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March 15, 2012
Aneurism is a state at which protrusion of a wall of an artery takes place, in more exceptional cases – veins. It occurs as a result of stretching or thinning of an artery. In view of such process there is an aneurysmal bag sometimes squeezing the fabrics located close. As a rule, aneurism – the phenomenon inborn. At the birth of such pathology do not find, development of the child happens normally. Aneurism is shown already owing to diseases at which blood vessels become gradually thinner. Also the disease can become an effect of injuries or wounds of blood vessels and emergence of the infected blood clots. Rather often aneurism is found in the course of radiological or ultrasonic research accidentally. At once after installation of such diagnosis it is necessary to take measures, at a rupture of aneurism there is bleeding which can lead to a lethal outcome. At a rupture of aneurism of people feels pain, at it arterial pressure sharply falls.
Also acquired aneurism meets, however its manifestation is more characteristic of people at advanced age – after fifty years. At people at younger age the acquired aneurism arises as an effect of injuries. There are several types of aneurism.
Brain aneurism which is also called intracranial aneurism, this education which arises on a brain blood vessel. Gradually increasing, it is filled with blood. Often there is pressure of a convex site of aneurism upon brain tissues, upon a nerve. But nevertheless the most dangerous state for the person is the rupture of aneurism of a brain because of which there is hemorrhage in brain tissue.
If the size of aneurism small, then it cannot lead to hemorrhage. Similar pathology arises practically in any area of a brain. However most often it appears in the place where branches, that is between a base of skull and the lower surface of a brain depart from an artery.
Often aneurism is shown as a result of existence inborn pathologists of walls of vessels. Sometimes aneurism of a brain arises at the persons having certain disturbances of genetic character. These are diseases of connecting fabric, blood circulation disturbance, a polycystosis of kidneys.
Besides, the reason of emergence of aneurism in vessels of a brain can become earlier got injured on the head, a constant high blood pressure, tumors, infectious diseases, atherosclerosis and some other illnesses of vascular system. Malicious smoking and drug addiction leads to developing of aneurism.
Today specialists allocate three types of aneurisms of a brain. Meshotchaty aneurism is the roundish sack filled with blood, fastening to the place where blood vessels branch off. This type of aneurism called by also "berry" aneurism in view of its structure is widespread most widely. It is pathology it is characteristic of adults.
At lateral aneurism there is a peculiar tumor of a wall of a blood vessel. Formation of spindle-shaped aneurism happens as a result of expansion of a vascular wall on a certain site.
Also there is a classification of aneurisms according to their size. If the size of aneurism is less than 11 millimeters in the diameter, then it is small aneurism, average can call aneurism with a diameter of 11-25 millimeters, huge — it is more than 25 mm.
This disease can overtake the person at any age. A little more often such pathology is fixed at women.
It is important to consider that the rupture of aneurism and, respectively, hemorrhage can occur at each of types of aneurisms of a brain. Different factors can provoke a rupture of aneurism of a brain: supertension, alcoholism, cocaine use, etc.
Owing to a hematencephalon the person can have a hemorrhagic stroke, serious damages of a nervous system and death. Also repeated rupture of aneurism or the subsequent development of new aneurisms in brain vessels is possible. Most often owing to a rupture of aneurism there is subarachnoidal hemorrhage which, in turn, conducts to hydrocephaly. At such state liquor collects in cerebral cavities which press on brain fabrics later.
As complication of bleeding there can also be a vasospasm, that is narrowing of blood vessels. In this case inflow of blood to some areas of a brain worsens that leads to damage of fabrics or to a stroke.
