CEREBRAL ANEURYSM

Latin word aneurysma- Dilation Aneurysm-abnormal local dilatation in the wall of a blood vessel TRUE Aneurysm a. Saccular b. Fusiform c. Dissecting FALSE Aneurysm

CAUSES
Atherosclerosis Hypertension Deep wounds, injuries High cholesterol & fat diet Inherited Infection Severe trauma

Risk Factors
Smoking Obesity Family history Hypertensive Usage of stimulant drugs

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS
NO EARLY SIGNS (some) Sudden headache Nausea and Vomiting Vision impairment Loss of Consciousness Nuchal rigidity Seizures Dysphagia Pupillary changes

CLASSIFICATION
SACCULAR FUSIFORM DISSECTING

SACCULAR ANEURYSM
rounded berrylike outpouchings that arise from arterial bifurcation points, most commonly in the circle of Willis.

dilatations of a vascular lumen caused by weakness of all vessel wall layers.

SACCULAR ANEURSYM
Subarachnoid hemorrhage
-a ruptured aneurysm is more of an irritantproducing vasospasm than a mass lesion.

SACCULAR ANEURSYM
VASOSPASM Ruptured aneurysms are most likely to rebleed within the first day (2-4%), and this risk remains very high for the first 2 weeks (about 25%) if left untreated

FUSIFORM ANEURYSM
lesions are exaggerated arterial ectasias that occur because of a severe and unusual form of atherosclerosis. Intraluminal clots are common, and perforating branches often arise from the entire length of the involved parent vessel.

DISSECTING ANEURSYM
blood accumulates within the vessel wall through a tear in the intima and internal elastic lamina. If blood dissects subintimally, it causes luminal narrowing or even occlusion. If the intramural hematoma extends into the subadventitial plane, a saclike outpouching may be formed. dissections with saclike outpouchings

DISSECTING ANEURYSM
Pseudoaneurysm - should be used for encapsulated, cavitated, paravascular hematomas that communicate with the arterial lumen.

LOCATIONS

DIAGNOSTIC EXAM
Catheter-Based Angiography

 Computed Tomography Scan Patent Aneursym

CT ANGIOGRAPHY

 MAGNETIC RESONANCE IMAGING

MAGNETIC RESONANCE ANGIOGRAPHY

MANAGEMENT
SURGICAL CLIPPING CRANIOTOMY

 CONSERVATIVE: a. WRAPPING b. TRAPPING c. PROXIMAL (hunterian) LIGATION

POST-OP CARE
Angiogram Vasospasm Transcranial Doppler Triple H (hypertension, hemodilution and hypovolemia) Transluminal balloon Angioplasty Intra-arterial Paparevine.

ENDOVASCULAR SURGERY
HYDROCOIL

GUGLIELMI DETACHABLE COILS

 EMBOLIZATION PROCEDURE

MICROCATHETERS

NURSING INTERVENTION
Establish and maintain a patent airway as needed. Administer supplemental oxygen as ordered. Position the patient to promote pulmonary drainage and prevent upper airway obstruction. Avoid placing the patient in the prone position as well as hyperextending his neck. Suction secretions from the airway as necessary to prevent hypoxia and vasodilation from carbon dioxide accumulation

 Monitor pulse oximetry levels and arterial blood gas level as ordered. Use these levels as a guide to determine appropriate needs for supplemental oxygen. Prepare the patient for emergency craniotomy, if indicated. If surgery cant be performed immediately, institute aneurysm precautions to minimize the risk of rebleeding and to avoid increasing the patients intracranial pressure. Administer hydralazine or another antihypertensive agent as ordered. Turn the patient often. Encourage deep breathing and leg movement.

 Apply elastic stockings or compression boots to the patients legs to reduce the risk of deep vein thrombosis. Give fluids as ordered and monitor I.V. infusions to avoid overhydration, which may increase ICP. If the patient has facial weakness, assist him during meals; assess his gag reflex and place the food in the unaffected side of his mouth. Implement a bowel elimination program based on previous habits. Raise the beds side rails to protect the patient from injury. Provide emotional support to the patient and his family.

THE END..