How to treat a burst brain

Cerebral artery aneurysm bleeding

Brain [arteries] aneurysm bleeding: Cerebral haemorrhage after a vascular sac (aneurysm) in the brain ruptures or ruptures. The main symptom is the sudden onset of annihilation headache, which spreads over the entire head and is often accompanied by neck stiffness, nausea and neurological failure symptoms. Bleeding of the brain aneurysms occurs mainly in middle age between 40 and 60 years, smokers and high blood pressure patients have a significantly higher risk.

A ruptured cerebral artery aneurysm requires immediate neurosurgical or endovascular treatment in the hospital. The prognosis is serious: a third of the patients die within the first 4 weeks after the cerebral haemorrhage, a third remain in need of care.

Leading complaints

  • Suddenly severe headache ("annihilation headache")
  • Nausea, vomiting, photophobia
  • Neurological abnormalities, e.g. B. Double vision, seizures, paralysis or speech disorders
  • Often stiff neck
  • Clouding of consciousness up to unconsciousness.

When to the doctor

Today if

  • Headache associated with mild neck stiffness

Call the ambulance immediately, if

  • Headaches occur with unprecedented strength
  • Neck stiffness, vomiting or neurological deficits can also occur.

The illness

Brain artery aneurysms are bulges from cerebral vessels, especially arteries at the base of the brain. They occur in around 2% of the general population, and slightly more common in older people. Aneurysms don't have to burst and bleed, in many cases they go unnoticed for life.

Most aneurysms are balloon-like in shape, and less often the affected vessel is also enlarged in a spindle-shaped manner. Aneurysms can have a diameter of less than 2 mm (microaneurysm) or, as so-called giant aneurysms, they can be over 25 mm in size. The larger an aneurysm, the greater the risk of it rupturing. Aneurysms less than 7 mm are considered small and have a relatively low risk of rupture of 1% per year.

Disease origin and course

Brain artery aneurysms develop in the course of life, the cause of their formation is still unclear. Damage to the vascular wall caused by high blood pressure, calcification or inflammation, which may be promoted by congenital weak points in the vascular walls, is discussed. Over time, the bulges widen more and more and the vessel wall becomes thinner and thinner until it finally ruptures (aneurysm rupture) and the blood flows out at high pressure. 2/3 of these ruptures occur spontaneously at rest, 1/3 is triggered by physical exertion.

Depending on where the aneurysm is and in which direction the blood is emerging, different situations arise:

  • Most often, the blood flows between the meninges. Such a subarachnoid hemorrhage (SAB) manifests itself in the most severe headache that has never been experienced before ("annihilation headache").
  • Less often, the blood flows into the surrounding brain tissue. This cerebral hemorrhage (intracerebral hemorrhage) leads to failure symptoms such as paralysis and speech disorders and causes up to 15% of strokes.

Risk factors

Smoking, alcohol abuse, and high blood pressure increase the risk of an aneurysm growing and eventually rupturing. Genetic factors also apparently play a role in the formation of aneurysms; in so-called aneurysm families, the disease is four times as common as in the normal population.

Complications

Cerebral haemorrhages are serious conditions and can lead to a number of complications. The most important are

  • Increase in intracranial pressure, especially in the case of heavy bleeding
  • Hydrocephalus (head of water) due to disruption of the liquor circulation (also possible as a late consequence due to healing-related adhesions)
  • Vascular cramps (vasospasms) and subsequent reduced blood flow due to vasoconstricting substances in the blood breakdown products. The result is neurological abnormalities such as B. paralysis or speech disorders (ischemic stroke)
  • Epileptic seizures
  • Bleeding into the vitreous humor (particularly unfavorable prognostic).

warning sign

The aneurysm does not always burst without warning. In about 30–50 of the bleeding of the brain aneurysms there is a small warning bleeding with moderate but persistent headache and sometimes a "somewhat stiff neck" hours to days beforehand. In some cases, large aneurysms also press on surrounding structures. If this affects the eye muscle nerves, this leads to disorders such as eye muscle paralysis or double vision. Such complaints must be clarified immediately, as they can indicate an impending aneurysm rupture.