Brain aneurism symptoms
Generally at brain aneurism the expressed symptoms of an illness are not shown until there is a rupture of aneurism, or this education does not become very big. At aneurism of the big sizes there is pressure upon fabrics and nerves. As a result, pain in eyes is shown, periodic spasms of the person, paralysis of one its party are possible. At the person sight can grow turbid, extend pupils. If there is a rupture of aneurism, as symptoms there is a severe and sudden headache, vomiting, doubling in eyes. The patient can faint. It should be noted that character of a headache in this case especially acute and intensive. Sometimes the person feels the "warning" headache some days before a rupture of aneurism. At a rupture of aneurism spasms can be also shown, in rare instances the patient can fell into a coma. In the presence of similar symptoms it is necessary to see a doctor immediately.
Diagnosis of aneurism of a brain
Brain aneurism is often revealed in the course of the inspections connected with diagnosis of other diseases. At aneurism usually examination is conducted how there was subarachnoidal hemorrhage for the purpose of confirmation of the diagnosis. Research of vessels by means of a radiological method is called an angiography. At the intracerebral angiogram it is possible to see changes which take place in an artery or a vein, and to learn whether arteries are narrowed or destroyed.
By means of a computer tomography detection of aneurism of vessels of a brain or hemorrhage is made after aneurism burst.
The magnetic resonant tomography allows to receive the informative image of a brain. Carrying out a magnetic resonant angiography provides the detailed image of blood vessels of a brain.
If the doctor suspects a rupture of aneurism, then to the patient the analysis of cerebrospinal liquid can be appointed. By means of a surgical needle cerebrospinal liquid for the analysis is extracted from a subarachnoid space.
Treatment and prevention of aneurism of a brain
At patients its gap happens to aneurism not always. Therefore those for whom small aneurism is diagnosed should stay under continuous supervision of doctors and to watch what dynamics of increase in aneurism, and also whether other symptoms develop. Such supervision is made not to pass time when it is necessary to begin complex therapy of aneurism. The doctor always considers that each of cases of aneurism is unique therefore for the choice of the correct approach to treatment of aneurism its size, type and situation is defined. Also the doctor surely pays attention to age of the patient, existence at him some diseases, probability of a rupture of aneurism, heredity. It is important to pay attention and to risk which makes treatment of aneurism.
Today two types of surgical treatment of aneurism of a brain are applied: cliping of aneurism and occlusion is made. Such operative measures are considered as rather difficult and represent big risk. In the course of their carrying out it is possible to damage other blood vessels, there is also a risk of an attack after operation.
As an alternative operative measure carrying out endovaskulyany embolization is possible. Such procedure can be carried out several times during human life.
There are no efficient methods of prevention of aneurism today. Those to whom the diagnosis of "a brain aneurysm" was established have to watch very carefully pressure level, refuse smoking and the use of drugs. With care it is necessary to treat also drugs which liquefy blood, for example to aspirin. Their reception is possible only after consultation with the attending physician. The women having aneurism need to get advice of the doctor about a possibility of the use of oral contraceptives.
The forecast at a rupture of aneurism very strongly depends on what age of the patient, his how satisfactory state of health whether it has other diseases, and also from other factors. Period duration from time of a rupture of aneurism before rendering the professional help is important. What carried out diagnosis earlier and treatment, especially the favorable forecast is begun.
Recovery after a rupture of aneurism of a brain continues from several weeks to several months.
Aneurism of heart is one of the most serious complications after myocardites, a myocardial infarction, and also after injuries. At aneurism of heart there is limited protrusion of a cordial wall in which there were certain changes earlier. Most often aneurism of heart arises at people who had a myocardial infarction, development of such pathology is directly connected with disturbance of food or integrity of a cardiac muscle.
If coronary circulation is broken for a long time, then on a certain site of a myocardium there is a necrosis. Later such site is substituted by fibrous plastics, and there is its scarring. There is a classification of aneurisms of heart: they can be subdivided on acute, subacute and chronic. If to consider an aneurism form, then allocate sacculate, diffusion, fungoid aneurisms.
