November 10, 2009

Cerebral Aneurysm short notes

1) What is cerebral aneurysm
- abnormal focal dilatation in the wall of blood vessel usually artery due to defect, disease or injury

2) what is the type of brain aneurysm
- saccular
- fusiform
- dissecting
- false aneurysm (cavity lined by blood clot)

3) Berry aneurysm vs Charcott Bouchard aneurysm

Berry aneurysm is incorrect nomenclature of aneurysm. it is actually a saccular aneurysm which commonly occur in bifurcation of artery in circle of willi. it is named as berry aneurysm due to it's shape is look like as berry. berry aneurysm usually associated with congenital causes due to defect in tunica media formation. when it rupture, it will cause subarachnoid hemorrhage

charcott bouchard is aneurysm of small blood vessel supplying the brain parenchyma. it is mostly acquired due to pathologic changes of hypertension. when it rupture, it usually cause hemorrhagic stroke.

4) clinical presentation
- rupture (SAH vs hemorrhagic stroke)
- Compression from aneurysm
- Incidental finding

5) complication

a) Intracranial
- rebleeding
- cerebral ischaemia or infarction
- hydrocephalus
- expanding hematoma

b) extracranial
- myocardial infarction
- cardiac arrythmia
- pulmonary edema
- gastric hemorrhage (stress ulcer)

5) investigation
-CT scan
- CT angiography

6) management
-antifibronolytic therapy

- operative technique
a) clipping
b) wrapping with superficial temporalis fascia
c) trapping
d) coil embolization
e) ballon remodelling
f) stenting
g) coil embolization with stenting.

Homework by Dr Saiful MMed Neurosurgery USM

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