Brain aneurysm - causes, symptoms, diagnosis, treatment and consequences. Where can it be located? Physical examination of the patient

Cerebral aneurysm is an extremely dangerous pathology, which, in conditions of late diagnosis or incorrect treatment, is associated with a fairly high level of mortality and disability. Aneurysm is a focus of pathological expansion of one or more blood vessels in the brain. In other words, it is a kind of protrusion of the vessel wall, which can be located in any part of the brain and can be either congenital or acquired. Since when an aneurysm forms, a defect in the wall of the blood vessel is formed ( usually arteries), then there is a risk of rupture with subsequent formation of intracranial bleeding, which can cause many severe neurological disorders and even death.

The frequency with which cerebral aneurysm occurs among general population, quite difficult to track. This is due to the difficulties in diagnosing this pathology and the peculiarities of its clinical course. However, according to various clinical data, average frequency cerebral aneurysms account for about 10–12 cases per hundred thousand population. According to morphopathological examination data ( autopsies), almost 50% of unruptured aneurysms are discovered incidentally.

The main danger of cerebral aneurysms is due to the high risk of rupture with the development of intracranial bleeding ( hemorrhage into the subarachnoid space or subarachnoid hemorrhage), which is a condition requiring immediate medical attention. According to statistics from Western clinics, 10% of patients with subarachnoid hemorrhage die almost instantly before any medical care can be provided, 25% - within the first day, 40 - 49% - within three months. Thus, the mortality rate from a ruptured aneurysm is about 65%, with a large proportion of deaths occurring in the first few hours and days after the event.

Today, the only effective method of treating cerebral aneurysms is surgery, which, however, even with the modern level of development of medicine and neurosurgery, does not guarantee one hundred percent survival. However, it should be understood that the risk of dying from a suddenly ruptured aneurysm is almost two to two and a half times higher than the risks associated with surgery.

Interesting Facts

• The highest incidence of cerebral aneurysms is about 20 cases per 100,000 population, which is typical for Finland and Japan.
• Brain hemorrhage caused by a ruptured aneurysm is one of the leading causes of maternal mortality during pregnancy and accounts for about 35%.
• Cerebral aneurysms are almost one and a half times more common among female population.
• Giant aneurysms are 3 times more common among women.
• Survival rates among women with a ruptured aneurysm are lower than among men of the same age.

Structure of cerebral vessels

The blood supply to the brain is provided by two large blood vessels - the paired internal carotid artery and the unpaired basilar artery. These vessels give off many branches that provide blood circulation to other organs of the neck and head, as well as the upper parts of the spinal cord and cerebellum. At the level of the brain stem, these arteries form the so-called Circle of Willis - the place where all these vessels unite into general formation, from which three pairs of main arteries of the brain depart. This organization of blood vessels allows one to avoid a decrease in blood circulation in the brain during blockage ( thrombosis) basilar or carotid artery.

The following arteries are located on the surface of the cerebral hemispheres:

• Anterior cerebral artery supplies blood to the lateral surface of the cerebral hemisphere, part of the frontal and parietal lobes.
• Middle cerebral artery provides blood circulation at the level of the frontal lobe, parietal lobe and part of the temporal lobe of the brain.
• Posterior cerebral artery supplies blood to the lower surface of the temporal and occipital lobes.

The outflow of venous blood occurs through the superficial and deep veins of the brain, which flow into special sinuses formed by the dura mater. These sinuses are formed by rigid structures and therefore do not collapse when damaged. For this reason, open skull injuries are often accompanied by heavy venous bleeding.

It should be noted that almost all types of vessels are connected to each other in one way or another, that is, they form anastomoses ( intervascular connections). In most cases, these anastomoses perform important physiological role, adapting blood circulation to changing conditions and requirements. However, in some cases, the junction of blood vessels can become the site of aneurysms, since these formations are exposed to fairly high pressure.

The following types of intervascular connections are distinguished:

• Arterioarterial anastomoses unite arteries of various sizes and origins. These compounds form a developed network of bypass pathways for the blood, thanks to which blood circulation can be maintained even if some vessels are blocked. However, if key arteries are damaged or blocked, these anastomoses may not be effective.
• Arteriovenular anastomoses are formed between arterioles ( the smallest arteries) and veins of various diameters. Provide redistribution of blood if necessary, by diverting blood flow directly into the venous bed. It should be noted that when forming an anastomosis between a large artery and a vein, there is a high risk of aneurysm formation ( the pressure in the arterial system significantly exceeds that in the venous network).
• Venovenous anastomoses They represent a developed venous network with a large number of connections between veins of different diameters. This type of intervascular connections allows the venous system to receive a fairly large volume of blood without changing the functional state of the body.

The arterial wall consists of the following layers:

• Inner shell The vessel or intima is represented by one row of small endothelial cells that come into direct contact with the blood. This layer is quite thin and vulnerable to a number of unfavorable factors. In addition, it is quite fragile and is easily damaged under the influence of mechanical factors. This is due to the small number of connective tissue fibers in the structure of the inner shell. On the surface of endothelial cells there are special substances that prevent blood clotting and prevent the formation of blood clots. It should be noted that the cells of the inner lining receive nutrients and oxygen directly from the blood flowing in the vessel. This phenomenon becomes possible due to the slowing down of blood flow near the vessel wall.
• Middle shell arteries consists of a layer of elastic connective tissue fibers that form an elastic frame, and a layer of muscle cells that provide rigidity and participate in adaptive reactions ( constriction and dilation of blood vessels to regulate blood pressure and speed).
• Outer shell ( adventitia) It is represented by a network of connective tissue fibers that significantly strengthen the vascular wall. In addition, this layer contains blood vessels that supply arteries and veins, as well as nerve fibers.

Meninges

The brain is located in the cranium, which is represented by a bone structure that is not capable of changing volume or shape. Between the medulla and the inner wall of the skull there are 3 membranes that protect the brain from a number of unfavorable factors, and also provide its nutrition and functioning.

The following meninges are distinguished:

• Dura mater ( dura mater) is located most superficially above the other two. It consists of strong and hard connective tissue, which is fused with the outer surface to the bones of the skull. The inner surface is smooth. In the area of ​​the sulci of the brain, the dura mater forms special outgrowths in which the venous sinuses are located, as well as processes ( greater and lesser falciformes, tentorium cerebellum, diaphragm sella), which separate some parts of the brain.
• Arachnoid mater ( arachnoidea) located directly under the dura mater, from which it is separated by a narrow space filled with fatty tissue and capillaries. It is formed by a network of connective tissue fibers that are intertwined with each other and with small blood vessels. In the area of ​​the base of the brain, the arachnoid membrane forms a number of cisterns - special cavities in which cerebrospinal fluid accumulates.
• Pia mater directly adjacent to the medulla, repeating all the bends and convolutions of the cerebral hemispheres. In some places, between the pia mater and the arachnoid membrane there is a narrow gap filled with cerebrospinal fluid. In the thickness of this membrane there are blood vessels.

Causes of cerebral aneurysm

Distal aneurysms, that is, protrusions located in more distant parts of the vessels, are usually smaller in size than aneurysms located in more proximal parts. However, the risk of rupture of these distant aneurysms is higher, which is associated with a thinner vascular wall. In addition, often surgical approach access to such aneurysms is difficult, which increases the risk of adverse complications.

The role of various factors in the development of aneurysm is still not well understood. Most scientists propose the theory of multiple causes, since it is based on the interaction between factors internal and external environment, such as, for example, atherosclerosis and high blood pressure in combination with congenital predisposition and various vascular anomalies.

IN clinical practice allocate following reasons damage to the vascular wall:

• Congenital. Congenital vascular defects include various genetic pathologies, in which the structure of connective tissue fibers is disrupted or arteriovenous anastomoses are formed between large arteries and veins. In addition, as a result of congenital defects, other vascular anomalies can form, which, to varying degrees, weaken the vascular wall and contribute to the formation of aneurysms.
• Purchased. Acquired defects of the vascular wall are extremely diverse and can arise under the influence of a huge number of unfavorable factors. In most cases, these are some kind of degenerative diseases, connective tissue diseases, arterial hypertension and infections. These pathologies in most cases cause changes in the structure of blood vessels.

Genetic abnormalities

The following pathologies are most often combined with cerebral aneurysms:

• autosomal dominant congenital polycystic kidney disease;
• fibromuscular dysplasia;
• arteriovenous malformations;
• Osler-Rendu syndrome;
• Moyamoya disease;
• Marfan syndrome;
• Ehlers-Danlos syndrome;
• violation of the synthesis of type 3 collagen;
• elastic pseudoxanthoma;
• alpha-1 antitrypsin deficiency;
• neurofibromatosis type 1;
• tuberous sclerosis;
• arterial hypertension.

Most of the diseases listed are quite rare. The presence of these pathologies is not a mandatory sign of a cerebral aneurysm. It should be understood that these diseases in most cases only increase the likelihood of developing an aneurysm due to direct or indirect effects on the vessels of the brain.

Arterial hypertension

An increase in blood pressure for quite a long time is effectively compensated by a number of physiological mechanisms, however, with a long course of the disease, as well as in the absence of proper drug treatment, this pathology causes a number of changes in the blood vessels and internal organs.

With an increase in pressure in the cerebral arteries, the hemodynamic stress on the vascular wall increases significantly, which, subject to the presence of individual characteristics ( genetic predisposition, trauma, degenerative vascular diseases, inflammatory vascular diseases) can lead to aneurysms.

It should be noted that arterial hypertension is often combined with atherosclerosis, a disease in which the metabolism of a number of lipid substances is disrupted ( fats and cholesterol), which are deposited in the wall of blood vessels. At the same time, the risk of developing complications such as myocardial infarction, hemorrhagic and ischemic stroke increases significantly. In addition, atherosclerosis itself can provoke the occurrence of aneurysms in the vessels of the brain, since atherosclerotic plaques quite weaken the vascular wall.

Infections

The risk of cerebral aneurysm increases with the following infectious diseases:

• Bacterial endocarditis. In the vast majority of cases, infectious aneurysms are located in distant branches of the middle cerebral artery ( 75 – 80% of cases), which indicates the embolic nature of these injuries. Emboli are small fragments of blood clots or, in in this case, pus, which, with the blood flow, entered a place remote from the primary focus. Bacterial endocarditis is a serious and dangerous disease in which infectious agents attack the inner surface of the heart. In this case, gradual damage to the valve apparatus of the heart develops, and the functioning of the heart muscle is disrupted. In most cases it is damaged left atrium and the ventricle, that is, that part of the heart that is directly involved in pumping blood into the arterial bed. As a result, infectious agents, together with the bloodstream, can easily penetrate the systemic circulation and affect distant organs. Damage to cerebral vessels is observed in almost 4 cases out of 100. With this nature of the development of an aneurysm, the risk of bleeding is extremely high.
• Fungal infections. Some systemic fungal infections cause brain damage with vascular involvement. This significantly increases the risk of an aneurysm.
• Meningitis. Meningitis is an infectious and inflammatory lesion of the meninges. At the same time, infectious agents also affect blood vessels, infiltrating them in the direction from the outer vascular layer to the inner, thereby gradually weakening them and creating the preconditions for the occurrence of aneurysms or other pathologies.

Closed head injuries

Often, after a strong mechanical impact, traumatic dissecting aneurysms are formed, which in their structure are somewhat different from a true aneurysm in that they are formed not due to protrusion of the intima through the other two membranes of the vessel, but due to the leakage of blood between these membranes. Thus, a pathological cavity is formed in the vessel, which gradually stratifies its membranes. In addition to the risk of rupture and bleeding, the detachment site gradually narrows the lumen of the artery, thereby reducing blood flow in the corresponding parts of the brain. The constantly growing cavity of the false aneurysm gradually compresses the surrounding nerve tissue and nerves, causing severe discomfort and neurological deficits varying degrees gravity. It should also be understood that at the site of formation of this traumatic aneurysm, prerequisites are created for the formation of blood clots. Basically, these dissecting aneurysms are localized at the base of the skull, at the level of large vascular trunks.

How can a cerebral aneurysm manifest itself?

However, in some cases, cerebral aneurysms may have certain symptoms. In most cases clinical manifestations occur when the aneurysm is quite large, but often small aneurysms are symptomatic. This is due to the fact that the clinical picture is based on neurological signs that appear as a result of compression of the brain matter by a space-occupying formation - a vascular aneurysm.