Diagnostic assurance

If aneurysm bleeding is suspected, the doctor immediately has a CT scan or an MRI performed, on which the bleeding is usually visible. Modern techniques allow vascular imaging in the same examination to determine the location of the aneurysm. Only if no bleeding is visible is a lumbar puncture followed by a CSF test for blood detection.

Differential diagnoses. Sudden extreme headaches are also found in sinus vein thrombosis, other intracerebral hemorrhages, meningitis and the rare primary thunderbolt headache.

treatment

All patients with bleeding of the cerebral aneurysms must be treated in hospital; intensive care is usually required.

The risk of renewed bleeding is particularly high shortly after the first bleeding; the mortality rate with such a second bleeding is 70–90%. The patient's outlook is therefore best if the neurosurgeons switch off the aneurysm as early as possible, either by operative clamping (clipping) or by pushing a metal coil into the aneurysm over a vascular catheter that is supposed to "plug" the aneurysm (coiling).

  • Clipping or coiling? The radiologist, neurosurgeon and patient or family member decide together which of the two procedures is used. In general, it can be said that doctors often recommend somewhat less invasive coiling for older patients with other underlying diseases, simple aneurysms with a narrow neck and a lack of intracerebral bleeding. The more complex clipping, on the other hand, is more suitable for younger patients without concomitant diseases, complex aneurysms with a wide neck and accompanying intracerebral bleeding.

If the patient is doing very badly or if he comes to the hospital too late (in the case of a milder outcome), the doctors wait before the operation because the risk of a stroke from an intervention would be too great. Because from the 3rd day on, the blood vessels in the brain cramp in response to the bleeding. These cramps resolve on their own after about two weeks, but can lead to circulatory disorders in the meantime.

Accompanying basic measures

Regardless of when the operation is performed, doctors prescribe vasodilator drugs such as nimodipine to improve blood flow to the brain during the period of vascular spasms. In order to reduce any stress, the patient is given sufficient pain relievers, e.g. B. metamizole or opioids. The blood pressure is adjusted so that the systolic pressure does not exceed 160 mmHg. Since a rise in blood pressure can trigger renewed bleeding, the person concerned must not get up and exert himself - not even when defecating, which is why he is prescribed laxatives.

After the hospital stay, similar to the procedure for a stroke, further rehabilitation measures are often required over a period of months.

forecast

The prospects are relatively good for slightly ill patients, but poor for initially unconscious patients - for them the mortality rate is around 80%.

A third of patients die before reaching hospital or within 30 days after the cerebral haemorrhage. One third remains dependent on permanent care, one third manages to cope with everyday life independently again, with permanent consequences such as concentration or memory disorders often remaining.

About 10% of patients with bleeding from the brain aneurysm develop hydrocephalus. Long-term hydrocephalus may require permanent liquor drainage.

Your pharmacy recommends

Anyone who has a small, accidentally discovered cerebral artery aneurysm that is regularly checked by doctors can reduce the risk of rupture by making the following lifestyle changes.

  • Treat high blood pressure. High blood pressure damages the blood vessels. You should therefore take your antihypertensive drugs consistently and have your blood pressure values ​​checked regularly.
  • Drink less alcohol. Like smoking and high blood pressure, alcohol abuse is one of the risk factors for bleeding aneurysms. Moderate alcohol consumption for men is no more than approx. 20 g alcohol per day (this corresponds to approx. 0.5 l beer or 0.2 l wine), for women no more than approx. 10 g (i.e. approx. 0.25 l beer or 0.1 l wine).
  • Have the aneurysm monitored. Make sure you have regular check-ups with your doctor so that he or she can see at an early stage whether the pouch has changed.

Authors

Dr. med. Nicole Menche in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 13:31


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.