Cerebral Aneurysm

Cerebral aneurysm Junchen zhang

Who is he ？ 

Bruce Lee is Hong Kong kungfu star. He was borned in San Francisco in November 1940 .His first film was called The birth of Mankind, his last film which was uncompleted at the time of his death in 1973 was called Game of Death( 死亡游戏） .

What's your choice on his death?

A B C D

murder 谋杀 myocardial infarction 心肌梗塞 allergy 过敏 aneurysm 动脉瘤

There’s various of guesses at that moment. What about your guess?

What is

aneurysm ？

A cerebral aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery causes a localized dilation or ballooning of the blood vessel.



A common location of cerebral aneurysms is on the arteries at the base of the brain, known as the Circle of Willis. Approximately 85% of cerebral aneurysms develop in the anterior part of the Circle of Willis,



Circle of Willis

Symptoms

1 symptoms of ruptured aneurysm

1.1 a subarachnoid hemorrhage (SAH) 

The risk of rupture varies according to the size of aneurysm, with the risk rising as the aneurysm size increases.

 Onset is usually sudden and

without warning. the rupture resulting from tiredness, agitation in most patients



When a large aneurysm ruptures, the individual may experience such symptoms as a sudden and severe headache, nausea, vomiting, and coma

1.2 vasospasm 

One complication of aneurysmal subarachnoid hemorrhage is the development of vasospasm.



The etiology of vasospasm is thought to be secondary to an inflammatory process that occurs as the blood in the subarachnoid space is resorbed.

Normal cerebral artery



spasm of the cerebral artery

Approximately 1 to 2 weeks following the initial hemorrhage, patients may experience 'spasm' of the cerebral arteries, which can result in stroke.

1.3 Rebleeding 

The risk of short term re-rupture increases dramatically after an aneurysm has bled, though after approximately 6 weeks the risk returns to baseline

2

symptoms of unruptured aneurysm

A small, unchanging aneurysm will produce little symptoms.

Bruce Lee 

Experience Sudden and severe headache ,nausea, coma,and treatment is not impossible ,

Cause

可能病因 







动脉壁先天缺陷学说 --- 动脉壁先天性平滑肌层缺乏 动脉壁后天性退变学说 --- 动脉粥样硬化和高血压造成内弹力板破坏 感染性 --- 感染性栓子脱落 外伤性

病理和分类

病

理

  肉眼： 　　　－－多位于动脉环分叉之处， 　　　－－大多数呈囊状、球形， 　　　－－分瘤颈、瘤体、瘤顶， 　　　－－瘤顶极薄 --- 破口处 



光镜： --- 瘤壁缺乏中层平滑肌， --- 弹性纤维断裂或消失 --- 瘤壁内有炎细胞浸润

诊

断

1 　确定有无蛛网膜下腔出血 



颅脑 CT 安全迅速可靠，阳性率极高 腰 穿 可诱发动脉瘤破裂出血

2 　筛选动脉瘤－ CT/MRI 造 影



可提示大型或巨大型的动脉瘤，常用于 颅内动脉瘤的筛选。

3 　明确动脉瘤－脑血管造影 

脑血管造影是确诊动脉瘤的必查手段，是“金 标准”



可明确动脉瘤的位置，形态，内径，数目， 供 血及载瘤动脉情况

前交通动脉瘤

后交通动脉瘤

Hunt-Hess 分级 　  评分 　　　  描述    0  　　 动脉瘤未破裂    1   　　无症状，或轻度头痛，轻度颈项强 直    2   　　头痛重，颈项强直，或动眼神经麻痹 　 　   3   　　嗜睡或混乱，轻度定向障碍    4   　　昏迷，中等至重度偏瘫    5   　　深昏迷，去脑强直，垂死表现

鉴别诊断 动脉瘤

动静脉畸形

高血压脑出血

发病年龄

40~60 岁

35 岁以下

出血前症状

无症状，少数动眼神 经麻痹

癫痫发作

头痛

血压

正常或增高

正常

高

脑神经麻痹

Ⅱ~Ⅵ 颅神经

无

无

偏瘫

少见

较常见

多见

CT 检查

SAH

可见 AVM 影

基底节区血肿

脑血管造影

动脉瘤和血管痉挛

AVM

无异常

治

疗

外科治疗  

是唯一的治疗方法 原则：诊断明确，尽早手术， 术前术中 避免再出血

外科治疗的手术时机　 －－ Hunt 1 、 2 级病人早期手术 －－ Hunt 3 级以上病情稳定后再手术

3 ）加固术

　　－－采用肌片，生物胶加固动 脉瘤 壁的方法 －－ 不肯定，少用

4 ）孤立术 　　　－－如动脉瘤基底过大或呈梭形， 无法夹闭，其侧支循环良好者，可将载 瘤动脉结扎，行动脉瘤孤立术 　　

围手术期处理    

避免再出血 和严重的脑 血管痉挛 绝对卧床休息 镇静 抗纤溶药物的应用 钙离子拮抗剂的应用