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surgery 2: neurosurgery > lecture 2: brain aneurysms > Flashcards

lecture 2: brain aneurysms Flashcards

1
Q

what is cerebral aneurysm

A

a bulge like dilation of the wall of a blood vessel within the brain

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2
Q

why do aneurysms develop?

A

due to weakness in the wall of a vessel, especially at branch points

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3
Q

what are the 3 types of cerebral aneurysms

A
  1. saccular
  2. fusiform
  3. ruptured
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4
Q

saccular cerebral aneurysm

A

Saccular aneurysm causes just one side of your artery to bulge

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5
Q

fusiform cerebral aneurysm

A

Fusiform aneurysm bulges out on all sides of your artery.

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6
Q

ruptured cerebral artery

A

spills blood into the surrounding tissue (hemorrhage)

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7
Q

CAUSES of aneurysms ?

A
  • idiopathic in majority of cases
  • congenital/familial inheritance
  • atherosclerosis
  • hypertension
  • connective tissue disorders
  • sickle cell anemia
  • infections
  • trauma
  • smoking
  • illicit drug use
  • alcohol
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8
Q

pp’s at higher risk of developing aneurysms

A
  • 40-60 year olds
  • Females

(very very rare in kids)

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9
Q

symptom associated with cerebral aneurysms and Subarachnoid hemorrhage are:

A

headaches
“ worst headache of my life”
ACUTE ONSET OF SEVERE HEADACHES

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10
Q

symptom associated with cerebral aneurysms and Subarachnoid hemorrhage are:

A

facial pain
- occipital pain
- cervical pain
- pain behind eye
- pain in low temple

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11
Q

symptom associated with cerebral aneurysms and Subarachnoid hemorrhage are:

A

NECK STIFFNESS / PAIN

due to irritation of meningeals

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12
Q

symptom associated with cerebral aneurysms and Subarachnoid hemorrhage are:

A

alterations in consciousness: confusion or impaired alertness

the sudden increase in intracranial pressure ass. with ruptured aneurysm can lead to a decline is cerebral perfusion pressure, causing syncope.

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13
Q

symptom associated with cerebral aneurysms and Subarachnoid hemorrhage are:

A

seizures; usually in SAH

mostly within 24 hours of onset

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14
Q

symptom associated with cerebral aneurysms and Subarachnoid hemorrhage are:

A

autonomic disturbances: fever, nausea, vomiting, sweating, chills, cardiac arrythmias

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15
Q

symptom associated with cerebral aneurysms and Subarachnoid hemorrhage are:

A

visual symptoms: blurry vision, diplopia, visual field defects

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16
Q

diagnosis of brain aneurysms

A
  1. HISTORY
    pp will complain of severe onset of headache: worst headache of their life, associated with a stiff/painful neck
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17
Q

diagnosis of brain aneurysms

A

CT & MRI
- in 90% of cases, this will show a subarachnoid hemorrhage in cases of a ruptured aneurysm

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18
Q

diagnosis of brain aneurysms

A

lumbar puncture + CSF analysis
- if not recognised by CT
- identification of blood in CSF that runs in subarachnoid space.

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19
Q

diagnosis of brain aneurysms

A

angiography:

small flexible tube is threaded into one of the brain arteries and is injected with dye whilst pictures of the arteries are being taken

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20
Q

what is vasospasm

A

A vasospasm is the narrowing of the arteries caused by vasoconstriction. This narrowing can reduce blood flow or even block it.

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21
Q

the two surgical C’s for aneurysm

A

Clipping
Coiling

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22
Q

what is clipping and what is the benefit of doing it

A
  • neurosurgeron performs this
  • cuts skull open
  • damaged vessel is identified
  • a metal clip id placed across the aneurysm
  • this prevents blood from entering the aneurysm causing further growth/damage
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23
Q

what is coiling and what is the benefit of doing it

A

Coiling involves approaching the aneurysm from inside the blood vessel, so that there is no need to open the skull. Small metal coils are inserted into the aneurysm via a catheter through the arteries that run from the groin to the brain. The coils remain in the aneurysm; they are not removed.

