Aneurysms are focal dilatation in the walls of arteries. Rupture of the cerebral aneurysm produces sub arachnoid hemorrhage (SAH) or intra cerebral hematoma which are neurosurgical emergencies.
Causes of intra cranial aneurysms:
- Hemodynamic induced degeneration of arterial wall
- Structural defects in arterial wall
- tumor associated
- radiation induced
The cardinal diagnostic feature remains a headache –severe, sudden onset. The other signs & symptoms are neck stiffness, nausea & vomiting,seizures,impairment of ocular movementsor sudden onset coma.
The importance of investigating with CT brain for SAH is from the observation that the highest rate of mortality occurs immediately following the hemorrhage & the mortality over the first week to 27%. Rebleeding occurs in 50 % of ruptured aneurysm within 6 months of the first hemorrhage & thereafter at a rate of 3% per year.
Neurological complication of aneurysmal rupture are raised intra cranial pressure, spasm of intra cranial arteries, hydrocephalus, seizure.
CT brain with CT Angiogram is a non invasive method of imaging the cerebral arteries.
DSA-digital subtraction angiography is a catheter based study which delineates the cerebral vascular anatomy in greater detail.
Microsurgery- involves a craniotomy & opening of skull, dissecting to the aneurysm & placing a titanium clip across the base of aneurysm thus obliterating it from the circulation.
Endovascular- done by a neuro interventional radiologist or surgeon, involves passing a catheter upto the aneurysm & filling it up with coils to obliterate it.
Apollo hospital brain & spine centre Bangalore has the infrastructure & trained man power of experienced neurosurgeons, neuro anesthetists, intensivist & interventional neuro radiologist to handle emergencies like aneurysm rupture.