Surely many people have come across such a concept as saccular aneurysm. So called protrusion of the walls of the artery, arising due to changes in its structure. Veins, aortas, whole organs are a little less likely to be affected.
What are the causes of aneurysm? What are the predisposing factors? Are there any symptoms indicating its occurrence? And, most importantly, how to treat this pathology? The answers to these and many other questions concerning the topic can be found in the article.
Briefly about pathology
So, saccular aneurysm is a protrusion of a weak spot in a blood vessel that occurs due to damage to its walls.
Why such a name? Because visually this neoplasm looks like a pouch. Very often, it does not manifest itself, and therefore remains unnoticed before the examination. But sometimes the pouch can burst. As a result, blood will be released into the skull, which will provoke unpleasant symptoms. There may be serious consequences (stroke).
A saccular aneurysm of the brain is also called saccular. This is a common education. Among all intracranial aneurysms, about 80-90% falls on it. As a rule, "bags" are formed on the branches of large arteries, as well as on their bifurcations.
Statistics and classification
It’s a little worth talking about the percentage probability of occurrence. Saccular aneurysms are formed in the following places:
- Internal carotid artery (36%).
- Medium cerebral (33%) and anterior (15%).
- The main artery, also called basilar (6%).
- Posterior cerebral (5%).
- External carotid (2%).
Depending on the location, these formations are divided into several types. There is such a small classification:
- Aneurysm of the artery of the brain. Visually looks like a small ball or bulge right in the vessel. It looks like it is "hanging" on a stalk.
- Aneurysm of the anterior connecting artery. Dangerous neoplasm. It does not make itself known at all. If it is not found during the examination, then the patient will know about it only after its rupture. And this is fraught with dysfunction of the hypothalamus or even a memory disorder.
- Aneurysm of the internal carotid artery. In this case, a separate section sticks out. This provokes a weak area of ​​the vessel.
Most often, these “bags” are true, that is, the inner wall protrudes outward. What are they made of? From dense hardening fiber. As it grows, the aneurysm often changes shape, and blood clots form inside it. In this case, the notorious gap occurs.
What about the sizes? These "bags" can be small (up to 5 mm), medium (6-15 mm), large (16-25 mm) and gigantic (over 25 mm).
Causes
Scientists from all over the world have been dealing with them for a long time. But today only predisposing factors are known, due to which a saccular aneurysm of the left or right artery can form. They can be distinguished in the following list:
- The abuse of nicotine.
- Drug addiction.
- Vascular injury.
- Meningitis.
- Hereditary predisposition. It manifests itself in the weak walls of blood vessels from birth.
- The transferred tuberculosis.
- Polycystic kidney disease.
- Gastrointestinal Disorders.
- Syphilis in an advanced stage.
- Diseases of the cardiovascular system.
- Hypertension.
- Atherosclerosis.
Sometimes there are cases in which the formation of aneurysms was preceded by infectious processes. Often cysts and tumors lead to this pathology.
It can develop in people of any age and gender. But the risk group, as a rule, includes men whose age exceeds 50 years.
Symptoms
Often, saccular aneurysm of the brain develops without any special signs indicating this. But there are often cases when there were symptoms. They can be distinguished in the following list:
- Headache. They differ in duration, but more often make themselves felt in the form of seizures. Often arise as a result of high blood pressure. The pains are localized in different places - it all depends on where exactly the saccular aneurysm was formed. If it is deep, then the discomfort will not bother the person much, because the brain does not have pain receptors. But superficial aneurysms compress the membranes - they can cause severe discomfort. Often patients even suffer from migraines that go away after surgery.
- Disturbed sleep. If saccular aneurysm has arisen in the area that controls sleep, then a person may experience drowsiness or insomnia.
- Nausea and vomiting. These symptoms appear if the meninges are irritated. And this reaction is caused by superficial aneurysms. Large "bags" cause increased intracranial pressure, and it is also fraught with nausea due to dizziness. And it does not go away even after taking the medication. In this case, there is reason to believe that there is a problem in a specific center of the brain.
- Meningeal symptoms. Their cause is superficial or large aneurysms. The most common manifestation is tension in the cervical muscles, the inability to bend the legs in the knee or hip joint.