An unruptured cerebral aneurysm may present with the following symptoms:

• Visual impairment. The proximity of the aneurysm to the optic nerves ( nerves that transmit visual impulses from the retina to occipital areas brain) may cause partial compression of these nerves with visual impairment. However, depending on the location of the aneurysm, these disorders can manifest themselves differently. If the optic chiasm is close to the optic chiasm, partial or total loss vision.
• Cramps. Some aneurysms, especially large ones ( with a diameter of more than 25 mm), can compress the motor parts of the cerebral cortex, thereby provoking uncontrollable muscle contractions– convulsions. At the same time, these seizures differ from epilepsy, however, differential diagnosis can only be made on the basis of a detailed examination.
• Headache. Headache is a fairly common symptom of cerebral aneurysm. Typically, pain occurs due to compression of the pia mater and arachnoid mater, which contain a fairly large number of pain receptors and nerve fibers. When the aneurysm is located deep in the medulla, such symptoms develop extremely rarely, since the brain itself is devoid of pain receptors. Usually the headache is one-sided, subacute in nature, with a predominant localization in the area behind the eyes, quite often the pain is throbbing.
• Transient ischemic attack. A transient ischemic attack is an incoming attack of acute cerebrovascular accident lasting up to 24 hours. Manifestations depend on the affected arteries and, accordingly, areas of the brain susceptible to oxygen starvation. The most typical symptoms are dizziness, loss of consciousness, nausea, vomiting, temporary loss of orientation in time and space, memory loss, sensory disturbances with complete or partial loss of certain sensations, various paralysis, speech impairment.
• Dysfunction of cranial nerves. Cranial nerves are nerve fibers that provide motor and sensory innervation to the head, neck and several other parts of the body. When they are compressed, various neurological disorders can occur, such as paralysis of facial muscles, taste disturbance, inability to turn the head in the direction opposite to the damage, partial or complete drooping of the upper eyelid, hearing impairment with tinnitus, or even auditory hallucinations.
• Pain in the face. Quite often, aneurysms originating from the branches of the internal carotid artery compress the branches of the facial nerve, causing periodic pain in the facial area.

The following symptoms often precede aneurysm rupture:

• double vision ( diplopia);
• dizziness;
• pain in the area behind the eyes;
• convulsions;
• drooping upper eyelid;
• noise in ears;
• sensory or motor deficits;
• speech disorders.

It should be understood that in most cases these symptoms occur quite rarely and are usually mild. It is extremely difficult to diagnose or even suspect a cerebral aneurysm based only on these manifestations.

Rupture of a cerebral aneurysm

According to statistics, almost 90% of cases of non-traumatic subarachnoid hemorrhage are caused by rupture of an intracranial aneurysm. This condition refers to pathologies that require emergency medical care, since without proper treatment the prognosis is extremely unfavorable.

Subarachnoid bleeding in the vast majority of cases has a pronounced clinical picture, manifested by severe headaches and other neurological symptoms. For this reason, most patients, one way or another, seek medical help.

The following symptoms are typical for a ruptured cerebral aneurysm:

• Strong headache. Intracranial bleeding is characterized by an extremely severe headache, which many patients describe as the worst headache they have ever experienced. This symptom occurs due to the irritating effect of spilled blood on the meninges, which, as mentioned above, contain a large number of nerve endings. Absence this symptom is extremely rare and often indicates an attack of amnesia in the patient.
• Signs of irritation of the meninges. The spilled blood has a pronounced irritating effect on the meninges, and in addition, under the influence of the growing hematoma, they are gradually compressed. The main manifestations of this process are the headache described above, photophobia, as well as stiffness and pain in the neck muscles, back muscles and legs. The last sign is the inability to touch the chin to the chest, that is, limited mobility of the neck, as well as the inability to bend the legs in hip joint. This is explained by the fact that when bending the head and moving the legs, some stretching of the meninges occurs, which causes a reflex contraction of the muscles that block these movements.
• Nausea and vomiting. Nausea and vomiting not associated with food intake are common but unnecessary symptoms of subarachnoid hemorrhage. They arise due to irritation of the meninges and medulla.
• Sudden loss consciousness. Almost half of patients with a ruptured cerebral aneurysm lose consciousness. This happens because due to the growing hematoma, gradual increase intracranial pressure, which eventually becomes higher than the pressure at which adequate blood circulation occurs in the brain. As a result, acute oxygen starvation occurs with the loss of some neurological functions.

Diagnosis of cerebral aneurysm

To identify cerebral aneurysms and determine other important indicators, the following research methods are used:

• physical examination of the patient;
• medical imaging techniques;
• electrocardiography ( ECG);
• general blood test and biochemical blood test.

During a conversation with the patient, the following indicators are determined:

• main disturbing symptoms;
• onset of disease manifestation;
• the presence of other systemic or other pathologies;
• treatment taken at home;
• presence of injuries;
• allergic reactions;
• family medical history ( identifies or suggests genetic diseases).

Physical examination of the patient

The physical examination of the patient includes the following procedures:

• Palpation. Palpation is a method of physical examination, during which the doctor, by pressing on various parts of the body, identifies painful areas, determines areas of swelling, and palpates skin formations. With a cerebral aneurysm, palpation is usually uninformative, but it can help in identifying other concomitant diseases. A particularly important indicator in this case is the condition skin, since many systemic connective tissue diseases, in which the prerequisites for the development of an aneurysm arise, are reflected on the skin ( excessive extensibility of the skin occurs, various growths and voluminous formations appear).
• Percussion. Percussion is the tapping of individual areas of the body in order to identify areas with increased or decreased acoustic resonance. For cerebral aneurysms, this examination is rarely used, but it helps to identify some concomitant pathologies from other organs - the heart and lungs.
• Auscultation. Auscultation is a method of physical examination in which the doctor uses a stethoscope to listen to various body noises. With a cerebral aneurysm, auscultation can reveal pathological murmurs at the level of the heart and aorta ( which occur with bacterial endocarditis, coarctation of the aorta), as well as at the level of the carotid arteries.
• Blood pressure measurement. Measuring blood pressure is a routine method of examining patients. Allows you to determine the general condition of the body at the current moment ( low blood pressure may indicate massive blood loss or damage to the vasomotor center of the brain), and also assume possible reason aneurysm formation. Additionally, high blood pressure in patients with an unruptured aneurysm is a definite risk factor that significantly increases the chances of rupture and hemorrhage.
• Measurement of heart rate and respiratory movements. The heart rate and respiratory movements can change under the influence of many factors, among which a special place belongs to systemic connective tissue diseases and infections.
• Neurological examination. Neurological examination is the most important and informative when examining patients with cerebral aneurysm. During this procedure, the doctor evaluates tendon-muscular and skin reflexes, determines the presence of pathological reflexes ( which appear only with certain diseases and damage to the central nervous system). In addition, motor activity is checked and sensory deficits are identified. If necessary, signs of irritation of the meninges are determined. However, it should be understood that in most cases the data obtained is not enough to determine a cerebral aneurysm, and for a more accurate diagnosis it is necessary to conduct an instrumental examination.

Medical Imaging Techniques

This examination method is the most informative for cerebral aneurysms and represents the basis for diagnosing this pathology. In addition to identifying aneurysms as such, medical imaging allows one to determine their number, location, size, and relationship with parts of the brain and other vessels.

The following medical imaging methods are used to detect cerebral aneurysms:

Electrocardiography ( ECG)

Lumbar puncture

Lumbar puncture is used to detect subarachnoid hemorrhage when medical imaging is unavailable or ineffective. Moreover, in the analysis of cerebrospinal fluid ( cerebrospinal fluid) traces of blood are revealed.

Electroencephalogram ( EEG)

EEG allows us to identify various neurological disorders, determine areas of brain damage or ischemia, and make a differential diagnosis of certain diseases with symptoms similar to aneurysms. However, this method is most valuable when performing surgery, since it allows you to evaluate brain activity during the operation.

General and biochemical blood test

When an aneurysm is detected, the following laboratory tests are indicated:

• Complete blood count with platelet count. Allows you to recognize certain infections, determine the degree of anemia, and recognize the risk of bleeding during surgery.
• Prothrombin time. Prothrombin time, or prothrombin index, is an indicator of the state of the blood coagulation system. Allows you to identify clotting problems and predict the risk of intraoperative bleeding.
• Blood electrolytes. Necessary to determine the initial level on which correction during surgery can be based.
• Functional liver tests. They allow you to identify liver pathologies, on the normal functioning of which many other indicators of the body depend. If there are serious anomalies, some correction is required.
• Other tests. Depending on hospital standards and the specific clinical situation, other laboratory tests may be required.

Treatment of cerebral aneurysm

It should be understood that the pharmacological drugs prescribed for treatment do not eliminate the aneurysm, but only reduce the risk of its rupture by eliminating a number of unfavorable factors. In addition, some medications are used as symptomatic treatment, that is, a set of therapeutic measures aimed at alleviating certain manifestations of the original pathology.

Medicines used in the treatment of cerebral aneurysm

Surgery

To date, several types of operations have been developed, each of which has strictly defined indications. The effectiveness of surgical treatment, unfortunately, is not one hundred percent, but the risks from surgical intervention are many times overshadowed by the probable risks from a rupture of a cerebral aneurysm.

The following methods of surgical treatment of aneurysm exist:

• Craniotomy and aneurysm clipping. This method is based on opening the skull ( craniotomy) and installation of a special metal clip directly on the neck of the aneurysm while preserving the parent vessel. As a result, gradual necrosis of the aneurysm cavity occurs, followed by its replacement with connective tissue. A significant disadvantage of this method is the inability to gain access to vessels located close to vital centers or deep in the brain.
• Endovascular repair of aneurysm. Endovascular method ( translated from Latin - intravascular) is a minimally invasive and highly effective method for eliminating aneurysms. At this method a special flexible catheter is inserted through one of the distant vessels into the bloodstream and gradually, under constant X-ray control, advances to the aneurysm. Then a special metal spiral is inserted from this catheter into the cavity of the aneurysm, which causes gradual blockage and death of the aneurysm. The advantage of this method is the ability to access deep-lying cerebral vessels. The endovascular method can be used even after aneurysm rupture and the onset of subarachnoid bleeding, as it eliminates the vascular defect.

Is treatment always necessary when an aneurysm is detected?

In the setting of an unruptured aneurysm, the decision on treatment should be made by the patient, having carefully understood the issue, consulted with qualified specialists and assessed all possible risks.

It should be understood that today the only effective method of preventing aneurysm rupture is surgery, which is the only method of treatment. The risks of this procedure depend on many indicators, including the general condition of the patient, the location and structure of the aneurysm, and its size. However, the 10-year survival rate among people who have their aneurysm repaired is significantly higher than among those who do not. Of course, there are exceptions, however, given the rapid development of safer endovascular techniques, this indicator may increase even more.

Prevention of stroke in cerebral aneurysms

The following measures slightly reduce the risk of subarachnoid hemorrhage:

• quitting smoking and alcohol;
• control blood pressure with medications prescribed by a doctor;
• balanced diet with a reduced content of animal fats and cholesterol;
• low physical activity;
• refusal from traumatic sports;
• periodic monitoring by a specialist;
• Regularly taking medications prescribed by your doctor.

Is it possible to treat a cerebral aneurysm with folk remedies?

First of all, we're talking about about those drugs that stabilize blood pressure and prevent it from increasing. It is sudden surges in pressure that usually cause aneurysm ruptures. In this case, folk remedies are used to prevent complications rather than treat the disease. In addition, many medicinal plants used in folk medicine contain large amounts of vitamins, minerals and other beneficial substances. This strengthens the body as a whole and improves the well-being of people who, for one reason or another, cannot have an aneurysm removed. surgically. Finally, some medicinal plants contain substances that strengthen the vascular wall. This directly reduces the risk of aneurysms rupturing.

The most effective in the fight against cerebral aneurysms are the following folk remedies:

• Beet juice. Freshly squeezed beet juice with honey is considered an effective remedy for lowering blood pressure. The effect occurs 1 – 2 weeks after the start of the course. The juice is mixed in equal proportions with flower honey and drunk 3-4 tablespoons three times a day.
• Honeysuckle. The berries of this plant are extremely effective. They have a general strengthening effect, which is especially noticeable in old age. Their main effect is also to lower blood pressure.
• Potato peel. Used to prevent hypertensive crises. You can drink the decoction ( boil the potatoes with their skins on for 10–15 minutes, and then drink the strained water) or simply eat the jacket potato with the peel.
• Corn flour infusion. For one glass of boiling water you need 1 full tablespoon of corn flour. It is mixed and left overnight. In the morning on an empty stomach you need to drink only liquid ( strain without stirring the sediment).
• Blackcurrant decoction. Dried berries black currants are poured with boiling water ( for 100 g of fruit 1 liter of water) and keep on low heat for 8 - 10 minutes. Then the broth cools and infuses for several hours. It is filtered and drunk 50 g three times a day. Vitamins and microelements will strengthen the vascular wall and reduce the likelihood of stroke.
• Valerian root. For 10 g of dry crushed root you need 1 glass of boiling water. The mixture is boiled for 20 – 25 minutes and allowed to cool to room temperature ( 1 – 2 hours). Drink 1 tablespoon of the decoction 2-3 times a day. It reduces the likelihood of increased blood pressure due to stress.
• Motherwort infusion. For a tablespoon of motherwort you need 1 cup of boiling water. The glass is covered with a saucer to reduce the evaporation of liquid ( you can use a sealed flask), and leave for 3 – 4 hours. After this, take the infusion 1 teaspoon three times a day ( preferably 30–60 minutes before meals).
• Immortelle decoction. For 25 g of dried flowers, 1 liter of boiling water is needed. The mixture continues to boil until approximately half of the water has evaporated. After this, the broth is cooled to room temperature and taken 20-30 ml three times a day. The therapeutic effect is felt 5 – 7 days after the start of treatment.

