Aneurysms: Subarachnoid Rupture

This tool is applied to the assigned CPG "Clinical guidelines for stroke management 2010" in relation to the management, diagnosis and treatment of stroke. Stroke occurs when there are blood clots

Various forms of acute trauma can lead to swelling of the brain within the cranium. Infection, ruptured blood vessels, or inflammation due to stroke can cause the brain to expand, potentially forcing the brainstem through the foramen magnum. During this expansion blood vessels may become compressed, leading to further accumulation of inflammatory molecules and stasis of blood flow to cerebral tissue. Lack of oxygen along with physical trauma due to expansion may cause irreversible damage and death. In extreme cases of intracranial swelling, a decompressive craniectomy may be necessary to alleviate pressure. Additionally, the procedure provides the surgeon with an access point to physically remove hematomas and repair damaged vasculature.

Surgical intervention is presently the only effective method of treating AAAs. The risk of surgical repair is outweighed by the risk of aneurysm rupture or aneurysm related death. Patients

Hemorrhagic strokes occur when blood vessels to the brain leak blood or burst open, the blood puts pressure onto the brain as it spreads and fills the crevices between the skull and the brain until the person has a stroke. The leaking of blood, or the bursting open of the blood vessels can be caused by hypertension, trauma, blood thinning medication, and aneurysms (Mcintosh 13). There are two common types of Hemorrhagic strokes, the most common one is Intracerebral Hemorrhagic, and the other less common type is Subarachnoid Hemorrhagic (Mcintosh 14). In an Intracerebral Hemorrhagic brain tissue is flooded with blood when a blood vessel bursts open (Mcintosh 14). However, in a Subarachnoid Hemorrhagic stroke, bleeding occurs in the subarachnoid space (area between the brain and the tissue it covers) (Mcintosh 14). Hemorrhagic strokes are preventable as they are caused by treatable conditions such as high blood pressure (Mcintosh

○ General: A history of significant hypoxia (e.g., strangling by hanging) or ischemia (e.g., cardiac arrest with cardiopulmonary

Solitaire AB stent is sometimes used in the coiling of small intracranial aneurysms that have ruptured. With the advances in Neuroradiology techniques, the diagnosis of small aneurysms has been improving. According to “Jifang Zhang, Donghai Wang and Xingang” (2015) in a study titled “Solitaire AB stent-assisted coiling embolization of the treatment of ruptured very small intracranial aneurysms” (page 1) a study was performed at the Qilu

Introduction: During the resection of deep-seated brain lesions, there is an associated risk of significant retraction-induced brain injury due to the retractors used. The most common approach is the use of metal blade retractors to displace tissue, which has been shown to cause secondary life-threatening brain injuries such as brain swelling, hemorrhage, and infarction due to the excessive focal pressure on delicate tissue. This paper discusses the validation of a novel tubular retractor sheath which enables radial distribution of forces to minimize retraction-induced injury.

All of the factors contribute to the patient’s risk, but only hypertension can potentially be modified to decrease the patient’s risk for further expansion of the aneurysm.

Aneurysms are a ballooning and weak area in the wall of an artery that supplies blood to the brain. They can burst at any moment and cause a subarachnoid hemorrhage, which is bleeding under the layer of brain coverings called the arachnoid. This can cause increased intracranial pressure which can lead to a stroke or even death if they aren’t discovered in time. They most commonly occur in the Circle of Willis in the anterior cerebral artery.

