Brain Aneurysm - OOKINFO
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6/17/2019

Brain Aneurysm

Brain aneurysms are enlargement of blood vessels in the brain due to weak blood vessel walls. When blood flow presses against the walls of blood vessels, blood vessels will bulge like a balloon. This condition can develop very seriously when a brain aneurysm ruptures and subarachnoid hemorrhage occurs.
 
Brain aneurysm is a serious disease because it can cause brain damage or even death. Anyone can experience brain aneurysms. However, this condition generally affects women over the age of 40 years.


Symptoms of Brain Aneurysm

Symptoms of brain aneurysm in each sufferer vary, depending on the severity. In cases of brain aneurysms that have not ruptured, new symptoms are shown when the aneurysm is so large that it suppresses the tissues or nerves in the brain. There are also symptoms such as :

  • Dizzy.
  • Pain around the eyes.
  • Talking difficult
  • Balance is disturbed.
  • Difficulty concentrating or having short memory.
  • Paralysis on one side of the face.
  • Visual impairment.
  • Eyelid drops.

In some cases, brain aneurysms can cause blood leakage . This condition is indicated by severe dizziness and sudden symptoms. Leaking blood is a sign that the risk of aneurysm ruptures is getting higher.
When the brain aneurysm has ruptured , the symptoms that appear can be :

  • Nausea and vomiting.
  • The neck becomes stiff
  • Vision becomes blurred or has double vision.
  • Seizures.
  • Severe headache.
  • Loss of consciousness.
  • Sensitive to light.
  • Paralyzed or weak on one side of the body or legs.
 

Causes of Brain Aneurysms


Brain aneurysms occur when blood vessel walls are weakened or thinned. The blood needed by the brain is channeled through four blood vessels through the neck to reach the brain. Aneurysms often occur in weak branches of blood vessels.
 
The exact cause behind the weakening of the blood vessel wall has not been confirmed. However, several factors are thought to be able to weaken the walls of blood vessels and trigger brain aneurysms. These factors include :

  • High blood pressure. This condition increases the pressure on the walls of blood vessels so that it triggers brain aneurysms. High blood pressure is vulnerable to people who are obese or consume too much salt, caffeine, and alcohol.
  • Age over 40 years. Brain aneurysms are more common in people over 40 years old. This is due to the condition of the blood vessel wall that weakens over time due to blood pressure passing through the wall.
  • Female sex. Most people with brain aneurysms are women. This is thought to be related to the decrease in the hormone estrogen which maintains the elasticity of blood vessels. This decrease usually occurs after menopause .
  • Head injury. Although rare, severe brain injury can increase the risk of brain aneurysms.
  • Alcohol consumption and drug abuse ( especially cocaine) .
  • Non-innate medical conditions , such as certain blood infections, arteriosclerosis (hardening of the arteries), and decreased estrogen hormone levels after menopause.
  • Congenital medical conditions, such as polycystic kidney disease , coarctation of the aorta, arteriovenous malformations, and disorders of body tissues (for example in the case of Ehlers-Danlos syndrome and Marfan syndrome ).
  • History of brain aneurysms in the family.
 

Diagnosis of Brain Aneurysms


The diagnosis of brain aneurysm can be ascertained through a physical examination and several supporting tests. These supporting tests include :

  • Scanning The methods used include CT scans combined with angiography (abbreviated as CTA) and MRI combined with angiography (abbreviated as MRA). CTA is done by doctors to ensure that blood vessels have been torn and bleeding in the brain. While the examination with the MRA is to see other blood vessels that are still intact.
  • Cerebrospinal fluid examination. Cerebrospinal fluid is fluid that surrounds the brain and spinal cord. The cerebrospinal fluid sample to be examined is taken with a lumbar puncture ( lumbar puncture ). This examination method is used if the CTA is unable to detect bleeding, but the symptoms present in the patient indicate this.
 

Treatment of Brain Aneurysms


Treatment of brain aneurysms aims to prevent aneurysm rupture, improve the patient's condition, and prevent complications.
 
Efforts to prevent aneurysm rupture require careful consideration based on age, family history, and the patient's medical condition, especially the location and size of the aneurysm, to determine the next action.
 
If the risk of a ruptured aneurysm is small, the doctor will only make regular observations. Patients will also be given blood pressure-lowering drugs, and are asked to change their diet and lifestyle, for example by quitting smoking, exercising regularly, limiting caffeine consumption, and avoiding strenuous activities.
 
Whereas in patients with a high risk of ruptured aneurysms, the doctor will recommend surgery. This procedure aims to prevent blood flow from entering the aneurysm. One type of surgery is a neurosurgical clipping operation. The aim is to close the aneurysm by using a metal clip in the blood vessel that feeds the blood on the aneurysm, so the aneurysm does not expand and break. This procedure will be preceded by general anesthesia.
 
Another method of operation is to put a coil in an aneurysm ( endovascular coiling ). This procedure begins with inserting a catheter hose from the artery in the thigh or groin to reach the location of the aneurysm. Furthermore, a platinum-based coil is inserted into the aneurysm. When blood flow cannot enter the aneurysm due to the presence of this coil, it is expected that aneurysm enlargement or rupture can be prevented. Installation of coils may need to be done repeatedly, but this procedure has a shorter recovery period compared to clamping.
 
For cases of ruptured aneurysms, emergency treatment needs to be done immediately. Doctors can give medications to relieve symptoms and deal with the risk of complications. The drugs given are :

  • Calcium canal inhibitors, which aim to prevent vasospasm which is a complication of brain aneurysms. The drug sample given is nimodipine.
  • Painkillers, such as paracetamol , to relieve dizziness.
  • Anticonvulsant drugs to relieve seizures due to ruptured aneurysms. Examples of these drugs are levetiracetam , phenytoin , and valproic acid .
  • Vasopressor drugs to prevent strokes due to lack of blood supply to the brain due to resistance to narrowed blood vessels. This class of drugs is usually given by intravenous injection.

Actions that can be taken to deal with ruptured brain aneurysms are by fitting a catheter hose and making a short channel ( ventricular or lumbar draining catheters and shunts ) to remove fluid from the brain and spine to reduce pressure on the brain .
 
Post-treatment of brain aneurysms, patients who experience subarachnoid hemorrhage are also recommended to undergo physiotherapy and speech therapy to restore the condition so that they can return to their activities.
 

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