It should be noted that some plants have a very noticeable hypotonic effect ( good for reducing blood pressure). Their use simultaneously with certain drugs of similar action can cause dizziness, tinnitus, darkening of the eyes and other symptoms. low pressure. If such symptoms appear, treatment with folk remedies should be temporarily stopped and consult a doctor.

The above folk remedies are relevant for all patients with cerebral aneurysm. However, they can be used for preventive purposes and in the postoperative period, when the aneurysm itself has already been surgically removed. This will speed up recovery.

It is strictly forbidden to give folk remedies a dominant place in the course of treatment of aneurysm. This disease should always be treated with highly effective pharmacological drugs ( before surgical correction of the problem), since we are talking about the patient's life. Self-medication without consulting a doctor greatly increases the risk various complications. The fact is that artificially lowering pressure in some cases can only worsen the patient’s condition ( for example, in patients with anemia or other underlying diseases). Therefore, traditional medicine begins to be taken only after a full comprehensive examination of the patient.

Can a cerebral aneurysm develop again?

A true cerebral aneurysm is a sac-like protrusion of the inner layer of the vessel through the middle and outer membranes. This pathology develops in various categories of patients, but most often occurs in older people. To date, no one clearly defined cause of this pathology has been identified, but there is a whole range of diseases in which the risk of developing an intracranial aneurysm is highest. Among these diseases, a special role belongs to genetic abnormalities and connective tissue diseases.

With acquired or congenital connective tissue diseases, the structure of the supporting frame of internal organs and blood vessels changes significantly. As a result, the walls of arteries and veins become less resistant to hemodynamic stress, that is, they are unable to withstand high blood pressure. As a result, under the influence of blood flow, peculiar defects are formed in the weakest places of the vessels, through which the inner lining of the vascular wall protrudes - an aneurysm cavity is formed.

Thus, based on the mechanism described above, it becomes clear that even with radical elimination of one of the aneurysms, internal and external factors that caused the primary pathology do not disappear anywhere. As a result, the possibility of re-formation of an aneurysm remains for a fairly long period of time.

In order to prevent recurrence of an aneurysm, you must follow the following recommendations:

• Monitor blood pressure. High blood pressure is one of the main factors that can trigger the development of intracranial vascular aneurysm. In order to reduce the negative impact of hypertension on the vascular wall, you should regularly take medications prescribed by your doctor, and also undergo periodic medical examinations.
• Follow a diet. A healthy and balanced diet can stabilize the general condition of the body and normalize the functioning of many organs and systems. It is extremely important to control the consumption of animal fats, since they are the main source of cholesterol, the excess of which can be deposited in the wall of blood vessels, weakening it ( atherosclerosis). To prevent this, you should use mainly vegetable fats, as well as a large amount of fresh vegetables and fruits.
• Take prescribed medications regularly. In most cases, after surgery to eliminate an aneurysm, the attending physician prescribes a long course of treatment, which is aimed at normalizing the general condition, controlling internal and external negative factors, and also reducing the likelihood of relapse.
• Avoid high physical activity. High physical activity in most cases increases the pressure in the cerebral artery system, which significantly increases the risk of aneurysm recurrence.
• Periodically undergo medical supervision. Even if you follow all the rules and recommendations of the doctor, the risk of re-formation of an aneurysm remains. In order to reduce the likelihood of rupture and subarachnoid bleeding ( which is an extremely serious complication), you should regularly, especially during the first year after surgery, undergo a medical examination, as this allows you to identify relapses at an early stage and provide adequate treatment.

Which doctor treats and diagnoses cerebral aneurysms?

The basis of any adequate medical intervention is a comprehensive multidisciplinary approach. In the majority of both domestic and Western clinics, doctors of different specialties constantly work together in order to increase the productivity and effectiveness of certain methods of medical treatment and diagnosis, which significantly increases the patient’s chances of a full recovery.

In the vast majority of cases, before undergoing surgery, patients go through a number of specialists who help identify the aneurysm, diagnose concomitant diseases, and prepare the patient for surgery.

The following specialists treat and diagnose patients with intracranial aneurysm:

• Family doctor. Despite the fact that the family doctor does not treat cerebral aneurysms, in most cases he is the specialist with whom the patient first encounters. The future fate of the patient depends on the correct tactics and clinical thinking of the family doctor. In most cases, these doctors, based on the data obtained during examination and conversation with patients, refer them for further examination and prescribe a consultation with a neurologist, who will further manage this patient.
• Neurologist. Neurologists are specialists who deal with diseases of the central nervous system. It is they who most often prescribe computed tomography or magnetic resonance imaging, with the help of which an aneurysm is detected.
• Radiologist. The area of ​​work of a radiologist is a variety of medical imaging methods, with the help of which an aneurysm can be identified, its position, structure and size determined. This specialist provides the surgeon with the most valuable data, without which no surgical intervention is possible.
• Anesthesiologist. Anesthesiologists are specialists who do more than just anesthetize a patient during surgery ( anesthesia), but also prepare him for the upcoming surgical intervention, together with the neurosurgeon they determine the most optimal and safe methods treatment.
• Neurosurgeon. It is the neurosurgeon who is the specialist who performs surgery and eliminates the aneurysm. However, his work is not limited to just surgery. In addition, he plans and develops the safest and most efficient therapeutic tactics, prescribes the necessary examinations, and guides the patient in the postoperative period.

What to do after surgery for a cerebral aneurysm?

However, in both cases, after removing an aneurysm or strengthening a vessel, patients should follow a number of rules that will prevent the development of various complications. In general, they represent a specific regimen that the patient adheres to. This regimen is discussed individually with the attending physician, since only this approach allows taking into account the condition of a particular patient, concomitant diseases and individual wishes. But in any case, there are a number basic principles, which are relevant for all patients.

In the postoperative period, you need to pay attention to the following points:

• Nutrition. Usually the food doesn't play key role in the postoperative period during surgical interventions on cerebral vessels. However, if the aneurysm was acquired due to atherosclerosis, diabetes mellitus or other metabolic diseases, diet becomes a key component of prevention. You should not overeat, eat a lot of sweets, or eat too fatty foods. Alcohol, salty and spicy foods can lead to reflex vasodilation. In the first weeks after surgery ( especially with open interventions) this can cause a stroke or re-formation of an aneurysm. An important factor that diet can influence is blood pressure. To curb its growth, you need to limit your consumption strong tea, coffee, and salt ( including as part of other dishes). Dairy products are healthy low-fat varieties meat ( boiled or steamed), cereals, vegetables and fruits.
• Limiting physical activity. Physical activity is limited after any vascular intervention. The fact is that when lifting weights, fast walking or running, the heart rate increases and blood pressure begins to rise. Because of this, a rupture may occur in the operated vessel. Physical activity after open surgery is limited to such an extent that in the first days after surgery the patient is not recommended to get out of bed. Then gradually it is allowed to walk, slowly climb stairs, and lift a load of several kilograms. With time ( in a few weeks or months) this restriction can be removed if the results of preventive examinations do not reveal a threat of rupture or recurrent aneurysm.
• Blood pressure measurement. After surgery, the patient needs to regularly measure blood pressure. In the hospital, this is done by medical personnel according to a certain schedule. However, you should not stop this procedure at home either. Normal blood pressure ( 120/80 mmHg) is the key to successful rehabilitation. As a rule, patients after surgery take certain medications to normalize blood pressure. Daily measurement ( it is important to carry it out at approximately the same time of day) will help evaluate the effectiveness of the prescribed treatment. If the pressure changes greatly throughout the day, or there is a tendency to a significant increase ( systolic pressure 140 mmHg Art. and more), you must notify your doctor about this.
• Periodic consultations with a doctor. Even if after discharge from the hospital all symptoms and manifestations of the disease have disappeared, this does not mean that you need to stop seeing a specialist. Typically, the schedule of visits is discussed with the attending physician after surgery. It depends on the patient’s condition, the type of surgery and the presence of concomitant diseases. At first, after discharge, you visit the doctor once every few days, then once every week or two. One month after surgery, they switch to monthly visits ( or less often, if the doctor does not see a danger to the patient). If necessary, additional instrumental examinations may be prescribed during these visits. If any neurological symptoms appear in the postoperative period, you must contact a specialist immediately, regardless of when the next consultation is scheduled.

Are any physical therapy procedures used to prevent or treat cerebral aneurysms?

However, this treatment method can be successfully used for hemorrhagic stroke, which occurs after the rupture of an aneurysm. At the same time, blood accumulates in the medulla. If the patient does not die directly from the hemorrhage, many brain functions are often impaired. Specific symptoms depend on the location of the damaged vessel. A long period of rehabilitation is required to restore normal brain function. This is where physiotherapeutic treatment methods can be successfully used.

During the rehabilitation period, physiotherapeutic procedures pursue the following goals:

• anti-inflammatory effect – reduces damage to brain tissue;
• absorbent effect – prevents the accumulation of fluid and compression of nerve fibers;
• improving blood flow to surrounding healthy areas of the brain ( this partly compensates for the lost functions);
• restoration of movements in the limbs in movement disorders.

The main principles of this treatment are:

• Passive movements of the limbs. They begin to be done 1 to 2 weeks after a hemorrhagic stroke. The patient does not try to tense his muscles. At first, the movements in the joints themselves are important. Alternate flexion, extension, rotation and other types of movements. The doctor tries to capture all the joints of the affected limb. Changing the position of the limb is done every 1 to 2 hours. For this period of time, the arm or leg is fixed in a certain position. Gradually this time is reduced, and the patient tries to help the doctor by conscious muscle contraction.
• Active movements. The patient performs such movements himself, without the help of a doctor, when his motor functions begin to return. The duration of active movements should initially be no more than a few minutes. Gradually the time increases.
• Neck massage recommended to improve cerebral circulation. It should be done in a position comfortable for the patient at a comfortable temperature. The massage therapist's hand movements are smooth. Muscles should not be stimulated ( as, for example, with a sports massage), and knead slightly.
• Massotherapy limbs. The massage therapist determines the condition of certain muscle groups in the affected limb. Those groups that are in a tense state ( hypertonicity) should be relaxed. The movements here are slower and smoother. Antagonist group ( performing a movement in the opposite direction), usually relaxed ( hypotonia). A stimulating massage is performed in this area using tapping, sharper movements and stronger pressure. This restores muscle tone and helps restore conscious control over movements.

For speedy rehabilitation, the following methods of physical and chemical influence can be used:

• Electrophoresis. The procedure involves introducing certain medications into the affected area under the influence of electromagnetic waves. By using special apparatus you can enter ( according to indications) aminophylline, papaverine, iodine preparations. Place of administration ( application of electrodes) is selected according to the location of the ruptured aneurysm. The current strength should not exceed 3 - 4 amperes. A course of 15–20 sessions is recommended ( daily) lasting 15–20 minutes. If necessary, the course of electrophoresis can be repeated after 1 – 2 months.
• Electrical muscle stimulation. The procedure involves applying current to the spastic ( tense) muscle groups. The variable operating mode of the device is set with a frequency of 100 – 150 Hz. The current strength is selected in the range of 25 - 45 amperes until a normal physiological muscle contraction is obtained ( appearance of a reflex). Each of the selected fields is affected 2 – 3 times for 2 minutes with short breaks ( 45 – 60 seconds). Procedures are carried out daily for 20 – 30 days. The interval between courses of treatment should be at least 3 weeks.

In addition to all of the above procedures, physiotherapy also includes the use of various medicinal baths. They speed up rehabilitation not only after a hemorrhagic stroke, but also after surgery to remove a cerebral aneurysm.

The following types of baths are most often prescribed:

• pine baths – 10 minutes, 8 – 10 procedures every other day;
• hydrogen sulfide baths ( optimal concentration – about 100 mg/l) – 5 – 10 minutes, 12 – 14 procedures every other day;
• iodine-bromine baths – 10 minutes, 10 – 15 procedures every other day;
• pine baths – 10 minutes, 10 – 12 procedures every other day;
• oxygen baths – 10–20 minutes, 10–15 procedures daily.