6 cm would be 20 percent. A less common aneurysm would be the thoracic aortic aneurysm, which is affected on the part of the aorta that is running through the chest. Studies show that Thoracic aortic aneurysm has an annual survival rate of 50 percent without treatment and 85 percent when it is done with surgery. The next type of aneurysm is known as a cerebral aneurysm, which is an aneurysm of the arteries that supply blood to the brain with blood known as intracranial aneurysms. When a brain has a ruptured aneurysm it can be fatal within 24 hours, and 40 percent of brain aneurysms can be fatal as well as 66 percent of the people who survive will be resulted in neurological impairment or a disability. When a cerebral aneurysm has been ruptured

The second major type of stroke is labeled as a hemorrhagic stroke. Hemorrhagic strokes are caused by arteries in the brain rupturing open or slowly leaking into the cranium. The rupture or leakage of blood then puts pressure on the surrounding brain cells. There are two types of hemorrhagic strokes; intracerebral-which occurs when a blood vessel in the “brain bursts and spills into surrounding brain tissue damaging brain cells. Brain cells beyond the leak are deprived of blood are also damaged.”2 The second type of hemorrhagic stroke is called a subarachnoid hemorrhage. With a subarachnoid hemorrhage “an artery on the surface of the brain bursts and spills blood between the surface of the brain and the skull. This bleeding is often signaled by a sudden, severe headache.”2 This type of stroke is usually caused by an aneurysm.

This journal article discusses how to manage acute intracranial hemorrhage and intraventricular hemorrhage if presented to the hospital, along with its pathophysiology and what possible outcomes can result from ICH or IVH. Intracranial hemorrhage (ICH) is associated with the highest case fatality of any stroke subtype. Based on follow-up one month after ICH, 50% of patients will have passed away and only 20% of patients will have regained functional independence by 1 year. On presentation, patients with ICH are often only mildly impaired and cognitively intact. Within a few short minutes or hours, a patient 's progress can change rapidly as a result of hematoma expansion, or cerebral edema, and hydrocephalus. Intraventricular (IVH) occurs in 12-45% of patients with ICH. It also can occur independently of ICH without a significant parenchymal component. Mortality estimates for IVH in any setting range from 45-80%. The most common cause of IVH is spontaneous ICH with approximately 40% of patients with primary ICH experience IVH later on.

Aneurysms, localized enlargements of artery walls, can be treated through unassisted endovascular coiling or stent assisted endovascular coiling (BA Foundation, n.d.). Although the treatment methods are effective, their durability and ability to prevent aneurysm recurrence are under question. The purpose of this study was to compare the recurrence rates of aneurysms treated with unassisted coiling and stent assisted coiling. I conducted a quantitative meta-analysis study and looked at studies from 2009 to 2017 involving the treatment of aneurysms of different characteristics with stent assisted coiling method or unassisted coiling method.

        A “cerebrovascular accident” is a term used to define a stroke. When a stroke occurs, blood flow cessates to the brain. If the blood flow cessation prolongs, the brain cannot receive oxygen and nutrients, which may lead to cell death and irreversible damage (Kantor et al., 2005 Stanford Health Care, 2015). The two types of stroke are ischemic and hemorrhagic. During an ischemic stroke, a blood vessel that provides blood to the brain is blocked by a clot. One way an ischemic stroke could happen is from an artery that was narrow initially (thrombotic stroke). Another way is if the clot breaks from another part of the body into the brain (embolic stroke). If there is plaque within the arteries, this  could cause a disruption of blood flow and eventually lead to a clot. If a clot is overfilled, the blood vessel may break open; this is a hemorrhagic stroke  (Kantor, Stanford Health Care, 2015). Other ways a hemorrhagic stroke can occur is through arteriovenous malformation (AVMs) and aneurysms. For a “normal” person, arteries and veins are usually arranged so there is a web of capillaries to regulate the flow of blood. For a person with AVM, his or her arteries and veins are tangled and swollen thus disrupting the blood flow.  An aneurysm is a vessel bulging due to its weak vessel walls. If unnoticed, it could rupture and cause a

According to Phoenix Neurological Associates, aneurysms is abnormal blood filled pouches that balloon out from weak spots in the wall of an artery and are the most common cause of subarachnoid hemorrhage. If an aneurysm ruptures, blood spills into the space between the surfaces of the brain and skull, and blood vessels in the brain may spasm (According to Phoenix Neurological Associates, 2015). Aneurysms are often caused or made worse by high blood