CEREBRAL
ANEURYSM
By: Srinivasa Murthy Manohar
Group 1903
BLOOD SUPPLY OF BRAIN:
• The brain receives its blood supply primarily
through two major arterial systems: the internal
carotid arteries and the vertebral arteries.
• These arteries form the Circle of Willis, a critical
structure that provides collateral circulation to the
brain.
Internal Carotid Arteries:
• These arise from the common carotid arteries and
supply the anterior and middle parts of the brain.
Vertebral artery:
• The vertebral artery originates from the first part of
the subclavian artery
• Paired vertebral arteries provide blood supply for
the upper part of the spinal cord, brainstem,
cerebellum, and posterior part of the brain.
Circle of Willis:
• The circle of Willis is an anastomotic arterial ring
located at the base of the brain.
• It provides a connection between the four main
arteries that supply the brain two vertebral and two
internal carotid arteries.
Branches :
• Anterior communicating artery – a short vessel
which connects the two anterior cerebral arteries.
• Anterior cerebral arteries – branches of the
internal carotid artery.
• Internal carotid arteries – continues after the
contributing to the circle of Willis as the middle
cerebral artery.
• Posterior communicating arteries – connects the
internal carotid and posterior cerebral arteries
• Posterior cerebral arteries – terminal branches of
the basilar artery (which is formed by the union of
the vertebral arteries)
Aneurysm:
• A brain aneurysm also called a cerebral
aneurysm or an intracranial aneurysm is a
ballooning arising from a weakened area in
the wall of a blood vessel in the brain.
• If the brain aneurysm expands and the
blood vessel wall becomes too thin, the
aneurysm will rupture and bleed into the
space around the brain.
• This event is called a subarachnoid
hemorrhage (SAH) and may cause a
hemorrhagic stroke.
Risk factors:
Modifiable risk factors Non modifiable risk factors
• Smoking • Age
• Hypertension • Female gender
• Heavy drinking • Genetics
• OCP • Collagen vascular disease
• Atherosclerosis • AVMs
• Caffine • Hereditary hemorrhagic
telangiectasia
• Fibromuscular dysplasia
Pathophysiology:
• The pathophysiology involves a combination of structural weakness in the
vessel wall and hemodynamic stress, leading to the formation and potential
rupture of the aneurysm.
Vessel Wall Abnormalities:
• Degeneration
• Loss of elastin
• Endothelial dysfunction
Hemodynamic Stress:
Increased pressure: Chronic high blood pressure (hypertension)
increases the force against the vessel walls, promoting dilation
and the formation of an aneurysm.
• Turbulent blood flow: Certain locations in the circulatory
system, such as arterial bifurcations , are prone to turbulent
flow, which stresses the vessel wall, leading to the development
of aneurysms.
Aneurysm Formation and Growth:
• As the vessel wall weakens, it bulges outward to form an
aneurysm. The size of the aneurysm may grow over time, and
the wall may continue to thin.
• Aneurysms often grow slowly but can rupture suddenly under
increased pressure, causing subarachnoid hemorrhage (SAH).
Location of cerebral aneurysm:
There are six common locations of brain
aneurysms that may be the cause of a
subarachnoid hemorrhage:
[Link] communicating artery (ACoA)
[Link] communicating artery (PCoA)
[Link] artery
[Link] inferior cerebellar artery (PICA)
• [Link] cerebral artery (MCA)
RUPTURED ANEURYSM UNRUPTURED ANEURYSM
• A sudden, severe headache is the key symptom of • An unruptured brain aneurysm may not have
a ruptured aneurysm. any symptoms, especially if it’s small.
• This headache is often described by people as the • However, a larger unruptured aneurysm may
worst headache they’ve ever experienced compress on brain tissues and nerves.
SYMPTOMS: SYMPTOMS:
• Nausea and vomiting • Pain
• Stiff neck • Dilated pupil
• Blurred or double vision • Change in vision or double vision
• Sensitivity to light • Numbness of one side of the face
• Seizure • Photophobia
• Drooping eyelid • Nuchal rigidity
• Loss of consciousness
• Confusion
Diagnosis:
• The first diagnostic test is non contrast CT.
• CT SCAN: CT scans used to detect
abnormalities and help identify the location
of the aneurysm and if it has ruptured or is
it leaking.
• A CT angiogram can also be obtained on a
CT scan to look at the vessels.
• Cerebral angiography. This provides an
image of the blood vessels in the brain to
detect a problem with vessels and blood
flow.
MRI:MRI uses magnetic fields to detect small
changes in brain tissue that help to locate and
diagnose an aneurysm.
MR angiogram
• Gold standard technique for the detection of cerebral aneurysms is
considered to be digital subtraction angiography (DSA) offering both
dynamic and morphological information on the intracranial
circulation.
• However, DSA is relatively expensive and not widely available.
Drug therapy:
The following drugs are usually ordered for the patient with an
aneurysm rupture:
• Anticonvulsants given as prophylaxis against seizures , phenytoin is
the usual agent used.
• Analgesics are administered as necessary to control headache.
• Sedatives is prescribed because an agitated patient is at risk for
elevated blood pressure.
• Heparin given to prevent emboli.
• Replacement of minerals such as potassium, magnesium, calcium and
phosphorus if it is necessary (based on laboratory testing)
Surgical intervention:
Microsurgical Clipping:
This procedure is performed through a craniotomy, where
a portion of the skull is temporarily removed to access the
brain.
Indications:
Suitable for accessible aneurysms, especially those with a
narrow neck.
• Often chosen for younger patients or aneurysms with
specific shapes or locations.
Advantages:
• Provides a durable solution with low recurrence rates.
Risks:
• Involves invasive brain surgery, with risks of infection,
stroke, or neurological damage.
Endovascular Coiling:
This is a less invasive procedure that uses a catheter inserted
through the femoral artery to reach the aneurysm.
• It is particularly effective for certain aneurysm shapes and
locations.
Indications:
Often preferred for older patients or aneurysms in less
accessible areas.
• Best for aneurysms with a wide neck or irregular shape.
Advantages:
Minimally invasive, with a shorter recovery time.
• Lower immediate surgical risks compared to clipping.
Risks:
Recurrence of the aneurysm is more likely than with clipping.
• Potential complications include artery damage.
Postoperative Care:
• Neurological assessments to monitor brain function.
• Imaging studies to confirm aneurysm repair and check for recurrence.
• Lifestyle changes and medications for managing blood pressure to
reduce the risk of future aneurysms.
Thank you