A chronic disease that affects the blood vessels of the brain and is characterized by local expansion of their walls is called an aneurysm. The pathology is common among people over 45-50 years of age and is a common complication of vascular and systemic diseases.

The essence of an aneurysm is expressed in impaired cerebral circulation and a high risk of ischemic complications. Let's consider how a cerebral aneurysm manifests itself and why it is dangerous.

A cerebral aneurysm is an expansion of the diameter of a cerebral vessel in a limited area. It is a round or uniform protrusion associated with the affected artery. Prevalence – 26-34 cases per 100,000 population.

ICD-10 codes: I67.0, I67.1.

Which aneurysms are more common in the vessels of the head:

• In terms of size, small (70-78%) and miliary (15-20%) varieties predominate.
• They are the most common in form (their ratio to other forms is 50:1).
• By anatomical type, arterial ones predominate (98-99%).

We wrote about the classification of this cerebral vascular lesion.

Causes

What causes a cerebral aneurysm? The main reasons for the appearance:

• Genetic syndromes (Sjögren, Marfan, Down, Turner);
• Dyslipidemia and;
• Arterial hypertension;
• Brain tumors;
• Congenital tortuosity of arteries.

At-risk groups:

• Women;
• Smoking;
• Persons over 40 years of age;
• Pregnant;
• Suffering from diabetes, alcoholism;
• Having undergone brain surgery, encephalitis, meningitis.

Is the predisposition inherited?

Predisposition to the disease is not inherited, since it is a consequence of primary diseases. However, the probability of developing causative diseases in the presence of such diseases in close relatives is 29-47%.

Development mechanism: how quickly does it grow and what does it depend on?

Aneurysms of intracerebral vessels typically develop in places where arterial trunks branch, where constant hemodynamic shocks of pulse waves occur. Under the influence of a causative disease, the arterial wall is subject to dystrophic and degenerative processes (thinning, calcification, fibrosis).

High blood flow speed leads to stretching of the affected area and its protrusion.

Average growth rate is 8-10 weeks. Aneurysms grow faster in severe cases and rapid progression of systemic diseases. With minimally expressed concomitant pathology, growth slows down, and the aneurysm may remain undetected for many years.

Where can it be located?

The following arteries of the brain are affected by an aneurysm:

• Basilar - in 1-3% of cases. Characterized by blindness, bulbar palsy, atrophy optic nerve. The course is rapidly progressive (within six months). Open surgery is preferred for treatment;
• Vertebrates (1-3%). Clinic – spinal syndrome, radicular lumbago, osteochondrosis, fainting. The course is perennial, erased. Treatment – ​​open removal;
• Anterior, middle, posterior cerebral (up to 60%). The clinical picture is varied - migraine-like headaches, visual and hearing impairment, episodes of loss of consciousness,... The course is steadily progressing. Treatment is open removal combined with the formation of a vascular shunt;
• Sleepy (25-30%). The clinic is dominated by unilateral facial paralysis, decreased vision, bulbar palsy, and memory loss. The course is erased, slowly progressing. Treatment is open removal. Read more about carotid artery aneurysm;
• Front connecting (1%). Clinic – disturbances of memory and attention, concentration, orientation in space, paralysis of half the body. The course can be hidden; the first manifestation is often a stroke. Treatment – ​​creation of a vascular shunt, resection of the affected area;
• Brachiocephalic trunk (up to 5%). Damage to this localization is manifested by fainting, thyroiditis, lethargy, and dizziness. The course is long. Treatment is removal of the aneurysm, replacement of the brachiocephalic trunk.

What are the symptoms?

Main clinical manifestations:

1. Pain;
2. Cerebral ischemia (tendency to fainting, dizziness, drowsiness, lethargy);
3. Feeling of fullness (with the addition of hydrocephalus);
4. Decline intellectual abilities, memory, attention;
5. Visual and hearing disorders;
6. Insomnia.

Progression leads to increased intensity and duration of pain, motor disorders (paralysis of the tongue, facial muscles, limbs), and convulsions.

In some cases, the first manifestation is a stroke:

• Sudden disorder of consciousness (lack of response to stimuli, stupor, loss of consciousness);
• Paralysis of half the body;
• An increase and then a decrease in pressure;
• Lack of pupillary response to light.

Differences in the clinic for men, women, children

There are no clinical differences by gender. Children are characterized by constant diffuse pain, refusal to eat, weight loss, bulging fontanelles, rapid heartbeat. Due to the imperfection of the nervous system, fever is often associated.

Nature of headaches

The pain is migraine-like, girdling or localized, and paroxysmal. As they progress, they become permanent and expanding. The pain intensifies with the addition of cerebral hydrocele.

The first signs that you should pay attention to and consult a doctor

The first symptoms of pathology:

• Repeated headaches localized in one area;
• Loss of consciousness;
• "Floaters" before the eyes;
• Brief episodes of decreased vision or hearing;
• Twitching of facial muscles;
• Noise in ears.

How is the diagnosis made?

The diagnostic algorithm includes the collection of complaints, examination, objective and laboratory and instrumental examination:

• Survey. When interviewed, patients indicate the presence of vascular diseases. Examination allows you to determine redness of the face, paralysis of the tongue, eyeballs, absence of the pupillary reflex;
• Objective examination— detection of hypertension, tachycardia, osteochondrosis, concomitant diseases;
• Laboratory research– increased cholesterol and blood glucose levels. In the cerebrospinal fluid there are erythrocytes;
• Ultrasound(transcranial Dopplerography) – effective in cases of damage to the middle cerebral artery basin;
• – accumulation of contrast, protrusion of the vascular wall;
• CT (MRI)– ischemia of brain tissue, type and size of protrusion, area of ​​hemorrhage, accumulation of cerebrospinal fluid and cerebral edema;
• EEG– disruption of the physiological electrical activity of the brain.

You can find out all the details about how a cerebral aneurysm is diagnosed.

Choice of treatment tactics

Depends on the complaints, the clinical picture, and the progression of the pathology. In the absence of manifestations and a stationary course, observation by a neurosurgeon with CT scanning twice a year is indicated. Treatment of concomitant diseases is carried out.

Indications for open surgery:

• Complaints of decreased vision and hearing;
• Sensory and motor dysfunctions;
• Migraine;
• Fainting;
• Threat or presence of complications;
• Progression of more than 5 mm per year;
• Violation of the outflow of cerebrospinal fluid.

Endovascular intervention is not performed in all patients, since open surgery allows for a more reliable assessment of the lesion. Indications:

• Age over 75 years (open surgery carries a risk of anesthetic complications);
• Damage to the vertebral artery (difficult to reach location for open intervention).

Complications and consequences of the disease

Possible complications:

• Bleeding;
• Stroke;
• Decreased vision, hearing, memory;
• Paralysis;
• Personality changes.

The risk of complications is higher among elderly and senile patients and amounts to 76-80%. In middle-aged people, complications occur in 30-43% of cases.

Without treatment, the disease leads to persistent impairment of motor and sensory functions.. Bleeding from a large aneurysm is the cause in half of patients.

Consequences after treatment:

• Residual effects (headache, memory impairment);
• Movement disorders;
• Myopia;
• Loss of smell, hearing;
• Surgical complications (shunt failure, bleeding, injury to the ventricles of the brain, thrombosis).

It is a potentially fatal complication of the disease and is characterized by a violation of the integrity and heavy bleeding from pathological protrusion. The rate of hemorrhage into the brain tissue reaches 50-100 ml/minute, which leads to the appearance of a large area of ​​ischemia and necrosis - the source of a stroke. Death occurs in 12-25% of patients.

The clinical picture, symptoms and diagnosis of the disease depend on the location of the aneurysm and its size. How to identify and treat the disease, read further in the article.

How to identify the symptoms of an aortic aneurysm

With an aneurysm, there is a sharp slowdown in the linear speed of blood flow in the sac and its turbulence. Only about 45% of the blood volume in the aneurysm enters the distal channel. The mechanism of symptoms of aortic aneurysm in the form of a slowdown in blood flow in the aneurysmal sac is due to the fact that the main flow of blood, passing through the aneurysmal cavity, rushes along the walls. The central flow slows down due to the return of blood caused by turbulence of the blood flow and the presence of thrombotic masses in the aneurysm.

The mechanism of development of symptoms of aortic aneurysm

Most aortic aneurysms are of atherosclerotic origin. Macroscopically, the inner surface of an atherosclerotic aneurysm is represented by symptoms in the form of atheromatous plaques, sometimes ulcerated and calcified. Inside the cavity of the aneurysm, compacted masses of fibrin are located near the wall. They constitute the "thrombotic cup". The following symptoms of an aortic aneurysm are noted:

damage to the muscular membrane with dystrophy and necrosis of elastic and collagen membranes,

sharp thinning of the media and adventitia and thickening of the intima due to atheromatous masses and plaques - the elastic frame of the wall is practically destroyed.

Gradually accumulating and compressing under blood pressure, thrombotic masses can almost completely fill the aneurysmal sac, leaving only a narrow lumen for blood flow.

Due to the deterioration of trophism in an aortic aneurysm, instead of the expected organization of a “thrombotic cup,” necrosis occurs at the site of contact with the walls of the aneurysm, and the wall itself is damaged. Thus, fibrin deposits lead not to strengthening, but to weakening of the aneurysm wall.

Signs of a thoracic aortic aneurysm

Their frequency, according to pathological autopsies, varies between 0.9-1.1%. There are aneurysms of the aortic root and its sinuses (sins of Valsalva), ascending aorta, aortic arch, descending aorta, and thoracoabdominal aneurysms. Combined lesions of adjacent segments are possible.

With an aneurysm, normal blood flow in the distal aorta is disrupted, the load on the left ventricle increases and coronary circulation worsens. In some patients, aortic valve insufficiency occurs, aggravating the severity of hemodynamic disorders.

Symptoms of arteriovenous aneurysm

With the long-term existence of an arteriovenous aneurysm, significant changes occur in the wall of the afferent artery, manifested in the following symptoms of an arteriovenous aneurysm: thinning of the muscle layer, fragmentation and focal destruction of the internal elastic membrane, hyperelastosis of the adventitia, which causes an increase in the diameter of the artery. In the wall of the vein extending from the aneurysm, on the contrary, hypertrophy of the muscular membrane and the development of the internal elastic membrane occur. These changes sometimes lead to a significant increase in the caliber of the vein.

Arteriovenous aneurysms and their combinations cause severe hemodynamic disorders, which are characterized by symptoms of arteriovenous aneurysm such as impaired peripheral circulation and central hemodynamics.

Pathological discharge arterial blood into the venous system causes disruption of venous outflow and overload of the right heart. Due to venous stasis they expand superficial veins, swelling and trophic changes in the distal limbs occur. Due to increased blood flow to the right atrium, working myocardial hypertrophy develops, which is then replaced by myogenic dilatation and cardiac decompensation.

Due to the constant arteriovenous discharge, the aneurysmal sac is usually small in size and less tense than with arterial aneurysms. In the area of ​​the aneurysm, dilatation of the saphenous veins is often observed, which sometimes pulsate, and the symptom of “cat purring” is determined. During auscultation, a constant “blowing” noise is heard over this area, increasing during systole.

The pathognomonic symptom of an arteriovenous aneurysm is a decrease in pulse by 15-30 beats per minute, combined with an increase in blood pressure when the afferent artery is compressed (Dobrovolsky's symptom). The slowing of the pulse is due to an improvement in cardiac activity due to a decrease in blood flow to the right side of the heart.

Symptoms of aneurysm complications

Most frequent complications aneurysms are:

rupture of the aneurysmal sac with profuse, life-threatening bleeding and the formation of massive hematomas,

aneurysm thrombosis, arterial embolism with thrombotic masses,

infection of the aneurysm with the development of phlegmon of surrounding tissues.

Types of aneurysm, forms and their symptoms

According to the clinical course, it is customary to distinguish:

uncomplicated,

complicated,

dissecting aneurysms.

Types of Aortic Aneurysm

According to the morphological structure, the walls of the aneurysm are divided into:

• true
• and false.

The formation of true aneurysms is associated with damage to the vascular wall by various pathological processes (atherosclerosis, syphilis, etc.). With true aneurysms, the structure of the vascular wall is preserved, this important symptom. The wall of false aneurysms is represented by scar connective tissue formed during the organization of a pulsating hematoma. Examples of false aneurysms are traumatic and postoperative aneurysms, the symptoms of which differ from false ones.

According to the shape of the aneurysm, they are divided into:

• baggy
• and fusiform.

The former are characterized by symptoms of aortic aneurysm in the form of local protrusion of the aortic wall, while the latter are characterized by diffuse expansion of the entire circumference of the aorta.

