Cerebral aneurysm
INTRODUCTION
• Aneurism is a bulging,
ballooning or dilation at
a weakened point of an
artery.
• Occur in any artery
common are
Aortic aneurism
Abdominal aorta
Carotid artery aneurism
Sites of Aneurysm Formation
• The most common sites of Cerebral
aneurysm are:
The Circle of Willis
Branch Bifurcations
Common sites of intracranial aneurysms and an
arteriovenous malformation
Sites of Aneurysm Formation
Anatomical distribution and relative incidence of Intracranial Aneurysms .
Cerebral aneurysm
• Intracranial aneurysm
• Brain aneurysm
• Cerebrovascular disorder in which
weakness in the wall of a cerebral artery or
vein causes a localized dilation or
ballooning of the blood vessel.
Risk factors
• Family history
• Previous aneurysm
• Gender - Female sex
• Hypertension
• Atherosclerosis
• Older age
• Use of oral contraceptives
• Analgesic use
Classification
• Extradural aneurysms
Occur outside of the dura mater
Less likely to cause subarachnoid
hemorrhage.
Intraduarl aneurysm
Fusiform - (Associated with tortuosity,
hypertension, atherosclerosis and advancing age)
Mycotic and Inflammatory – (Caused by
bacteria)
Oncotic – (Caused by metastasis)
Dissecting – (Caused by a disruption in the
vessel walls)
Saccular (Berry) – (Develop over time and
resemble a “berry”)
DeNovo – (Caused by carotid occlusion or
ligation)
Fusiform aneurysms
Represent a widening of a
segment of an artery around
the entire blood vessel, rather
than just arising from a side
of an artery's wall.
They can rupture but usually
do not.
• Saccular aneurysms
Berry aneurysms
Appear as a round out
pouching and are the
most common form of
cerebral aneurysm
• Giant aneurysms are defined as aneurysms
that are 25 mm or larger in size.
• Microaneurysms
Charcot-Bouchard aneurysms
typically occur in small blood vessels (less than 300
micrometre diameter)
associated with chronic hypertension
common cause of intracranial haemorrhage.
• True Aneurysms are when the intima, media and advential
layers are all intact.
• False (Pseudoaneurysms) occur when the layers or wall
has been perforated and the rupture is contained by an
extraluminal hematoma.
Causes of Pseudoaneurysm
Trauma
Dissection
Surgical or Endovascular Interventional Injury
Biopsy
Adjacent Infection
Clinical features
Ruptured aneurysm
Severe headaches – Acute onset of an excruciating
headache, with or without loss of consciousness
Different from past headaches.
Localized and intense
Vomiting
Blurred vision
Changes in speech
Stiff neck or neck pain
Clinical features(CONT.. )
Pain above and behind eye
Dilated pupils
Sensitivity to light
Loss of sensation
Seizures.
Clinical features( CONT..
• Vasospasm – 4-14 days after hemorrhage
• Middle cerebral artery produces contra
lateral hemiparesis and dysphasia
• ACA – bilateral leg weakness, and
incontinence
• PCA –hemianopia
• Basilar and cerebral arteries - focal brain
stem ischemia .
Clinical features
unruptured brain aneurysm
may produce no symptoms,
Pain above and behind an eye
Dilated pupil
Change in vision or double vision
Numbness, weakness or paralysis of one side of
the face
Drooping eyelid
Clinical features
• Leaking' aneurysm
In some cases, an aneurysm may leak a slight
amount of blood. May cause :
Sudden, extremely severe headache
A more severe rupture almost always follows
leaking.
Intnsive care
Quiet, dimly lit room
Sedation and headache management
Stool softeners
Steroids
Closely monitor cardiac and respiratory function
Restore deteriorating respiration
Reduce intracranial pressure
Prevent rebleeding
Prevent vasospasm
Liberal isotonic fluids are used
GCS
Maintain patent airway with Po2> 85 mm of Hg and PCo2 between 25-35 mm of
Hg
Continuous hemodynamic monitoring
Surgical management
• Surgical clipping
Clipping the base of the
aneurysm with a specially-
designed clip to isolate it
from normal blood circulation.
This decreases the pressure
on the aneurysm and
prevents it from rupturing.
Surgical management
• Endovascularcoiling
Refers to the insertion
of platinum coils into
the aneurysm
Complication
Rebleeding
Hydrocephalus
Intraventricular haemorrhage
Increased intracranial pressure
Intracerebral hemorrhage
Seizures
Cerebral vasospasm
Respiratory complication
Cardiovascular complication
Fluid and electrolyte disturbance
Gastrointestinal complication
Care after coiling
Admitted in the ICU
Heparin administered 12 – 24 hours after
the procedure
Assess puncture site for bleeding or
hematoma
Check peripheral pulses
Complications
Rupture can occur during coiling
Ischemic stroke
Nursing Diagnosis
• Altered neurological function related to
haemorrhage from cerebral aneurysm.
• Pain due to cerebral haemorrhage.
• Sensory input distortion related to meningeal
irritation.
• Potential for seizure related to cerebral
irritation.
• Potential for neurological deterioration related
to rebleeding or cerebral vasospasm.
