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CEREBROCULAR VASCULAR DISEASES

Aneurysms:

It is popularly known as ballooning of the vein. Aneurysms of the brain vessels are generally enlargements of the vessels (arteries) that carry clean blood. Aneurysms can occur in very large vessels such as the aorta, as well as in small and medium-sized vessels.
Aneurysms are of two types. Ballooning may occur in the form of budding, or it may occur in the form of expansion of the vessel as a whole, which will not be discussed here, and weakening of the vessel wall in this expanded area.
The bubble wall bursts when it cannot withstand the pressure. Explosion either occurs spontaneously or occurs through activation of the body that requires excessive effort, such as coughing, straining, or sexual intercourse, and causes increased intracranial pressure.

Who Occurs Aneurysm?

  • – Deficiencies in the vascular wall (congenital)
  • – Arteriosclerotic or hypertensive changes in the vessel wall
  • – Traumatic (head injuries resulting from assault or accident)
  • – It may be due to infection

What are the Risk Factors?

  • – Hypertension
  • – Smoking
  • – Oral contraceptives (Birth control drugs)
  • – Alcohol (Suspicious)
  • – Cocaine
The majority of people with aneurysms have no complaints. However, sometimes migraine-like or non-specific headaches may occur. In addition, in cases where the aneurysm is large, symptoms may occur due to mass effect, causing pressure on the structures in the adjacent regions of the brain.
If the aneurysm reaches a significant size, it may coincidentally show symptoms of the cranial nerves (such as paralysis of the optic nerve) on a tomography or MRI scan taken for other reasons. This is the most common condition that occurs as a result of bleeding. It occurs after the aneurysm bursts and can be fatal. Bleeding may occur as a leak between the brain membranes (subarachnoid hemorrhage) or into the brain tissue.
Bleeding caused by the rupture of the aneurysm begins with a very severe headache that occurs suddenly. Patients often express this situation as “lightning struck my head.” After the headache, it may occur with neck pain and stiffness, vomiting, impaired consciousness depending on the type and severity of bleeding, and sometimes lower back pain.

How is aneurysm diagnosed?

  • – Patients who have no complaints are not screened for an aneurysm.
  • – If there is a complaint, the first thing to do is to consult a neurologist or brain surgeon.
  • – Patients often apply to the emergency room for bleeding that occurs when the aneurysm ruptures.
  • – In aneurysms, the first brain tomography taken without medication gives sufficient information about whether there is bleeding.
  • – In the second stage, angiography using computerized tomography, MR angiography or digital catheter angiography must be performed.

Arteriovenous malformation (AVM)

Arteriovenous Malformations (AVM), also known as a vascular ball, is a disease that occurs when the brain’s arteries and veins merge into a ball without capillaries in between. AVMs are congenital pathologies and tend to grow with age and change from low flow to medium-high flow and high pressure lesions. It occurs at an average rate of 0.14% and is slightly more common in men. Since they are congenital, there is a lifelong risk of bleeding.
How it appears:
  • – Most commonly with bleeding
  • – With seizures (fainting-epilepsy seizures)
  • – With symptoms of pressure formations due to mass effect
  • – Since the blood flow in AVMs is high, it reduces the blood supply to the surrounding brain tissues (steal effect) and causes the symptoms that occur as a result
  • – With findings of increased intracranial pressure
The most common age for bleeding is 15-20 years of age. 10% result in death. There is a 30-50% risk of neurological disorder for each bleeding. Small AVMs bleed more often than large AVMs.
Aneurysm may also be present in 7% of patients with AVM and is often on the feeding artery.
Diagnosis is made with computed tomography, MRI and Angiography. Angiography should be performed to see especially the feeding and draining vessels.

Brain Hemorrhages

We can examine intracranial hemorrhages in two parts: those due to trauma and those not due to trauma.
Non-Traumatic Brain Hemorrhages
These are sudden hemorrhages that occur in different parts of the brain tissue and develop as a result of damage to the brain vessels due to various reasons, without any trauma to the brain tissue.
It accounts for 15-30% of strokes, but is the most fatal.
Its difference from ischemia is that it develops slowly, lasting from minutes to hours, and often causes severe headache, vomiting and changes in the level of consciousness.
Non-contrast computed tomography (CT) is preferred in initial diagnostic workup.
The amount of blood is associated with the risk of seizures and death
The clot expands within the first 3 hours in at least 33% of cases
Angiography is recommended in young patients and those without a previous history of hypertension or stroke, unless it prevents urgent treatment.
Risk factors
Age: Its incidence increases significantly after the age of 55 and doubles every 10 years until the age of 80. At age 80, the prevalence is 25 times higher than in the previous decade.
Gender: It is much more common in men.
Race: In the USA, it affects black people more than white people. This may be related to the fact that hypertension is more common in blacks than whites. The frequency may be higher in Easterners.
Previous SVA (stroke) (any type) increases the risk by 23:1.
Alcohol intake.
Smoking: is among the risk factors because it damages the vascular structure.
Hypertension: It is the most important reason for the formation of this disease. Especially uncontrolled hypertension is a great risk.
Diabetes: Uncontrolled diabetes damages the vascular structure and increases the risk of bleeding.
Drugs used: The use of blood thinners prescribed for some diseases, and the use of illegal drugs that fall into the drug group can cause this disease by causing changes in the vascular structure.
Migraine: during or following a migraine attack (probably a very, very rare event)
Physical factors: Excessive physical load, exposure to cold…
Due to vascular anomalies (Arteriovenous malformation rupture or aneurysm bleeding. Rarely venous angioma bleeding)
Arteriopathies: Amyloid angiopathy, cerebral arteritis, fibrinoid necrosis, etc.
Rarely, it may be due to a brain tumor.
Coagulation or coagulation disorder diseases.
Those receiving anticoagulant and thrombolytic therapy.
What causes this disease is the rupture of a blood vessel in the brain and bleeding. This bleeding may last from a few minutes to an hour. Sometimes it may last up to a few days as a leak.
Depending on the duration and severity of bleeding; sudden onset of headache, fainting, seizure, nausea, vomiting, loss of consciousness. These complaints occur suddenly. But its severity may vary depending on the patient and the location of the bleeding in the brain. Edema and ischemic necrosis around hemorrhage may cause delayed deterioration.
Diagnosis: It is made by CT. CT is fast and easily shows blood in the brain immediately after a hemorrhage. Clot volume is important. Volume can be measured on CT, with little change in volume in the first 2 weeks. MRI is usually not necessary initially. It does not show blood well in the first few hours. It is difficult to ensure breathing in an unconscious patient during the shooting. Cerebral Angiography can show AVMs and aneurysms when they are associated with bleeding. Gain may increase if the study is delayed.
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