How to diagnose an aortic aneurysm

Medium and large aneurysms are characterized by pain caused by pressure on surrounding tissues and stretching of the nerve plexuses; this is an important diagnostic symptom.

• With aortic arch aneurysms, pain is often localized in the chest and radiates to the neck, shoulder and back;
• with aneurysms of the ascending aorta, patients report chest pain,
• and for descending aneurysms - in the interscapular region.

If an aneurysm compresses the superior vena cava, the following may occur: headache, swelling of the face, and suffocation. With large aneurysms of the arch and descending aorta, hoarseness occurs (compression of the recurrent nerve); sometimes dysphagia (compression of the esophagus) appears. Patients often complain of shortness of breath and cough associated with the pressure of the aneurysmal sac on the trachea and bronchi. Sometimes there is difficulty breathing, which gets worse during horizontal position. When branches of the aortic arch are involved in the process, symptoms of chronic insufficiency of blood supply to the brain may occur. With thoracoabdominal aneurysms, the development of angina abdominalis syndrome is possible.

List of clinical signs of aortic aneurysm

Examination of patients reveals the following symptoms of aortic aneurysm:

puffiness,

cyanosis of the face and neck,

swelling of the neck veins due to obstruction of venous outflow. A pulsating protrusion on the anterior surface of the chest is caused by a large aneurysm that destroys the sternum and ribs. Compression of the cervical sympathetic trunk is manifested by Bernard-Horner syndrome.

Symptoms of Marfan syndrome, often combined with an aneurysm

With Marfan syndrome (anomaly of connective tissue development), patients have characteristic appearance:

high growth,

narrow face,

disproportionately long limbs and spider-like fingers;

Sometimes kyphoscoliosis and funnel chest are detected.

50% of patients have luxation or subluxation of the lens.

When the brachiocephalic arteries are damaged, asymmetry of pulse and pressure in the upper extremities and expansion of the boundaries of the vascular bundle to the right of the sternum are observed. A common symptom disease is a systolic murmur, which in case of aneurysms of the ascending aorta and aortic arch is heard in the second intercostal space to the right of the sternum. It is caused by the turbulent nature of the blood flow in the cavity of the aneurysmal sac. With an aneurysm combined with aortic valve insufficiency, a systolic-diastolic murmur is heard in the third intercostal space to the left of the sternum.

How to determine the manifestations of a dissecting aortic aneurysm

Diagnosis of aortic aneurysm dissection

Symptoms of aortic aneurysm dissection are varied and can mimic almost all cardiovascular, as well as neurological and urological diseases. The occurrence of certain symptoms depends on the localization of intimal fenestration and the extent of dissection and compression of the branches of the aorta. The onset of aortic aneurysm dissection is characterized by sudden appearance extremely intense pain behind the sternum, radiating to the back, shoulder blades, neck, upper limbs, accompanied by increased blood pressure and motor restlessness. Such a clinical picture leads to an erroneous diagnosis of myocardial infarction.

When dissection begins in the ascending aorta (types I and II of dissecting aneurysms), acute development of aortic valve insufficiency is possible with the appearance of a characteristic systolic-diastolic murmur in the aorta, and sometimes coronary insufficiency due to involvement of the coronary arteries in the pathological process. Impaired blood flow through the brachiocephalic arteries leads to severe neurological disorders (hemiparesis, strokes, etc.) and pulse asymmetry in the upper extremities. As the dissecting aneurysm spreads to the descending and abdominal aorta, symptoms of compression of its visceral branches, as well as signs of arterial insufficiency of the lower extremities, appear. The final outcome of the disease is a rupture of the aortic wall, accompanied by massive bleeding into the pleural cavity or pericardial cavity with a fatal outcome.

The period of dissection can be acute (up to 48 hours), acute (up to 2-4 weeks) or chronic (up to several months). Up to 45% of patients die within the first 2 days.

In the diagnosis of dissecting aneurysms, X-ray and ultrasound examination methods, computed tomography and aortography are used. X-ray examination reveals an expansion of the mediastinal shadow, aorta, and sometimes the presence of hemothorax. Echocardiography makes it possible to detect an increase in the size of the ascending aorta, dissection of the aortic root wall, and aortic valve insufficiency. Using ultrasound and computed tomography for a dissecting aneurysm, it is possible to register two lumens and two contours of the aortic wall (Fig. 18.19), determine its extent, as well as a breakthrough into the pleural or pericardial cavity. The main angiographic feature of a dissecting aneurysm is a double aortic contour.

Early signs of aortic aneurysm dissection

In the initial period of dissection of an aortic aneurysm, a tear occurs in the inner and sometimes its middle membrane while maintaining the integrity of the outer membrane of the aorta. Subsequently, the blood penetrating under high pressure dissects the entire wall of the aorta and breaks through the outer membrane, which leads to the instant death of the patient from massive internal bleeding. In other cases, the spread of dissection is more often distal, less often proximal, which leads to hemopericardium, aortic valve rupture, severe aortic insufficiency, occlusion coronary arteries. Dissection may result in re-rupture of the inner lining of the aorta below the site of initial dissection. A so-called double-barreled shotgun is formed; however, such successful cases of self-healing are extremely rare.

Dissection of an aortic aneurysm begins acutely, and the rate of development is rapid. The main symptom of a dissecting aortic aneurysm is severe chest pain, often of a tearing or cutting nature. The pain can be localized in the precordial region or in the interscapular space, radiates to the back and often spreads to the epigastric region. The patient is excited, rushing about, unable to find a place to rest due to pain.

After the first attack of an aortic aneurysm, short-term relief may occur, followed by a new attack of the same pain. The alternation of painful attacks and light intervals is due to the fact that dissection of the aortic wall sometimes occurs in several stages. In addition, the involvement of new areas of the aortic wall in the process of dissection may change the place of greatest severity of pain; migration of pain from the site of the initial tear of the aorta along the course of dissection is a characteristic sign of this pathology. After an initial attack of chest pain, it can subsequently be localized mainly in the abdomen and lower back, which should be taken into account when diagnosing.

Late symptoms of dissecting aortic aneurysm

Often, immediately following the pain of a dissecting aortic aneurysm, a picture of severe collapse develops with a drop in pressure, threadlike pulse, and peripheral manifestations vascular insufficiency; It is almost never possible to bring a patient out of collapse. In other cases, the first painful attack of an aortic aneurysm is accompanied by sharp increase HELL.

Due to impaired blood flow in the arteries extending from the aorta, significant asymmetry of pressure in the right and left arms may occur (ischemia of the limbs sometimes makes it impossible to determine blood pressure in one or both arms), symptoms of cerebrovascular accident (paraparesis, paraplegia), myocardial infarction, and frequent episodes of loss of consciousness . Involvement of the abdominal aorta in the process is usually accompanied by a symptom of circulatory disorders in the basin of the main mesenteric vessels with the addition of a picture of severe intestinal obstruction. With proximal dissection of an aortic aneurysm, in more than half of the cases, objective examination reveals aortic insufficiency. When a dissecting aneurysm ruptures into the pericardial cavity, pericardial tamponade and also rupture of the aorta into the left pleural cavity are possible.

From the moment of the initial rupture of the aortic aneurysm of the inner membrane to the final breakthrough of the outer membrane and the death of the patient, from several minutes to several days pass, during which sometimes short periods of relative well-being occur. Depending on how long ago the disease developed, acute (up to 2 weeks) and chronic (more than 2 weeks) dissection of the aortic aneurysm is distinguished.

There are three types of dissecting aneurysms:

• Type I - dissection of the ascending aorta with a tendency to spread to its remaining parts;
• Type II - dissection of the ascending aorta only;
• Type III - dissection of the descending aorta with the possibility of transition to its abdominal segment.

Instrumental methods for diagnosing the disease

A radiological sign of a thoracic aortic aneurysm is the presence of a homogeneous formation with smooth, clear contours, inseparable from the shadow of the aorta and pulsating synchronously with it. Aneurysms of the ascending and descending aorta are especially clearly visible in the second oblique projection when diagnosing an aortic aneurysm. X-ray examination can also detect displacement of the trachea, bronchi and esophagus by the aneurysm, contrasted with barium.

Computed tomography makes it possible to determine the location and size of aneurysms, the presence of thrombotic masses in the cavity of the aneurysmal sac (Fig. 18.17). Diagnosis of aortic aneurysm in the form of echocardiography makes it possible to identify aneurysms of the ascending section and aortic arch. In recent years, ultrasound using a transesophageal probe has often been used to diagnose thoracic aortic aneurysms.

In the diagnosis of aneurysms, Seldinger angiography is more often used, which is advisable to perform in two projections with the introduction of a contrast agent into the ascending aorta. The diagnosis can be confirmed by CT and MP angiography. Differential diagnosis should be performed with tumors of the lungs and mediastinum.

Diagnosis of symptoms of dissecting aortic aneurysm

The diagnosis of dissecting aortic aneurysm is made based on the clinical picture, taking into account:

discrepancy between the severity of pain and the absence of ECG changes characteristic of myocardial infarction,

migration of pain localization as aortic dissection spreads (in particular, pain spreads to the lower abdomen and legs),

disturbances in arterial pulsation,

signs of increasing anemia.

Sometimes X-ray signs of dissection of the aortic aneurysm help make the correct diagnosis: in half of the cases, expansion of the mediastinum is detected - to the right when the ascending aortic arch is dissected and to the left when the descending part of the thoracic aortic arch is affected. A visible expansion of the aortic shadow over calcium deposits in the aortic wall by 4-5 mm can be determined; limited protrusion of the aortic arch; effusion in the pleural cavity (usually on the left).

The diagnosis of dissecting aortic aneurysm can be confirmed by ultrasound examination and verified by aortography in a specialized institution (mandatory before surgical treatment).

Differential diagnosis. Dissecting aortic aneurysm is usually differentiated from myocardial infarction, which presents significant difficulties due to the similarity of pain and symptoms of both diseases in general, especially in the initial period of the disease. According to many studies, the correct diagnosis is made only in half of the cases. In contrast to the most acute stage of myocardial infarction, anticoagulants and thrombolytics are contraindicated in dissecting aortic aneurysm.

Features of treatment of aortic aneurysm

A patient with suspected dissecting aortic aneurysm is subject to urgent hospitalization, subject to absolute rest during transportation. Urgent Care for aortic aneurysm consists of creating absolute rest, relieving pain by administering 1-2 ml of a 1% Morphine solution subcutaneously or intravenously. To correct high blood pressure in case of suspected aortic aneurysm dissection at the prehospital stage, calcium antagonists can be used - Verapamil intravenously at a dose of 0.05 mg/kg or Nifedipine at a dose of 10-20 mg sublingually every 2-4 hours.

Surgical removal of an aneurysm

As a rule, aneurysm resection is performed with aortic replacement. In recent years, closed endoluminal endoprosthesis replacement of aneurysms has begun to be used with a special endoprosthesis, which is inserted into the lumen of the aneurysm using a special guide and fixed above and below the aneurysmal sac with hooks located at the ends of the prosthesis. The greatest technical difficulties are presented by surgical interventions for aneurysms of the aortic arch, when reconstruction of the brachiocephalic arteries is simultaneously performed.

After diagnosing a thoracic aortic aneurysm, the prognosis is unfavorable. Most patients die within 2-3 years from aneurysm ruptures or heart failure.

Treatment of dissecting aortic aneurysm

In cases of dissecting aortic aneurysm, emergency aortic replacement is successfully performed, which makes early diagnosis of aortic aneurysm symptoms especially important. Emergency correction is carried out in the intensive care unit arterial hypertension(used for this purpose combination therapy The myotropic vasodilator sodium nitroprusside and the beta-blocker obzidan are administered intravenously), and an examination is performed to verify the diagnosis (chest x-ray, ultrasound).

After this, in the treatment of aortic aneurysm, consultation with a vascular surgeon is indicated to decide on the need and scope of surgical treatment. Calcium antagonists and beta-blockers are used as maintenance antihypertensive therapy. In the case of chronic aortic aneurysm, in order to maintain systolic blood pressure at a level of no more than 130-140 mm Hg. Art. Beta blockers and calcium antagonists are also used, and diuretics are added to therapy for fluid retention.

Conservative treatment of dissecting aortic aneurysm

IN acute period It is possible to carry out conservative treatment aimed at relieving pain and lowering blood pressure. In some cases, this makes it possible to transform an acute dissection into a chronic one and carry out surgical treatment in more favorable conditions. However, the progression of dissection, the development of acute aortic insufficiency, compression of vital branches of the aorta, the threat of rupture or rupture of the aneurysm are indications for emergency surgery. Depending on the size of the aneurysm, some patients undergo resection, suturing of the dissected aortic wall, followed by end-to-end anastomosis, while others undergo resection with aortic replacement. In case of aortic valve insufficiency, the operation is supplemented with its replacement.