Display of acute aneurism happens at a myocardial infarction in the first weeks. Then not reduced nekrotizirovanny site of heart stretches in view of impact of chamber pressure on it. As a result it eminates. Such phenomenon arises owing to existence of a number of factors — the high arterial pressure, the extensive center of a necrosis. However decisive is a disturbance of the mode of rest at once after a myocardial infarction.
Several weeks later there is a scarring of nekrotizirovanny muscle fibers, and aneurism passes into a chronic form. After a while its wall is thickened.
Much less often subacute aneurisms which are shown on weak sites of cicatricial fabric meet.
At aneurism of heart its activity is broken. At the person the state sharply worsens, there is a development of an acute left ventricular failure which passes into chronic total later. Blood stagnates in the left auricle, pulmonary and arterial pressure increases. Gradually walls of ventricles hypertrophy, heart increases.
Often at this state there are heartaches which can proceed both several hours, and several days. At a physical tension of pain become more intensively, they do not act analgetics and Nitroglycerine. Acute pains are replaced by stupid. Sometimes the person periodically feels asthma, shortage of air. Face skin turns pale, the fluid lungs of which periodic tussiculations and noisy breath are characteristic is gradually shown. With increase of hypostasis there are strong rattles, plentiful expectoration, cough becomes stronger. Often aneurism is followed by a thrombendocarditis, subfebrile temperature, tachycardia.
There is also a risk of emergence of a cardiorrhesis in the field of aneurism. It occurs suddenly, at the patient sharp pallor, cold sweat is shown. Face skin quickly becomes cyanochroic, in cervical veins blood overflow is observed. Extremities grow cold, the consciousness is quickly lost. Very quickly there occurs the death. As a rule, the similar phenomenon arises between the 2nd and 9th day of an illness.
Also owing to aneurism the heart rhythm can change, develop a fibrous pericardis.
Upon transition of aneurism to a chronic form the patient has already other complaints. Periodically in heart inflow or dying down are felt, the person suffers from an asthma and weakness, it shows dizziness. At first at chronic aneurism tachycardia is observed, after a wall of ventricles extend. Heart increases in sizes, and signs of right ventricular insufficiency take place a little later.
Diagnosis of aneurism of heart is carried out by means of electrocardiographic inspection and by X-ray inspection of bodies of a thorax.
Treatment of aneurism of heart is very complex challenge. It is carried out only in the conditions of a hospital. The main method of treatment is the surgery on excision and sewing up of defect of a cordial wall. But perform this operation only in the presence of complications of a disease.
As prevention of aneurism of heart it is important to diagnose a myocardial infarction in time and to provide competent approach to treatment and recovery of the patient.
Most often the aortic aneurysm develops in belly department, in more exceptional cases – in chest department. Also aneurisms of other arteries – a popliteal artery, carotid, femoral, cerebral, coronary arteries are sometimes diagnosed. Most often aneurism develops in places of a branching of arteries where the wall of vessels is exposed to more expressed loadings and, respectively, is more often injured. As the artery aneurism reason most often define atherosclerosis of vessels, in more exceptional cases its emergence is connected with injuries. In an artery the blood stream is broken, there can be turbulent flows of blood which promote formation of blood clots and their separations. As complication of an aortic aneurysm often there is a renal failure.
If diameter of aneurism does not exceed 5 cm, then such aneurism is broken off infrequently. Therefore, means which reduce arterial pressure are painfully applied to treatment. They are applied to reduction of probability of a gap. It is regularly important to pass researches to see dynamics of development of aneurism. If it increases too quickly, to the patient can appoint carrying out a surgery. Also an operative measure is appointed if diameter of aneurism makes more than 5 centimeters.
Two ways of operational treatment of aneurisms of a ventral aorta are applied. The first consists in carrying out a section on a stomach and a vshivaniye in a transplant aorta. When using the second method through a femoral artery the catheter with a stent is entered. It is established in an aorta. Both operations are difficult from the technical point of view. The same methods of treatment are applied also at aneurism of a chest aorta.
Section: Diseases of vessels