A cerebral aneurysm or brain aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Cerebrovascular disease is damage to the blood vessels in the brain, resulting in a stroke. ... For other uses, see Brain (disambiguation). ... Section of an artery For other uses, see Artery (disambiguation). ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ...

Locations

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, and involve the internal carotid arteries and their major branches that supply the anterior and middle sections of the brain. The most common sites include the anterior communicating artery (30-35%), the bifurcation of the internal carotid and posterior communicating artery (30-35%), the bifurcation of the middle cerebral artery (20%), the bifurcation of the basilar artery, and the remaining posterior circulation arteries (5%). For other uses, see Brain (disambiguation). ... The circle of Willis (also called the cerebral arterial circle or arterial circle of Willis) is a circle of arteries that supply blood to the brain. ... Arteries of the neck. ... The arterial circle and arteries of the brain. ... In human anatomy, the carotid artery refers to a number of major arteries in the head and neck: Common carotid artery External carotid artery Internal carotid artery Category: ... The arterial circle and arteries of the brain. ... The middle cerebral artery (MCA) is one of the three major arteries that supplies blood to the brain. ... The basilar artery is one of the arteries which the brain supplies with oxygen-rich blood. ...

Causes

Aneurysms may result from congenital defects, preexisting conditions such as high blood pressure and atherosclerosis (the buildup of fatty deposits in the arteries), or head trauma. Cerebral aneurysms occur more commonly in adults than in children but they may occur at any age. They are slightly more common in women than in men. Post surgical photo of brain aneurysm survivor. ... A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... For other uses of the word head, see head (disambiguation). ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ...

The pursuit to identify Genetics of Intracranial Aneurysms has identified a number of locations, most recently 1p34-36, 2p14-15, 7q11, 11q25, and 19q13.1-13.3.

Classification

Cerebral aneurysms are classified both by size and shape. Small aneurysms have a diameter of less than 15mm. Larger aneurysms include those classified as large (15 to 25mm), giant (25 to 50mm), and super giant (over 50mm). Saccular aneurysms are those with a saccular outpouching and are the most common form of cerebral aneurysm. Berry aneurysms are saccular aneurysms with necks or stems resembling a berry. Fusiform aneurysms are aneurysms without stems.

Symptoms

A small, unchanging aneurysm will produce no symptoms. Before a larger aneurysm ruptures, the individual may experience such symptoms as a sudden and unusually severe headache, nausea, vision impairment, vomiting, and loss of consciousness, or the individual may be asymptomatic, experiencing no symptoms at all. Onset is usually sudden and without warning. Rupture of a cerebral aneurysm is dangerous and usually results in bleeding into the meninges or the brain itself, leading to a subarachnoid hemorrhage (SAH) or intracranial hematoma (ICH), either of which constitutes a stroke. Rebleeding, hydrocephalus (the excessive accumulation of cerebrospinal fluid), vasospasm (spasm, or narrowing, of the blood vessels), or multiple aneurysms may also occur. The risk of rupture from an unruptured cerebral aneurysm varies according to the size of an aneurysm, with the risk rising as the aneurysm size increases. The overall rate of aneurysm rupture is estimated at 1.3% per year. The risk of short term re-rupture increases dramatically after an aneurysm has bled, though after approximately 6 weeks the risk returns to baseline. For other uses, see Nausea (disambiguation). ... Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of ones stomach through the mouth and sometimes the nose. ... Consciousness is a quality of the mind generally regarded to comprise qualities such as subjectivity, self-awareness, sentience, sapience, and the ability to perceive the relationship between oneself and ones environment. ... The meninges (singular meninx) are the system of membranes that envelop the central nervous system. ... For other uses, see Brain (disambiguation). ... A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ... Hematoma on an elbow, nine days after a blood sample was taken Hematoma on a forearm, one day after repeated shocks A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage, or, more specifically, internal bleeding. ... For other uses, see Stroke (disambiguation). ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... Vasospasm refers to a condition in which blood vessels spasm, leading to constriction. ...

Classification of ruptured aneurysm severity

In outlining symptoms of ruptured cerebral aneurysm, it is useful to make use of the Hunt and Hess scale of subarachnoid hemorrhage severity: To meet Wikipedias quality standards and make it more accessible to a general audience, this article may require cleanup. ... To meet Wikipedias quality standards, this article or section may require cleanup. ...

• Grade 1: Asymptomatic; or minimal headache and slight nuchal rigidity. Approximate survival rate 70%.
• Grade 2: Moderate to severe headache; nuchal rigidity; no neurologic deficit except cranial nerve palsy. 60%.
• Grade 3: Drowsy; minimal neurologic deficit. 50%.
• Grade 4: Stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity and vegetative disturbances. 20%.
• Grade 5: Deep coma; decerebrate rigidity; moribund. 10%.

The Fisher Grade classifies the appearance of subarachnoid hemorrhage on CT scan: A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. ... Neurology is a branch of medicine dealing with disorders of the nervous system. ... Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... Palsy is a medical term derived from the word paralysis that is defined as paralysis of a body part often accompanied by loss of feeling and uncontrolled body movements such as shaking. ... Hemiparesis is the partial paralysis of one side of the body. ... A woman with malaria displaying decerebrate posturing, with arms extended at her sides. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ...