Causes of aortic aneurysm

The development of aneurysms is caused by:

• congenital diseases (coarctation of the aorta, Marfan syndrome, congenital tortuosity of the aortic arch),
• and acquired (atherosclerosis, syphilis, Takayasu syndrome, rheumatism),
• as well as chest injuries.

Aneurysms can also occur in the area of ​​the vascular suture after operations on the aorta; it is necessary to monitor alarming symptoms. The arteriovenous type of aneurysm most often has a traumatic origin and is formed as a result of simultaneous damage to an artery and vein.

Causes of dissecting aortic aneurysm

A disease such as dissecting aortic aneurysm most often occurs in elderly men with a history of atherosclerosis and hypertension. Less commonly, symptoms of dissecting aortic aneurysm are diagnosed in combination with syphilitic aortitis. Marfan syndrome, birth defects aortic valve disease are also risk factors for dissecting aortic aneurysm.

Dissecting aneurysms of the thoracic aorta account for 20% of aneurysms in this segment and 6% of all aortic aneurysms, and are characterized by intimal tearing and dissection of the aortic wall by blood flow penetrating between the intima and the muscular layer. The process of formation of a dissecting aneurysm begins with a tear and detachment of the intima (fenestration), as a result of which, under the influence of high blood pressure, a false lumen is formed between the intima and the altered muscular layer - additional channel in the wall of the aorta. The most common cause of the development of dissecting aneurysms is atherosclerotic damage to the aortic wall in the presence of concomitant arterial hypertension. Other causes may be Marfan syndrome, idiopathic Erdheim's medial necrosis.

Cough and shortness of breath, swelling are observed. Once such symptoms appear, immediate diagnosis and subsequent treatment are required. To eliminate the problem, one of the possible operations is often performed. The drugs cannot completely cope with the pathology, so they are used only for preventive purposes.

Different types of pathology

Aortic pathology is common among older people. It is extremely rare in women, which cannot be said about the stronger half of humanity. Pathology can develop for a very long time, for years. The patient needs regular care and medical supervision. Lifestyle plays a huge role.

Aortic pathology can be classified according to etiology, shape, segments and wall structure. Based on this, it is divided into subspecies, each of which has its own characteristics and manifestations. Aneurysms are distinguished by segments:

• aortic arch;
• sinus of Valsalva;
• ascending department;
• descending department;
• abdominal aorta.

In addition, an aneurysm can be combined, that is, it affects several areas at once. In this case, special treatment is needed, step by step.

Morphological differences in aortic disease divide it into false and true. In the latter case, the membrane thins and bulges outward. This happens with atherosclerosis, syphilis and similar diseases. In the false one, hematomas are detected. Appear after interventions by a surgeon or as a result of injury to an organ. This is quite possible as a consequence of surgery on the organ.

According to the shape, the pathology of the aorta is divided into saccular and fusiform. In the first case, there is a bulging of the walls outward, locally. In the second, the same thing happens, but over the entire diameter of the aorta. Depending on how the disease progresses, it can be:

The most serious is complicated. It often leads to rupture of the aortic sac. As a result, internal bleeding, hematomas, and thromboembolism are observed. As a consequence, death is obvious, and almost instantaneous due to blood loss. If there are no qualified medical professionals nearby, this aortic problem cannot be dealt with. It is for this reason that the patient should always be under medical supervision.

What causes the disease to develop?

Regardless of the form, aortic pathology can be acquired or congenital. Congenital aortic aneurysm is formed due to diseases that are often transmitted at the genetic level from relatives. These include fibrous dysplasia, hereditary elastin deficiency and other syndromes. If the disease is acquired, the causes may be arthritis, infections or fungal infections. But pathology can occur without inflammatory process, for example, as a result of atherosclerosis, prosthetic defects and suture material.

Mechanical causes are common. In this case, it means both external and internal damage to the organ. This happens due to an incorrectly performed surgical operation on an organ or after it.

Known causative factors that increase risks are:

More often, pathology is detected among representatives of the stronger sex. Aneurysm of the aortic arch and its other locations often manifests itself as a result of defects in suture materials and grafts. Simply put, after various operational actions. Post-traumatic consequences are not uncommon today. After injury, pathology does not appear immediately: it can take from a month to several years. There is evidence of cases where aortic disease made itself felt after 20 years.

Hypertension will go away. for 147 rubles!

Hypertension weakens the body's tone, which creates an aneurysmal sac. This mainly happens after 60 years. Increasing blood flow pressure only increases the risk. This becomes the result of internal bleeding, which in turn has tragic consequences. To prevent this from happening, you need to know the symptoms of an aneurysm.

Symptoms of pathology

Any aortic aneurysm is identified based on its characteristics, depending on its location, length, size and other factors. In some cases, it does not show obvious signs. She is discovered by accident preventive examinations. If there are symptoms, then the main symptom is always the same - pain arising from stretching of the aortic lining.

With abdominal disease, the following symptoms can be observed:

1. Painful sensations.
2. Discomfort in the abdominal area.
3. Heaviness.
4. Belching.
5. Feeling of full stomach.

With an aneurysm of the ascending section, the following appear:

1. Heart pain.
2. Dyspnea.
3. Tachycardia.
4. Dizziness.

If the pathology of the aorta reaches a large size, headaches, swelling of the chest and face may occur. This happens due to the pressure of the expanding aorta on neighboring tissues. In this case, immediate medical attention is required, as in all other cases.

When the descending aorta of the heart is irritated, pain appears in the shoulder blade and arm, on the left side. Often the pain radiates to other areas of the body. Spinal cord ischemia and paraplegia are possible.

When the aortic arch is damaged, compression of the esophagus is observed, as well as:

The greater the pathology of the aorta becomes, the more it compresses neighboring anatomical structures - nerve plexuses, tissues. In this case, there is often pain behind the chest, throbbing, pain radiating to the shoulder, neck and back. Horner's syndrome appears, and the pupils become constricted. It is by these symptoms that you can promptly identify the pathology yourself.

How is an aortic aneurysm diagnosed?

A number of methods are used to detect aortic aneurysms. diagnostic measures. X-rays, tomography and ultrasound examinations are performed. Systolic murmurs are detected in the aorta. However, diagnosis begins with palpation. It reveals a pulsating swelling, indicating the presence of an aneurysm. External examination is the basis of diagnosis. In addition to pulsation, it helps to identify protrusions of the aortic sac. An anamnesis is taken to identify secondary diseases or injuries. This will help confirm or refute the presence of pathology.

After manual study, instrumental study must be performed. It begins with radiographic studies. Diagnosis includes plain radiography of the abdominal cavity, fluoroscopy, radiography of the stomach, esophagus and chest. Well defined ECG abnormalities, an ultrasound scan may also be prescribed. A CT scan of the abdominal or thoracic aorta identifies possible dilations of the arteries, blood clots, and hematomas.

Finally, aortography is performed to determine the localization of the pathology, its extent and size. Only such comprehensive diagnostic actions make it possible to establish an accurate diagnosis and develop appropriate treatment. After this, you can begin to implement therapeutic procedures.

Troubleshooting

When an aortic aneurysm is confirmed, it needs to be repaired. If the pathology does not manifest visible symptoms, then dynamic is sufficient medical supervision. In this case, regular X-ray examinations play an important role. Of course, procedures are carried out in parallel to prevent complications using different therapy methods. Medications play an important role here.

If the aneurysm reaches a large size, then surgery cannot be avoided. If the pathology progresses intensively, surgical treatment is also necessary. Emergency measures are needed for ruptures. In all such situations, the main measure can be considered excision of the area vascular system. It is possible to replace the defective area with a prosthesis or stitch it together. In general, two methods can be used - surgical and medicinal. But it all starts with therapy, that is, conservative prevention is carried out.

Conservative methods

For isolated aneurysms, this approach is justified if the lesion is small in diameter or symptoms do not appear. Various herbal formulations and tablets are prescribed:

When carrying out such recovery, dynamic observation is important. In this case, the affected organ is regularly examined by a cardiologist. MRI, CT, Echo CG are prescribed.

The main goal of drugs used in conservative treatment is to relieve symptoms when they are detected. Reducing risk and preventing the growth of pathology are also important goals of the technique. In addition, this is a kind of prevention, and very effective. At the same time, one must understand that not a single medicine unable to completely get rid of the pathology, but only pushes it aside and freezes it. To ensure that the aneurysm no longer bothers you, radical techniques are required.

This treatment of the aneurysm root should be carried out under the guidance of an experienced professional with medical education. Self-medication will not work positive results, but it may well cause harm. Therefore, it is extremely important to take only those medications prescribed by your doctor. IN otherwise Possible death.

Surgical techniques

Such treatment is carried out when an aneurysm larger than 5 cm in diameter is detected, if there is compression syndrome, pain, dissection and other complications, such as thrombosis. This technology consists of resection. With its help, the aneurysm is dissected. The aortic defect is eliminated by replacing the affected area with a graft. This method is the most common. Of course, such an operation is very complicated, but almost always it guarantees complete relief from the pathology.

Held this procedure only after starting artificial blood flow. It is worth mentioning that such surgery sometimes ends in death. Therefore, the selection of a clinic and medical personnel for its implementation must be approached with special care. But of course, this is not the only method. Closed prosthetics are also used. In such a situation, an endoprosthesis is used. It is inserted into the lumen of the aorta, where it is fixed below or above the aneurysm sac.

There are cases when carrying out any of the operations described above is unacceptable. These include identifying complete contraindications. In this case, the affected artery is wrapped in synthetic fabric. Such palliative intervention is relevant only when there is a threat of rupture. In other cases, the patient's stable condition is coordinated regular appointments medications.

Preventive measures

The sooner you start taking care of your health, the greater the likelihood of leaving serious problems with him. First of all, we mean a change in lifestyle, that is:

1. Getting rid of bad habits.
2. Proper nutrition.
3. Constant and regular examinations by a doctor.

Physical overload and stressful situations should be avoided.

Possible complications

If, when aortic disease is detected or a pathology is suspected, serious treatment is not carried out, death is inevitable. This happens due to a number of consequences. With this pathology, the most dangerous thing is rupture of the aortic aneurysm, leading to serious bleeding. Shocks and collapses, heart failure are possible. When ruptured, conditions often transform, leading to death. These include:

If blood clots form in the aortas, when they break off, acute occlusion, soreness of the fingers, cyanosis, and intermittent claudication may develop. A stroke is also possible.

Most often, aortic defects and heart failure appear. Such complications are characteristic of pathologies in the ascending aorta. Especially if their origin is syphilitic. It is quite possible to develop decompensation of the heart. As mentioned, the most serious of them is rupture with bleeding. The flow of fluid from the veins can go into the bronchi, trachea, cardiac sac, pleural cavity, esophagus, even into large vessels of the chest. Thus, cardiac tamponade is more likely to occur. Rapid blood loss causes rapid death.

Another serious complication is blood clots in the aorta. Subacute and acute thrombosis occurs more often in the abdominal aortas. When they overlap, the most dire consequences can occur. As in other cases, this always leads to rapid death. Only measures taken in a timely manner will help. Accordingly, the patient should be under medical supervision at this moment. If all necessary measures are taken, an aneurysm will not cause problems.

Aortic aneurysm symptoms and treatment | How to identify an aortic aneurysm

The clinical picture, symptoms and diagnosis of the disease depend on the location of the aneurysm and its size. How to identify and treat the disease, read further in the article.

How to identify the symptoms of an aortic aneurysm

With an aneurysm, there is a sharp slowdown in the linear speed of blood flow in the sac and its turbulence. Only about 45% of the blood volume in the aneurysm enters the distal channel. The mechanism of symptoms of aortic aneurysm in the form of a slowdown in blood flow in the aneurysmal sac is due to the fact that the main flow of blood, passing through the aneurysmal cavity, rushes along the walls. The central flow slows down due to the return of blood caused by turbulence of the blood flow and the presence of thrombotic masses in the aneurysm.

The mechanism of development of symptoms of aortic aneurysm

Most aortic aneurysms are of atherosclerotic origin. Macroscopically, the inner surface of an atherosclerotic aneurysm is represented by symptoms in the form of atheromatous plaques, sometimes ulcerated and calcified. Inside the cavity of the aneurysm, compacted masses of fibrin are located near the wall. They constitute the "thrombotic cup". The following symptoms of an aortic aneurysm are noted:

damage to the muscular membrane with dystrophy and necrosis of elastic and collagen membranes,

sharp thinning of the media and adventitia and thickening of the intima due to atheromatous masses and plaques - the elastic frame of the wall is practically destroyed.