- Cramps. They arise due to squeezed superficial parts of the brain. This symptom indicates major aneurysms. It is serious, because breathing may even occur due to a cramp.
- Impaired sensitivity. Often, saccular aneurysms of the cerebral vessels compress structures that are responsible for this. Often even tactile sensitivity is lost in certain areas, hearing and vision disorders occur. The presence of aneurysm can also affect the coordination of movements.
Even more serious symptoms are impaired movement and function of the cranial nerves. In general, we can say that all patients who have a saccular aneurysm of the cerebral artery have individual symptoms. This greatly complicates the diagnosis.
Saccular carotid aneurysm
This pathology deserves special attention. It never passes without a trace, and its symptoms are different.
Large aneurysms can even be seen with the naked eye. They are small pulsating tumors on the neck. The saccular carotid aneurysm to the touch can be tensile-elastic (if filled with liquid blood) or dense (in the case when there are only clots inside it).
The following alarming symptoms are distinguished:
- Dizziness.
- Insomnia.
- Chronic fatigue.
- Noise in ears.
- Headaches for no reason.
- Unpleasant sensations in the heart.
- Visual impairment.
- Dyspnea.
- Dilated pupils and pain in the eyes.
- Hoarseness of voice.
- Sensation as if blood vessels were pulsing.
- Pain in the shoulder, back of the head, neck.
If the saccular aneurysm of the internal carotid artery is large, then it presses on the trachea, throat, even the esophagus. Because of this, various functional disorders occur. They may be indicated by causeless nosebleeds, dyspnea (shortness of breath), dysphonia, hoarseness.
As it develops, the tumor progresses, spreads deeper, compresses adjacent nerve trunks. Because of this, acute pain, paresis appears, paralysis develops.
It should be noted that saccular aneurysm of the right artery is characterized by common symptoms. These are fainting, headaches, impaired consciousness, dyspepsia, cramps, psychomotor agitation. If the neoplasm occurs on the left vessel, then epileptiform seizures, motor aphasia, hemianopsia, paresthesia are possible.
Saccular aortic aneurysm
Another case requiring further consideration. Due to this formation, an irreversible expansion of the lumen of the arterial trunk occurs. They occur in the abdominal part (37%), in the ascending and descending thoracic regions (23% and 19.5%) and arches (19%). Very often, this neoplasm is combined with coarctation and aortic insufficiency.
Symptoms differ depending on where exactly the “pouch” appeared. Usually the leading manifestation is pain. It is caused by stretching or damage to the aortic wall or the so-called compression syndrome.
If, for example, the abdominal aorta is affected, then the patient is faced with such manifestations:
- Pain spilled.
- Epigastric severity.
- Burping.
- Discomfort in the abdomen.
- Nausea and vomiting.
- Fullness of stomach.
- Dramatic weight loss.
- Intestinal dysfunction.
- Intense ripple in the abdomen.
In the case when an aneurysm is formed in the ascending aorta, chest pains, dizziness, tachycardia, shortness of breath appear. Upper vena cava syndrome, swelling of the face or even the upper body may occur.
When the “sacs” form on the aortic arch, compression of the esophagus, dry cough, hoarseness, bradycardia and salivation occurs. Stridor breathing, shortness of breath may occur. And with an aneurysm of the descending aorta, pain appears in the scapula, left arm. If the intercostal artery is also involved, there is a risk of developing ischemia of the spinal cord.
Diagnostics
As a rule, the examination is carried out according to the same principle - it does not matter whether it is a suspicion of a saccular aneurysm of the superior vena cava or one that has formed in the carotid artery.
First, the doctor conducts a general examination, clarifies complaints, collects an anamnesis, examines the clinical picture. Then instrumental examination methods are prescribed. Based on their results, specialists make an accurate diagnosis and prescribe competent treatment. Here are the most informative methods:
- Ultrasound It is able to give accurate information about the structure of the vascular wall, as well as the speed of blood flow and the state of the lumen.
- Dopplerographic examination. Helps determine if a patient has vascular disease.
- Angiography. It implies the intravenous administration of a contrast medium for the subsequent creation of x-rays. They are accurate, clear, demonstrate the state of the vessels and all the changes in them.
