Vascular diseases

Question 1

What is an aneurysm?

Answer 1

An aneurysm is a bulging, weak area in the artery wall which can develop anywhere throughout the vascular system but mostly develops along the aorta and in the blood vessels in the brain. They are potentially fatal if they rupture and can cause death in minutes.

Question 2

What causes aneurysm?

Answer 2

There are different causes of aneurysm
1. Inherited diseases that may result in weaker than
normal blood vessels
2. Women are more likely to develop a brain aneurysm
or suffer from subarachnoid hemorrhage
3. Trauma such as crush injury to the chest
4. Syphilis infection targets the aorta and weakens it if
left untreated
5. Polycystic kidney diseases increases the chance of
aneurysm
6. Occasionally, it is an infection that targets and
weakens the region

Question 3

Where does an aneurysm commonly occur?

Answer 3

1. Cerebral aneurysm (accounts for 15% of all strokes)
2. Thoracic aortic aneurysm
3. Abdominal aortic aneurysm

Question 4

What are the symptoms of cerebral aneurysm?

Answer 4

• Unruptured cerebral aneurysms may have no
  symptoms related to them and may be discovered
  incidentally
• Symptoms of ruptured aneurysm include severe
  headache with rapid onset, neck pain and stiffness,
  increasing drowsiness, paralysis, seizures, impaired
  speech and visual problems

Question 5

What are the four types of cerebral aneurysms?

Answer 5

1. Saccular aneurysms (accounts for 80 to 90% of all 
   intercranial aneursysm)
2. Fusiform aneurysm
3. Giant aneurysm
4. Dissecting aneurysm

Question 6

Relative and frequency of strokes

Answer 6

Ischaemic strokes (80-85%)
- Embolic strokes: blood clot occurs outside brain and t
travels to the brain (25%)
- Thrombotic strokes: blood clot occurs in the blood
vessels supplying the brain (60%)
Haemorrhagic strokes (10-15%)
- Subarachnoid stroke occurs under the arachnid layer
(5%)
- Intracerebral stroke occurs in blood vessels deep
within the brain (10%)

Question 7

Brain aneurysm statistics

Answer 7

1. Occurs in 1:50 people
2. Women are more affected than men at a ratio of 3:2
3. Ruptured cerebral aneurysms are fatal in 40% of the
   cases. Two-thirds of the remaining people suffer from
   permanent neurological deficit
4. 15% of patients with subarachnoid stroke dies before
   reaching the hospital
5. Most prevalent in people aged between 35 to 60 but
   can occur in children as well
6. 50 to 80% of all aneurysms do not rupture in the
   course of a person’s lifetime

Question 8

Saccular aneurysm

Answer 8

• “berry aneurysm”
• Round lobulated focal outpouchings which usually
  arise at arterial bifurcations. May arise from the lateral
  wall
• Most common type of cerebral aneurysm

Question 9

Fusiform aneurysm

Answer 9

• Outpouching of an arterial wall on both sides

- Does not have a neck/stem

Question 10

Giant aneurysms

Answer 10

• Most aneurysms are small (0.5 to 2 cm)
• Aneurysms greater than 2.5 cm pose high risk and can
  be difficult to treat

Question 11

Dissecting aneurysm

Answer 11

• Wall of an artery rips longitudinally
• Bleeding into the weakened walls causes wall to split
• Creates a false lumen
• Most damaging type of aneurysm

Question 12

Aortic aneurysm statistics

Answer 12

• Prevalence increase sharply with age
• Rupture is associated with 80% mortality
• Annual survival rate for aneurysms greater than 5 cm is
  20%
• Surgical repair of ruptured AA has 50% mortality
• Screening men over the age of 65 years reduces
  aneurysm related mortality
• Patients diagnosed with small AA should be under-
  surveillance with ultrasound and cardiovascular
  modification risk factors

Question 13

Treatment of aneurysms

Answer 13

Things to consider:

• Risk of hemorrhage
• Size and location
• Age and health of patient
• Family history
• Surgical risks

Pharmacological treatments include Mannitol and Ca2+ channel blockers. Surgical treatments includes surgical clipping and endovascular coiling