Gradually accumulating and compressing under blood pressure, thrombotic masses can almost completely fill the aneurysmal sac, leaving only a narrow lumen for blood flow.

Due to the deterioration of trophism in an aortic aneurysm, instead of the expected organization of a “thrombotic cup,” necrosis occurs at the site of contact with the walls of the aneurysm, and the wall itself is damaged. Thus, fibrin deposits lead not to strengthening, but to weakening of the aneurysm wall.

Signs of a thoracic aortic aneurysm

Their frequency, according to pathological autopsies, varies between 0.9-1.1%. There are aneurysms of the aortic root and its sinuses (sins of Valsalva), ascending aorta, aortic arch, descending aorta, and thoracoabdominal aneurysms. Combined lesions of adjacent segments are possible.

With an aneurysm, normal blood flow in the distal aorta is disrupted, the load on the left ventricle increases and coronary circulation worsens. In some patients, aortic valve insufficiency occurs, aggravating the severity of hemodynamic disorders.

Symptoms of arteriovenous aneurysm

With the long-term existence of an arteriovenous aneurysm, significant changes occur in the wall of the afferent artery, manifested in the following symptoms of an arteriovenous aneurysm: thinning of the muscle layer, fragmentation and focal destruction of the internal elastic membrane, hyperelastosis of the adventitia, which causes an increase in the diameter of the artery. In the wall of the vein extending from the aneurysm, on the contrary, hypertrophy of the muscular membrane and the development of the internal elastic membrane occur. These changes sometimes lead to a significant increase in the caliber of the vein.

Arteriovenous aneurysms and their combinations cause severe hemodynamic disorders, which are characterized by symptoms of arteriovenous aneurysm such as impaired peripheral circulation and central hemodynamics.

Pathological discharge of arterial blood into the venous system causes disruption of venous outflow and overload of the right side of the heart. Due to venous stasis, the superficial veins dilate, swelling and trophic changes in the distal limbs occur. Due to increased blood flow to the right atrium, working myocardial hypertrophy develops, which is then replaced by myogenic dilatation and cardiac decompensation.

Due to the constant arteriovenous discharge, the aneurysmal sac is usually small in size and less tense than with arterial aneurysms. In the area of ​​the aneurysm, dilatation of the saphenous veins is often observed, which sometimes pulsate, and the symptom of “cat purring” is determined. During auscultation, a constant “blowing” noise is heard over this area, increasing during systole.

The pathognomonic symptom of an arteriovenous aneurysm is a decrease in pulse by 15-30 beats per minute, combined with an increase in blood pressure when the afferent artery is compressed (Dobrovolsky's symptom). The slowing of the pulse is due to an improvement in cardiac activity due to a decrease in blood flow to the right side of the heart.

Symptoms of aneurysm complications

The most common complications of aneurysms are:

rupture of the aneurysmal sac with profuse, life-threatening bleeding and the formation of massive hematomas,

aneurysm thrombosis, arterial embolism with thrombotic masses,

infection of the aneurysm with the development of phlegmon of surrounding tissues.

Types of aneurysm, forms and their symptoms

According to the clinical course, it is customary to distinguish:

Types of Aortic Aneurysm

According to the morphological structure, the walls of the aneurysm are divided into:

• true
• and false.

The formation of true aneurysms is associated with damage to the vascular wall by various pathological processes (atherosclerosis, syphilis, etc.). With true aneurysms, the structure of the vascular wall is preserved; this is an important symptom. The wall of false aneurysms is represented by scar connective tissue formed during the organization of a pulsating hematoma. Examples of false aneurysms are traumatic and postoperative aneurysms, the symptoms of which differ from false ones.

According to the shape of the aneurysm, they are divided into:

• baggy
• and fusiform.

The former are characterized by symptoms of aortic aneurysm in the form of local protrusion of the aortic wall, while the latter are characterized by diffuse expansion of the entire circumference of the aorta.

How to diagnose an aortic aneurysm

Medium and large aneurysms are characterized by pain caused by pressure on surrounding tissues and stretching of the nerve plexuses; this is an important diagnostic symptom.

• With aortic arch aneurysms, pain is often localized in the chest and radiates to the neck, shoulder and back;
• with aneurysms of the ascending aorta, patients report chest pain,
• and for descending aneurysms - in the interscapular region.

If an aneurysm compresses the superior vena cava, the following may occur: headache, swelling of the face, and suffocation. With large aneurysms of the arch and descending aorta, hoarseness occurs (compression of the recurrent nerve); sometimes dysphagia (compression of the esophagus) appears. Patients often complain of shortness of breath and cough associated with the pressure of the aneurysmal sac on the trachea and bronchi. Sometimes there is difficulty breathing, which gets worse in a horizontal position. When branches of the aortic arch are involved in the process, symptoms of chronic insufficiency of blood supply to the brain may occur. With thoracoabdominal aneurysms, the development of angina abdominalis syndrome is possible.

List of clinical signs of aortic aneurysm

Examination of patients reveals the following symptoms of aortic aneurysm:

cyanosis of the face and neck,

swelling of the neck veins due to obstruction of venous outflow. A pulsating protrusion on the anterior surface of the chest is caused by a large aneurysm that destroys the sternum and ribs. Compression of the cervical sympathetic trunk is manifested by Bernard-Horner syndrome.

Symptoms of Marfan syndrome, often combined with an aneurysm

With Marfan syndrome (anomaly of connective tissue development), patients have a characteristic appearance:

disproportionately long limbs and spider-like fingers;

Sometimes kyphoscoliosis and funnel chest are detected.

50% of patients have luxation or subluxation of the lens.

When the brachiocephalic arteries are damaged, asymmetry of pulse and pressure in the upper extremities and expansion of the boundaries of the vascular bundle to the right of the sternum are observed. A common symptom of the disease is a systolic murmur, which, with aneurysms of the ascending aorta and aortic arch, is heard in the second intercostal space to the right of the sternum. It is caused by the turbulent nature of the blood flow in the cavity of the aneurysmal sac. With an aneurysm combined with aortic valve insufficiency, a systolic-diastolic murmur is heard in the third intercostal space to the left of the sternum.

How to determine the manifestations of a dissecting aortic aneurysm

Diagnosis of aortic aneurysm dissection

Symptoms of aortic aneurysm dissection are varied and can mimic almost all cardiovascular, as well as neurological and urological diseases. The occurrence of certain symptoms depends on the localization of intimal fenestration and the extent of dissection and compression of the branches of the aorta. The onset of aortic aneurysm dissection is characterized by the sudden appearance of extremely intense chest pain, radiating to the back, shoulder blades, neck, and upper limbs, accompanied by increased blood pressure and motor restlessness. Such a clinical picture leads to an erroneous diagnosis of myocardial infarction.

When dissection begins in the ascending aorta (types I and II of dissecting aneurysms), acute development of aortic valve insufficiency is possible with the appearance of a characteristic systolic-diastolic murmur in the aorta, and sometimes coronary insufficiency due to involvement of the coronary arteries in the pathological process. Impaired blood flow through the brachiocephalic arteries leads to severe neurological disorders (hemiparesis, strokes, etc.) and pulse asymmetry in the upper extremities. As the dissecting aneurysm spreads to the descending and abdominal aorta, symptoms of compression of its visceral branches, as well as signs of arterial insufficiency of the lower extremities, appear. The final outcome of the disease is a rupture of the aortic wall, accompanied by massive bleeding into the pleural cavity or pericardial cavity with a fatal outcome.

The period of dissection can be acute (up to 48 hours), acute (up to 2-4 weeks) or chronic (up to several months). Up to 45% of patients die within the first 2 days.

In the diagnosis of dissecting aneurysms, X-ray and ultrasound examination methods, computed tomography and aortography are used. X-ray examination reveals an expansion of the mediastinal shadow, aorta, and sometimes the presence of hemothorax. Echocardiography makes it possible to detect an increase in the size of the ascending aorta, dissection of the aortic root wall, and aortic valve insufficiency. Using ultrasound and computed tomography for a dissecting aneurysm, it is possible to register two lumens and two contours of the aortic wall (Fig. 18.19), determine its extent, as well as a breakthrough into the pleural or pericardial cavity. The main angiographic feature of a dissecting aneurysm is a double aortic contour.

Early signs of aortic aneurysm dissection

In the initial period of dissection of an aortic aneurysm, a tear occurs in the inner and sometimes its middle membrane while maintaining the integrity of the outer membrane of the aorta. Subsequently, the blood penetrating under high pressure dissects the entire wall of the aorta and breaks through the outer membrane, which leads to the instant death of the patient from massive internal bleeding. In other cases, the spread of dissection is more often distal, less often proximal, which leads to hemopericardium, aortic valve rupture, severe aortic insufficiency, and occlusion of the coronary arteries. Dissection may result in re-rupture of the inner lining of the aorta below the site of initial dissection. A so-called double-barreled shotgun is formed; however, such successful cases of self-healing are extremely rare.

Dissection of an aortic aneurysm begins acutely, and the rate of development is rapid. The main symptom of a dissecting aortic aneurysm is severe chest pain, often of a tearing or cutting nature. The pain can be localized in the precordial region or in the interscapular space, radiates to the back and often spreads to the epigastric region. The patient is excited, rushing about, unable to find a place to rest due to pain.

After the first attack of an aortic aneurysm, short-term relief may occur, followed by a new attack of the same pain. The alternation of painful attacks and light intervals is due to the fact that dissection of the aortic wall sometimes occurs in several stages. In addition, the involvement of new areas of the aortic wall in the process of dissection may change the place of greatest severity of pain; migration of pain from the site of the initial tear of the aorta along the course of dissection is a characteristic sign of this pathology. After an initial attack of chest pain, it can subsequently be localized mainly in the abdomen and lower back, which should be taken into account when diagnosing.

Late symptoms of dissecting aortic aneurysm

Often, immediately following the pain of a dissecting aortic aneurysm, a picture of severe collapse develops with a drop in pressure, threadlike pulse, and peripheral manifestations of vascular insufficiency; It is almost never possible to bring a patient out of collapse. In other cases, the first painful attack of an aortic aneurysm is accompanied by a sharp increase in blood pressure.

Due to impaired blood flow in the arteries extending from the aorta, significant asymmetry of pressure in the right and left arms may occur (ischemia of the limbs sometimes makes it impossible to determine blood pressure in one or both arms), symptoms of cerebrovascular accident (paraparesis, paraplegia), myocardial infarction, and frequent episodes of loss of consciousness . Involvement of the abdominal aorta in the process is usually accompanied by a symptom of circulatory disorders in the basin of the main mesenteric vessels with the addition of a picture of severe intestinal obstruction. With proximal dissection of an aortic aneurysm, in more than half of the cases, objective examination reveals aortic insufficiency. When a dissecting aneurysm ruptures into the pericardial cavity, pericardial tamponade and also rupture of the aorta into the left pleural cavity are possible.

From the moment of the initial rupture of the aortic aneurysm of the inner membrane to the final breakthrough of the outer membrane and the death of the patient, from several minutes to several days pass, during which sometimes short periods of relative well-being occur. Depending on how long ago the disease developed, acute (up to 2 weeks) and chronic (more than 2 weeks) dissection of the aortic aneurysm is distinguished.

There are three types of dissecting aneurysms:

• Type I - dissection of the ascending aorta with a tendency to spread to its remaining parts;
• Type II - dissection of the ascending aorta only;
• Type III - dissection of the descending aorta with the possibility of transition to its abdominal segment.

Instrumental methods for diagnosing the disease

A radiological sign of a thoracic aortic aneurysm is the presence of a homogeneous formation with smooth, clear contours, inseparable from the shadow of the aorta and pulsating synchronously with it. Aneurysms of the ascending and descending aorta are especially clearly visible in the second oblique projection when diagnosing an aortic aneurysm. X-ray examination can also detect displacement of the trachea, bronchi and esophagus by the aneurysm, contrasted with barium.

Computed tomography makes it possible to determine the location and size of aneurysms, the presence of thrombotic masses in the cavity of the aneurysmal sac (Fig. 18.17). Diagnosis of aortic aneurysm in the form of echocardiography makes it possible to identify aneurysms of the ascending section and aortic arch. In recent years, ultrasound using a transesophageal probe has often been used to diagnose thoracic aortic aneurysms.

In the diagnosis of aneurysms, Seldinger angiography is more often used, which is advisable to perform in two projections with the introduction of a contrast agent into the ascending aorta. The diagnosis can be confirmed by CT and MP angiography. Differential diagnosis should be made with tumors of the lungs and mediastinum.

Diagnosis of symptoms of dissecting aortic aneurysm

The diagnosis of dissecting aortic aneurysm is made based on the clinical picture, taking into account:

discrepancy between the severity of pain and the absence of ECG changes characteristic of myocardial infarction,

migration of pain localization as aortic dissection spreads (in particular, pain spreads to the lower abdomen and legs),

disturbances in arterial pulsation,

signs of increasing anemia.