- Duplex scanning. Helps to evaluate in two-dimensional projection, in what state the vessels are. Triplex, respectively, in three-dimensional.
- MRI Using this method, you can establish a diagnosis, as well as determine the form and stage of the disease. In the future - to decide on therapeutic tactics. But more often, MRI is preferred by CT - computed tomography is more accurate.
If the doctor considers it necessary, then electroencephalography is prescribed. This method allows you to determine the presence of other vascular problems in the brain.
Operation
Surgical intervention is indicated if the size of the unbroken aneurysm exceeds 7 mm.
Before the appointment of the operation, general clinical trials are mandatory. Among them:
- General analysis of urine and blood.
- Coagulogram.
- Blood chemistry.
- ECG.
- Chest x-ray.
- A blood test for the presence or absence of viral hepatitis, RW, HIV.
If there is evidence, a therapist, a neurologist and other specialists are consulted. MRI, CT, and digital subtraction angiography are also required. This is necessary in order to choose the most optimal method of intervention.
How is saccular aneurysm removed? The operation can be open or endovascular. The first type is much more complicated, since it involves craniotomy. In the second case, only a puncture is done.
Rehabilitation
After the operation, the person is under the supervision of medical personnel in the intensive care unit. Approximately after 24-48 hours it is transferred to neurological. There, for 7-14 days, doctors continue monitoring and treatment.
Are there any complications? Yes, but they are extremely rare. This may be an adverse reaction to anesthesia, damage to the vascular wall. In modern medicine, this almost never happens, but a person must be aware of possible complications. Among them:
- Blood clots.
- Stroke.
- Cerebral edema.
- Difficulty in speech.
- Infection.
- Impaired memory or vision.
- Problems with coordination of movement and balance.
But removing the aneurysm minimizes the possibility of serious complications. The operation and the difficulties of the rehabilitation period are not comparable with the consequences that may arise due to rupture of the “bag”. In addition, many complications are eliminated during the intervention or in the postoperative days.
For two weeks, the patient will be disturbed by headaches, anxiety and fatigue. If an open intervention was carried out, then the uncomfortable sensations will be slightly delayed.
A full recovery takes about two months. You may need to undergo physiotherapeutic procedures, the help of a psychologist, working with a speech therapist, physiotherapy exercises, and massage sessions. Be sure to take painkillers and medications prescribed by a neurologist, as well as observe a relaxed lifestyle. It is strictly forbidden to lift something weighing more than 2-2.5 kg.
Rupture of aneurysm
If it occurs, then the prognosis is usually unfavorable. About 30% of patients die, and that is why disturbing symptoms cannot be ignored. An operation can save a life.
If a rupture occurs, the person is hospitalized and surgery is performed. This is the only true way to treat saccular aneurysm. Then a person is required to observe strict bed rest and take medications. As a rule, the doctor prescribes one of the following:
- Sedatives: Persen, Bellaspon, Valocordin.
- Analgesic: “Brustan”, “Ibuklin”, “Ketonal”.
- Vasodilating: Cinnarizine, Pentoxifylline, Papaverine.
- Means that improve the properties of blood: Trental, Complamin, as well as nicotinic acid.
- Antihypoxants: Actovegin.
- Antiplatelet agents: Cardiomagnyl, Curantil, Aspirin.
- Vitamins: Neuromultivit.
The goal of drug treatment is to stabilize the healing process and strengthen the vascular walls. Some people still practice folk remedies, but this is only possible if the attending physician has approved. The tincture of propolis, dill or hawthorn, dogrose broth, and the aronia infusion work well.
But besides this, it will still be necessary to normalize the way of life. It is strictly forbidden to smoke and drink alcohol, eat red meat and junk food. The diet should be varied with fresh fruits and vegetables, be sure to monitor the level of cholesterol in the blood.
And then, when the rehabilitation period ends, you need to start leading a more or less active lifestyle. More often walking in the fresh air, walking a couple of times a week to the pool. And, of course, undergo regular examinations. Aneurysm is a dangerous disease, but it is not a sentence. With timely treatment and a responsible attitude of the patient to his health, the prognosis is favorable.