• Grade 1: No hemorrhage evident.
• Grade 2: Subarachnoid hemorrhage less than 1mm thick.
• Grade 3: Subarachnoid hemorrhage more than 1mm thick.
• Grade 4: Subarachnoid hemorrhage of any thickness with intra-ventricular hemorrhage (IVH) or parenchymal extension.

The Fisher Grade is most useful in communicating the description of SAH. It is less useful prognostically than the Hunt-Hess scale.

Vasospasm

One complication of aneurysmal subarachnoid hemorrhage is the development of vasospasm. Approximately 1 to 2 weeks following the initial hemorrhage, patients may experience 'spasm' of the cerebral arteries, which can result in stroke. The etiology of vasospasm is thought to be secondary to an inflammatory process that occurs as the blood in the subarachnoid space is resorbed. It appears that macrophages and neutrophils that enter the subarachnoid space to phagocytose senescent erythrocytes and clear extracorpuscular hemoglobin, remain trapped in the subarachnoid space, die and degranulate 3-4 days after their arrival, and release massive quantities of endothelins and free radicals that in turn induce vasospasm. ^[1]. Vascular narrowing, however, is only one component of the transient inflammatory injury, which is extensive. Vasospasm refers to a condition in which blood vessels spasm, leading to constriction. ...

Vasospasm is monitored in a variety of ways. Non-invasive methods include transcranial Doppler, which is a method of measuring the velocity of blood in the cerebral arteries using ultrasound. As the vessels narrow due to vasospasm, the velocity of blood increases. The amount of blood reaching the brain can also be measured by CT or MRI or nuclear perfusion scanning. Transcranial Doppler (TCD) is a test that measures the velocity of blood flow through the brains blood vessels. ... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... MRI Image Magnetic resonance imaging (MRI) is a method of creating images of the inside of opaque organs in living organisms as well as detecting the amount of bound water in geological structures. ... A radionuclide is an atom with an unstable nucleus. ... In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ...

The definitive, but invasive method of detecting vasospasm is cerebral angiography. It is generally agreed that in order to prevent or reduce the risk of permanent neurological deficits, or even death, vasospasm should be treated aggressively. This is usually performed by early delivery of drug and fluid therapy, or 'Triple H' (hypertensive-hypervolemic-hemodilution therapy) (which elevates blood pressure, increases blood volume, and thins the blood) to drive blood flow through and around blocked arteries. For patients who are refractive (resistant) to Triple H therapy, narrowed arteries in the brain can be treated with medication delivered into the arteries that are in spasm and with balloon angioplasty to widen the arteries and increase blood flow to the brain. Although the effectiveness of these treatments is well established, angioplasty and other treatments delivered by interventional radiologists have been in evolution over the past several years. It is generally recommended that aneurysms be evaluated at specialty centers which provide both neurosurgical and interventional radiology treatment and which also permit angioplasty, if needed, without transfer. Cerebral angiography or arteriography is a form of medical imaging that visualises the arterial and venous supply of the brain. ... A sphygmomanometer, a device used for measuring arterial pressure. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... This article does not cite any references or sources. ...

Treatment

Emergency treatment for individuals with a ruptured cerebral aneurysm generally includes restoring deteriorating respiration and reducing intracranial pressure. Currently there are two treatment options for brain aneurysms: surgical clipping or endovascular coiling. Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937. It consists of performing a craniotomy, exposing the aneurysm, and closing the base of the aneurysm with a clip. The surgical technique has been modified and improved over the years. Surgical clipping has a lower rate of aneurysm recurrence after treatment. Endovascular coiling was introduced by Guido Guglielmi at UCLA in 1991. It consists of passing a catheter into the femoral artery in the groin, through the aorta, into the brain arteries, and finally into the aneurysm itself. Once the catheter is in the aneurysm, platinum coils are pushed into the aneurysm and released. These coils initiate a clotting or thrombotic reaction within the aneurysm that, if successful, will eliminate the aneurysm. In the case of broad-based aneurysms, a stent is passed first into the parent artery to serve as a scaffold for the coils ("stent-assisted coiling").Either surgical clipping or endovascular coiling is usually performed within the first three days to occlude the ruptured aneurysm and reduce the risk of rebleeding. This article or section does not adequately cite its references or sources. ... // In animal physiology, respiration is the transport of oxygen from the ambient air to the tissue cells and the transport of carbon dioxide in the opposite direction. ... Intracranial pressure, (ICP), is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brains circulating blood volume. ... Walter Dandy, American neurosurgeon is credit for the development of air encefalography in 1918, a major breaktrough in brain imaging and set the basis for the development of neuroradiology ... The Johns Hopkins Hospital is a teaching hospital in Baltimore, Maryland. ...