Sometimes X-ray signs of dissection of the aortic aneurysm help make the correct diagnosis: in half of the cases, expansion of the mediastinum is detected - to the right when the ascending aortic arch is dissected and to the left when the descending part of the thoracic aortic arch is affected. A visible expansion of the aortic shadow over calcium deposits in the aortic wall by 4-5 mm can be determined; limited protrusion of the aortic arch; effusion in the pleural cavity (usually on the left).

The diagnosis of dissecting aortic aneurysm can be confirmed by ultrasound and verified by aortography in a specialized institution (mandatory before surgical treatment).

Differential diagnosis. Dissecting aortic aneurysm is usually differentiated from myocardial infarction, which presents significant difficulties due to the similarity of pain and symptoms of both diseases in general, especially in the initial period of the disease. According to many studies, the correct diagnosis is made only in half of the cases. In contrast to the most acute stage of myocardial infarction, anticoagulants and thrombolytics are contraindicated in dissecting aortic aneurysm.

Features of treatment of aortic aneurysm

A patient with suspected dissecting aortic aneurysm is subject to urgent hospitalization, subject to absolute rest during transportation. Emergency care for an aortic aneurysm consists of creating absolute rest and relieving pain by administering 1-2 ml of a 1% Morphine solution subcutaneously or intravenously. To correct high blood pressure in case of suspected aortic aneurysm dissection at the prehospital stage, calcium antagonists can be used - Verapamil intravenously at a dose of 0.05 mg/kg or Nifedipine sublingually every 2-4 hours.

Surgical removal of an aneurysm

As a rule, aneurysm resection is performed with aortic replacement. In recent years, closed endoluminal endoprosthesis replacement of aneurysms has begun to be used with a special endoprosthesis, which is inserted into the lumen of the aneurysm using a special guide and fixed above and below the aneurysmal sac with hooks located at the ends of the prosthesis. The greatest technical difficulties are presented by surgical interventions for aneurysms of the aortic arch, when reconstruction of the brachiocephalic arteries is simultaneously performed.

After diagnosing a thoracic aortic aneurysm, the prognosis is unfavorable. Most patients die within 2-3 years from aneurysm ruptures or heart failure.

Treatment of dissecting aortic aneurysm

In cases of dissecting aortic aneurysm, emergency aortic replacement is successfully performed, which makes early diagnosis of aortic aneurysm symptoms especially important. In the intensive care unit, emergency correction of arterial hypertension is carried out (for this purpose, combination therapy with the myotropic vasodilator sodium nitroprusside and the beta-blocker obzidan is used intravenously), and an examination is performed to verify the diagnosis (chest x-ray, ultrasound).

After this, in the treatment of aortic aneurysm, consultation with a vascular surgeon is indicated to decide on the need and scope of surgical treatment. Calcium antagonists and beta-blockers are used as maintenance antihypertensive therapy. In the case of chronic aortic aneurysm, in order to maintain systolic blood pressure at a level of no more than mm Hg. Art. Beta blockers and calcium antagonists are also used, and diuretics are added to therapy for fluid retention.

Conservative treatment of dissecting aortic aneurysm

In the acute period, conservative treatment aimed at relieving pain and lowering blood pressure is possible. In some cases, this makes it possible to transform an acute dissection into a chronic one and carry out surgical treatment in more favorable conditions. However, the progression of dissection, the development of acute aortic insufficiency, compression of vital branches of the aorta, the threat of rupture or rupture of the aneurysm are indications for emergency surgery. Depending on the size of the aneurysm, some patients undergo resection, suturing of the dissected aortic wall, followed by end-to-end anastomosis, while others undergo resection with aortic replacement. In case of aortic valve insufficiency, the operation is supplemented with its replacement.

Causes of aortic aneurysm

The development of aneurysms is caused by:

• congenital diseases (coarctation of the aorta, Marfan syndrome, congenital tortuosity of the aortic arch),
• and acquired (atherosclerosis, syphilis, Takayasu syndrome, rheumatism),
• as well as chest injuries.

Aneurysms can also occur in the area of ​​the vascular suture after aortic surgery; it is necessary to monitor alarming symptoms. The arteriovenous type of aneurysm most often has a traumatic origin and is formed as a result of simultaneous damage to an artery and vein.

Causes of dissecting aortic aneurysm

A disease such as dissecting aortic aneurysm most often occurs in elderly men with a history of atherosclerosis and hypertension. Less commonly, symptoms of dissecting aortic aneurysm are diagnosed in combination with syphilitic aortitis. Marfan syndrome and congenital aortic valve defects are also risk factors for dissecting aortic aneurysm.

Dissecting aneurysms of the thoracic aorta account for 20% of aneurysms in this segment and 6% of all aortic aneurysms, and are characterized by intimal tearing and dissection of the aortic wall by blood flow penetrating between the intima and the muscular layer. The process of formation of a dissecting aneurysm begins with a tear and detachment of the intima (fenestration), as a result of which, under the influence of high blood pressure, a false lumen is formed between the intima and the altered muscular layer - an additional channel in the aortic wall. The most common cause of the development of dissecting aneurysms is atherosclerotic damage to the aortic wall in the presence of concomitant arterial hypertension. Other causes may be Marfan syndrome, idiopathic Erdheim's medial necrosis.

Cerebral aneurysm is a ticking time bomb

As children, we often played war games. I remember how they made a “bomb” - they poured water into a plastic bag, tied it and threw it into the “enemy camp”. When the bag came into contact with anything, it would burst and water would fly in all directions...

This is approximately how a cerebral aneurysm works—a time bomb. It’s like that bag filled with water, only the consequences are much sadder. The walls of the blood vessels or heart become thinner and bulge, and the resulting sac fills with blood. The lump puts pressure on nerve endings or surrounding brain tissue, causing a dull pain. But the greatest danger is the rupture of an aneurysm. Any awkward movement can activate this time bomb and lead to death. Such prominent figures as Charles de Gaulle, Albert Einstein, Andrei Mironov and Yevgeny Belousov died from aneurysm.

Why does this disease occur and how to fight it?

Disease throws up a red flag

The cause of a cerebral aneurysm may be a congenital pathology of blood vessels, connective tissue or circulatory disorders, such as a pathological plexus of veins and arteries of the brain, affecting blood circulation in the body. The disease can develop as a result of previous injuries and even bruises, high blood pressure, atherosclerosis, smoking and drug use. Some scientists suggest that the cause of the disease may also be the use of hormonal contraceptives.

Diagnosing an aneurysm is quite difficult - symptoms may not appear throughout life. IN in rare cases severe headache occurs in the fronto-orbital region.

A sharp increase in blood pressure, heavy physical activity and stress can provoke aneurysm rupture. Most often this happens spontaneously. When hemorrhage into the subarachnoid space occurs, a sudden and very severe headache, light immunity, nausea, vomiting, and loss of consciousness occur. In the case of hemorrhage in the brain, a hematoma is formed and, as a result, blurred vision, squint, immobility of the eyes, slurred, inarticulate speech, insensitivity to other people's speech, convulsions, complete or partial loss of consciousness.

Distinguishing the “enemy”: forms of cerebral aneurysm

Based on anatomical characteristics, the disease is divided into saccular (the artery wall stretches in the form of a bag) and fusiform (in a limited area of ​​the vessel wall an expansion in the form of a spindle is formed).

According to the location, a cerebral aneurysm can be superficial - on the convex surface of the brain, and deep - located directly inside the substance of the brain.

An aneurysm can reach 60 mm in diameter.

How to diagnose cerebral aneurysm at an early stage?

Complaints about headache, blurred vision and speech, unresponsiveness to speech addressed to the patient, partial paralysis are clear signs of a developing aneurysm. In such cases, you can perform a computer or magnetic resonance imaging of the brain with a vascular program, which allows you to examine the structure of the brain and identify cerebral aneurysms at an early stage.

Also, to diagnose the disease, the patient is injected with a special substance, which is visible on X-ray images.

Consultation with a therapist is required.

Treatment of cerebral aneurysm

Unfortunately, it is impossible to prevent the disease, but if you keep an eye on it blood pressure and blood cholesterol levels, eliminate the use of drugs, tobacco and fatty foods, then the risk of disease is sharply reduced.

Treatment of an aneurysm is highly individual and depends on its type, size and location. The likelihood of a rupture and a person's age can also have a big impact.

Removal of a cerebral aneurysm occurs surgically - using aneurysm clipping, occlusion or endovascular embolization. Last method used more than once during a person's life.

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- This is an abnormal expansion of a certain part of the vessel, which leads to the appearance of a small cavity and the accumulation of blood in it. This type of aneurysm is also called a cerebral aneurysm. The causes include congenital deformation of blood vessels, past illnesses brain and various head injuries.

According to statistics, the disease occurs more often in women than in men.

Factors that provoke the onset of the disease include:

• bad habits,
• taking medications,
• ecology,
• heredity,
• constant stressful situations.

Among the genetic factors that can cause the disease are:

• kidney diseases,
• connective tissue pathology,
• circulatory disorders.

Symptoms of cerebral aneurysm

Symptoms of a cerebral aneurysm depend on its location and the occurrence of complications. The most dangerous complication, which may be incompatible with the patient’s life, is aneurysm rupture and bleeding.

In this regard, the signs are not always clearly expressed, which makes early diagnosis of the disease and timely therapy difficult. Moreover, up to a certain point, a brain aneurysm can be asymptomatic and not bother a person.

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The most common symptoms of the disease are headaches, which many patients mistake for a manifestation of migraine. If the condition worsens due to an increase in the size of the aneurysm and compression of the brain, symptoms such as vomiting, nausea, increased intracranial pressure, and loss of coordination and movement may occur.

Then symptoms of visual impairment, convulsions, epileptic seizures, impaired sense of smell, photophobia. In cases where an aneurysm ruptures, it may be coma, often leading to the death of the patient.

Therefore, if you experience unbearable headaches that do not go away after taking medications, you need to consult a specialist and undergo a medical examination. As a rule, if the aneurysm was asymptomatic, and severe headaches suddenly appear, they are considered a harbinger of vascular rupture, and the type of pain is called cephalgia.

Symptoms may appear suddenly and gradually intensify, but in any case, you must remember that if any incomprehensible symptoms appear, you should consult a doctor as soon as possible and go to the hospital, since in most clinical cases, cerebral artery ruptures lead to death.

Diagnosis of cerebral aneurysm

Currently, there are several very accurate and reliable diagnostic methods that can be indispensable for early diagnosis. In its turn, early diagnosis can sometimes save the patient’s life, since the operation is widely used and gives good results.

What diagnostic methods can detect cerebral aneurysm:

1. - this is done using x-rays and contrast agents. This diagnostic method is widely used in modern medicine and can determine the degree of narrowing or widening of the arteries of the brain and neck. The method is used for cerebrovascular accidents, various brain tumors, and also in case of hemorrhage in the brain.
2. CT (computed tomography) of the head is a non-invasive diagnostic method that allows you to determine the rupture of an aneurysm, which is used immediately if the doctor suspects the possibility of a cerebral artery rupture. If contrast agents are used in CT, this method is called CT angiography.
3. MRI (magnetic resonance imaging) is a harmless diagnostic method, since the diagnosis uses a magnetic field and radio waves of various frequencies. If CT provides a two-dimensional image of the skull and blood vessels, then with MRI it is possible to obtain layer-by-layer three-dimensional images, allowing one to examine all the details of the vascular aneurysm.
4. Cerebrospinal fluid analysis - performed if a cerebral artery rupture is suspected.

Treatment of cerebral aneurysm

If, after all the studies, a patient is found to have a cerebral aneurysm, this does not mean that he is guaranteed a rupture of the vessel. As a rule, the clinic depends on the size of the aneurysm. If it is small in size, it will be enough for such a patient to be under the supervision of a neurologist or angiologist, as well as periodically undergo outpatient examinations.

The likelihood of rupture depends on gender, age, profession and location of the aneurysm. The older a person is and his activities involve heavy physical activity, the more likely it is to rupture.

Treatment of cerebral aneurysm is mainly surgical, but recently endovascular embolization has been used, which is a good alternative method for treating unruptured aneurysm. In this case, the treatment consists of filling the aneurysm with a platinum thread to completely destroy the pathology of the vessel.

Among the surgical operations, the clipping method is used, in which a titanium clip is placed on the neck of the aneurysm. This clip subsequently disrupts blood flow to the aneurysm.

These treatment methods are quite risky and complex, since damage to other brain vessels may occur during the operation. There is no prevention for aneurysm, and with such a diagnosis, the best prevention is a healthy lifestyle.