the location of aneurism then becomes diffusion. The headache is followed by nausea and repeatedly repeating vomiting. There are meningealny symptoms: giperesteziya, rigidnost of occipital muscles, Brudzinsky's symptoms and Kerniga. Then there is a consciousness loss which can last various period of time. Epileptiformny attacks and mental disorders from small confusion of consciousness to psychoses can be observed. The Subarakhnoidalny hemorrhage arising at a rupture of aneurism of vessels of a brain is followed by a long spasm of the arteries located near aneurism. Approximately in 65% of cases this vascular spasm leads to brain substance defeat as an ischemic stroke.
Besides subarakhnoidalny hemorrhage the become torn aneurism of vessels of a brain can cause hemorrhage in substance or ventricles of a brain. The intracerebral hematoma is observed in 22% of cases of a rupture of aneurism. Except all-brain symptomatology it is shown by the accruing focal symptomatology depending on localization of a hematoma. In 14% of cases the become torn aneurism of vessels of a brain to become the hemorrhage reason in ventricles. It is the heaviest option of development of a disease which is often leading to a lethal outcome.
The focal symptomatology by which the become torn aneurism of vessels of a brain is followed can have various character and depends on the place of localization of aneurism. So, the aneurism of vessels of a brain located in the field of bifurcation of a carotid leads to emergence of disorders of visual function. Aneurism of a forward brain artery is followed by paresis of the lower extremities and mental violations, average brain — a hemiparesis on the opposite side and violations of the speech. The aneurism of vessels of a brain which is localized in vertebro-bazilyarny system at a gap is characterized by a dysphagy, a dizartriya, nistagmy, an ataxy, alternating syndromes, the central paresis of a facial nerve and damage of a trigeminal nerve. The aneurism of vessels of a brain located in a kavernozny sine is outside a firm brain cover and therefore its gap is not followed by hemorrhage in a skull cavity.
Diagnosis of aneurism of vessels of a brain
Rather often aneurism of vessels of a brain is characterized by an asymptomatic current and can be revealed in a random way at inspection of the patient in connection with absolutely other disease. At development of clinical symptoms of an aneurysm of vessels of a brain it is diagnosed by the neurologist on the basis of data of the anamnesis, neurologic survey of the patient, radiological and tomographic inspections, a research of tserebrospinalny liquid.
Neurologic survey allows to reveal meningealny and focal symptoms on the basis of which it is possible to make the topichesky diagnosis, i.e. to define the place of localization of pathological process. The X-ray analysis of a skull can find petrifitsirovanny aneurisms and destruction of bones of the basis of a skull. Carrying out KT and MPT of a brain gives more exact diagnostics. Finally it is possible to make the diagnosis of "an aneurysm of vessels of a brain" by results of an angiographic research. The angiography allows to establish an arrangement, a form and the sizes of aneurism. Unlike a radiological angiography magnetic and resonant (MRA) does not demand introduction of contrast substances and it can be carried out even in the sharp period of a rupture of aneurism of vessels of a brain. It gives the two-dimensional image of cross section of vessels or their volume three-dimensional image.
In the absence of more informative ways of diagnostics the become torn aneurism of vessels of a brain can be diagnosed by carrying out a lyumbalny puncture. Detection of blood in the received tserebrospinalny liquid testifies about existence of subarakhnoidalny or intracerebral hemorrhage.
During diagnostics opukholepodobny aneurism of vessels of a brain has to be differentiated from a tumor, a cyst and abscess of a brain. Apoplectic aneurism of vessels of a brain demands a differentiation from an epileptic attack, the tranzitorny ischemic attack, an ischemic stroke, meningitis.
Treatment of aneurism of vessels of a brain
Patients at whom aneurism of vessels of a brain has the small sizes have to constantly are observed at the neurologist or the neurosurgeon as such aneurism is not the indication for surgical treatment, but needs control of its sizes and a current. Conservative therapeutic actions at the same time are directed to the prevention of increase in the sizes of aneurism. They can include normalization of arterial pressure or a warm rhythm, correction of level of cholesterol of blood, treatment of consequences of ChMT or the available infectious diseases.
Expeditious treatment is directed to prevention of a rupture of aneurism. Its main methods are clipping of a neck of aneurism and endovascular occlusion. Stereotaksichesky electrothermic coagulation and an artificial trombirovaniye of aneurism by means of coagulants can be applied. Concerning vascular malformation make radio surgical or transkranialny removal of AVM.
The become torn aneurism of vessels of a brain is medical emergency and demands conservative treatment of a hemorrhagic stroke similar to treatment. According to indications carry out surgical treatment: removal of a hematoma, its endoscopic evacuation or stereotaksichesky aspiration. If aneurism of vessels of a brain is followed by hemorrhage in ventricles make ventrikulyarny drainage.
Forecast of aneurism of vessels of a brain
The forecast of a disease depends on the place where aneurism of vessels of a brain, from its sizes, and also from existence of the pathology leading to degenerate changes of a vascular wall or haemo dynamic violations settles down. The aneurism of vessels of a brain which is not increasing in sizes can exist during all life of the patient without causing any clinical changes. The become torn aneurism of vessels of a brain in 30-50% of cases leads of the patient to death. 25-35% of patients after a rupture of aneurism have resistant invalidiziruyushchy consequences. Repeated hemorrhage is observed at 20-25% of patients, the lethality after it makes reaches 70%.