At this point it appears that the risks associated with surgical clipping and endovascular coiling, in terms of stroke or death from the procedure, are the same. The major problem associated with endovascular coiling, however, is a higher aneurysm recurrence rate. For instance, the most recent study by Jacques Moret and colleagues from Paris, France, (a group with one of the largest experiences in endovascular coiling) indicates that 28.6% of aneurysms recurred within one year of coiling, and that the recurrence rate increased with time. ^[2] These results are similar to those previously reported by other endovascular groups. For instance Jean Raymond and colleagues from Montreal, Canada, (another group with a large experience in endovascular coiling) reported that 33.6% of aneurysms recurred within one year of coiling. ^[3] The long-term coiling results of one of the two prospective, randomized studies comparing surgical clipping versus endovascular coiling, namely the International Subarachnoid Aneurysm Trial (ISAT) are turning out to be similarly worrisome. In ISAT, the need for late retreatment of aneurysms was 6.9 times more likely for endovascular coiling as compared to surgical clipping. ^[4]

Therefore it appears that although endovascular coiling is associated with a shorter recovery period as compared to surgical clipping, it is also associated with a significantly higher recurrence rate after treatment. It is unclear, however, whether the higher recurrence rate translates into a higher rebleeding rate, as the data thus far does not show a difference in the rate of recurrent hemorrhage in patients who had aneurysms clipped vs. coiled after rupture. ^[4] The long-term data for unruptured aneurysms is still being gathered.

Patients who undergo endovascular coiling need to have annual studies (such as MRI/MRA, CTA, or angiography) indefinitely to detect early recurrences. If a recurrence is identified, the aneurysm needs to be retreated with either surgery or further coiling. The risks associated with surgical clipping of previously-coiled aneurysms are very high. Ultimately, the decision to treat with surgical clipping versus endovascular coiling should be made by a cerebrovascular team with extensive experience in both modalities.

Prognosis

The prognosis for a patient with a ruptured cerebral aneurysm depends on the extent and location of the aneurysm, the person's age, general health, and neurological condition. Some individuals with a ruptured cerebral aneurysm die from the initial bleeding. Other individuals with cerebral aneurysm recover with little or no neurological deficit. The most significant factors in determining outcome are grade (see Hunt and Hess grade above) and age. Generally patients with Hunt and Hess grade I and II hemorrhage on admission to the emergency room and patients who are younger within the typical age range of vulnerability can anticipate a good outcome, without death or permanent disability. Older patients and those with poorer Hunt and Hess grades on admission have a poor prognosis. Generally, about two thirds of patients have a poor outcome, death, or permanent disability ^{[5] [6]} Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ...

References

See also

• Charcot-Bouchard aneurysm
• Intracranial berry aneurysm
• Stroke
• International Subarachnoid Aneurysm Trial
• Neil Young, a famous recipient of a coil embolization for a brain aneurysm. Dennis Danell, Laura Branigan, Bill Berry and Quincy Jones are among the notable musicians who have suffered ruptured brain aneurysms; Branigan's was fatal, as was Danell's.

Charcot-Bouchard aneurysms are aneurysms of the brain vasculature which occur in small blood vessels (less than 300 micrometre diameter). ... An intracranial berry aneurysm, also known as a saccular aneurysm, is a sac-like outpouching in a cerebral blood vessel, which can seem berry-shaped, hence the name. ... For other uses, see Stroke (disambiguation). ... The International Subarachnoid Aneurysm Trial is a large multicentre, prospective randomised clinical medical trial, comparing the safety and efficacy of endovascular coil treatment and surgical clipping for the treatment of ruptured brain aneurysms. ... Neil Percival Young[1] OM (born November 12, 1945, Toronto, Ontario) is a Canadian singer-songwriter, guitarist, and film director from Winnipeg, Manitoba. ... Dennis Danell (June 24, 1961-- February 29, 2000) was the guitarist for the punk rock band Social Distortion. ... Laura Branigan (July 3, 1957 – August 26, 2004) was a popular American singer/actress from Brewster, New York, best known in the U.S. for the song Gloria (1982). ... William Bill Thomas Berry (born July 31, 1958) was the drummer in alternative rock band R.E.M. for 17 years, before retiring from the group and becoming a farmer. ... This article is about the producer and songwriter. ...

External links

The base text for this article was taken from the National Institute of Neurological Disorders and Stroke public domain resource at http://www.ninds.nih.gov/health_and_medical/disorders/ceraneur_doc.htm. Image File history File links Broom_icon. ... The National Institute of Neurological Disorders and Stroke is a part of the U.S. National Institutes of Health. ... Shortcut: WP:PD There are many resources available on the net that are in the public domain, and therefore freely usable without restrictions for Wikipedia content. ...

• [http://www.brainhelp.co.uk/ Addressing the Challenges Faced as a Result of

Brain Haemorrhage.

• behindthegray.net | Subarachnoid Hemorrhage support group with forums, articles, chat and general advice.
• Aneurysm - Cerebral
• Brain Aneurysm & Cerebrovascular Resource
• http://www.brainaneurysm.com/
• Brain Aneurysm-Brain Surgery Patient Help Site