24
Q

mechanism of formation of aneurysm

A
  1. developmental defects in the media and elastica
  2. focal destruction of internal elastic membrane caused by haemodynamic forces
  3. enlargement of sac, then rupture
24
Q

mechanism of formation of aneurysm

A
  1. developmental defects in the media and elastica
  2. focal destruction of internal elastic membrane caused by haemodynamic forces
  3. enlargement of sac, then rupture
25
Q

those who survive SAH, are left with neurological deficits, due to

A
  • hemorrhage
  • cerebral vasospasm with infarction
  • hydrocephalus
26
Q

three most common locations of saccular/berry aneurysm

A
  1. internal carotid artery (terminal)
  2. middle cerebral artery
  3. basilar artery (top)
27
Q

what is sentinal bleeds

A

aneurysms undergoing small ruptures and leaks of blood into the subarachnoid space

28
Q

third nerve palsy - ptosis, diplopia, dilation of pupils can indicate aneurysm at what point

A

junction of post communicating artery and post cerebral arteries

29
Q

sixth nerve palsy may indicate aneurysm at where

A

caverous sinus

30
Q

unilateral blindness can indicate an aneurysm where

A

circle of willis (anteriormedially)

31
Q

the side that a ruptured aneurysm is on, can be indicated by what ?

A
  1. monocular pain
  2. unilateral headache
  3. terson syndrome
32
Q

ddx of SAH

A
  • migraines (thunderclap headaches)
  • stroke
  • neurosyphillis
  • pheochromocytoma (tumor)
  • cerebral venous thrombosis
  • pituaritary apoplexis
  • ## hypertensive encthalopathy
33
Q

delayed neurological deficits

A

delayed neurological deficits is the MAIN preventable cause of SAH

34
Q

4 major causes of delayed neurological deficits

A
  1. rupture/bleed
  2. hydrocephalus
  3. vasospam
  4. hyponatremia
35
Q

hydrocephalus

A

this is build up of fluid within brain and can be caused due to sah

36
Q

hydrocephalus can cause

A

-stupor
-coma
-progressive drowsiness
- abulia

37
Q

vasospams can cause the two I’s

A
  1. ischemia; signs of ischemia are present 4- 14 days after hemorrhage, mostly 7 days after
  2. infarction
38
Q

Hyponatremia; is a complication of sah; what does Hyponatremia mean

A

decreased sodium level in blood.
- can develop within 2 weeks of developing sah

39
Q

systemic changes ass. with sah

A
  • ecg changes that may show MI
  • increased troponin / MB levels
  • decrease in EF = heart failure
  • hyponatremia ( decreased ca levels in blood)
  • albuminuria ( increased albumin in kidneys = kidney problem )
  • glycosuria ( presence of reducing sugars in urine)
  • ## leukocytosis
40
Q

within 72 hrs of developing sah, what scan is effective enough to detect sah

A

high quality NON CONTRAST CT SCAN

41
Q

On a CT, the exact offending aneurysm can be concluded by ?

A

the location of the main clot shown by the CT scan

42
Q

on a ct, if there’s a collection of blood in the anterior inter-hemispheric fissure (the midline between both hemispheres); this indicates that there’s a rupture where?

A

rupture at the anterior comminicating

43
Q

on a ct, if there’s blood in the slyvian fissure ( lateral hemispheric surface of the brain); this indicates that there’s a rupture where?

A

middle cerebral artery

44
Q

on a ct, if there’s blood in the anterior perimesencephalic cistern, this indicates there’s a rupture where?

A

posterior communicating artery or distal basilar artery aneurysm

45
Q

labs for sah :
moniotr electrolytes once or twice daily. why

A

because low calcium levels can occur randomly within two weeks of developing sah

46
Q

what other lab test should we do

A

troponin levels must be looked at

47
Q

how to manage raise intracranial pressure

A
  • most times it occurs secondary to other diseases so you must treat the underlying condition
48
Q

management of vasospasm ( narrowing of arteries)

A
  • calcium channel antogonist nimodipine 60mg every 4 hr

:( = it can cause hypotension worsening the aneurysm

49
Q

management of hydrocephalus

A

ventricular shunting - this could be permanent dependent on if its chronic or not

50
Q

the role of steroids; how do glucocorticoisteroids help sah

A

reduce head and neck ache caused by irritative effect of the subarachnoid blood

51
Q

benefit of early aneurysm repair? via clipping or coiling ( INTERVENTIONAL MANAGEMENT)

A
  • prevention of rupture
52
Q

what scale is helpful in assessing the patient before deciding for interventional management ?

A

hunt - hess scale

5 grades from mild, severe, somnolent, stupor to coma.

53
Q

during clipping, craniotomy is required. what is this ?

A

An operation in which a small hole is made in the skull or a piece of bone from the skull is removed to show part of the brain

54
Q

when conducting coiling of an aneurysm via a cathether, what artery is it passed from to reach this bulge?

A

the femoral

55
Q

clipping is a type of ________ repair

A

surgical

56
Q

coiling is a type of ____________ repair

A

endovascular technique

surgery 2: neurosurgery (8 decks)

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