GERARD GABRIEL PASION-REOTUTAR, RM, RN, MAN

A small, unchanging aneurysm will produce little, if any, symptoms. Before a larger aneurysm ruptures, the individual may experience such symptoms as: a sudden and unusually severe headache,

If an aneurysm ruptures, it leaks blood into the space around the brain. This is called a subarachnoid hemorrhage. Depending on the amount of blood, it can produce:

The ruptured aneurism (hemorrhage) may also damage the brain directly, usually from bleeding into the brain itself. This is called a hemorrhagic stroke. This can lead to:

Aneurysms may result from:

congenital defects preexisting conditions such as high blood pressure and atherosclerosis head trauma more commonly in adults than in children but they may occur at any age more common in women than in men, by a ratio of 3 to 2

Hunt and Hess scale of subarachnoid hemorrhage severity:

Grade 0: Incidentally discovered, un-ruptured, asymptomatic aneurysm. Grade 1: Asymptomatic; or minimal headache and slight nuchal rigidity. Grade 2: Moderate to severe headache; nuchal rigidity; no neurologic deficit. Grade 3: Drowsy; minimal neurologic deficit.

Grade 4: Stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity and vegetative disturbances.
Grade 5: Deep coma; decerebrate rigidity.

The Fisher Grade classifies the appearance of subarachnoid hemorrhage on CT scan: Grade 1: No hemorrhage evident. Grade 2: Subarachnoid hemorrhage less than 1 mm

Grade 3: Subarachnoid hemorrhage more than 1 mm thick. (Highest risk of vasospasm.)

Grade 4: Subarachnoid hemorrhage of any thickness with intra-ventricular hemorrhage (IVH) or parenchymal extension.

The most important method of monitoring:

frequent neurological check and ICU monitoring. Non-invasive methods include transcranial Doppler, which is a method of measuring the velocity of blood in the cerebral arteries using ultrasound. The amount of blood reaching the brain can also be measured (CT or MRI or nuclear perfusion scanning). The definitive, but invasive method of detecting vasospasm is cerebral angiography

Surgical Clipping
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 chosen specifically for the site. The surgical technique has been modified and improved over the years. Surgical clipping has a lower rate of aneurysm recurrence after treatment.

Endovascular coiling
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 prevent further bleeding from the aneurysm.

Thank You