Cannabinoids in the Treatment of Cerebral Aneurysm
Cerebral Aneurysm
An aneurysm is a weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out. When an aneurysm occurs in a blood vessel of the brain, it is a cerebral aneurysm.
Causes
Aneurysms in the brain occur when there is a weakened area in the wall of a blood vessel. An aneurysm may be present from birth (congenital) or it may develop later in life, such as after a blood vessel is injured.
There are many different types of aneurysms. A berry aneurysm can vary in size from a few millimeters to over a centimeter. Giant berry aneurysms can reach well over 2 centimeters. These are more common in adults. Multiple berry aneurysms are inherited more often than other types of aneurysms.
Other types of cerebral aneurysm involve widening of an entire blood vessel, or they may appear as a "ballooning out" of part of a blood vessel. Such aneurysms can occur in any blood vessel that supplies the brain. Atherosclerosis, trauma, and infection, which can injure the blood vessel wall, can cause cerebral aneurysms.
About five percent of the population has some type of aneurysm in the brain, but only a small number of these aneurysms cause symptoms or rupture. Risk factors include a family history of cerebral aneurysms, and certain medical problems such as polycystic kidney disease, co-arctation of the aorta, and high blood pressure.
A common location of cerebral aneurysms is on the arteries at the base of the brain, known as the Circle of Willis. Approximately eighty five percent of cerebral aneurysms develop in the anterior part of the Circle of Willis, and involve the internal carotid arteries and their major branches that supply the anterior and middle sections of the brain.
Cerebral aneurysms are classified by size and shape. Small aneurysms have a diameter of less than (15 mm). Larger aneurysms include those classified as large (15 to 25 mm), giant (25 to 50 mm), and super giant (over 50 mm). Saccular aneurysms are those with a saccular outpouching and are the least common form of cerebral aneurysm. Berry aneurysms are saccular aneurysms with necks or stems resembling a berry. Fusiform aneurysms are aneurysms without stems.
Symptoms
A person may have an aneurysm without having any symptoms. This kind of aneurysm may be found when an MRI or CT scan of the brain is done for another reason.
A cerebral aneurysm may begin to "leak" a small amount of blood. This may cause a severe headache that a patient may describe as "the worst headache of my life." Another phrase used to describe this is a sentinel headache. This means the headache could be a warning sign of a rupture days or weeks after the headache first happens.
Symptoms may also occur if the aneurysm pushes on nearby structures in the brain or breaks open (ruptures) and causes bleeding into the brain.
Symptoms depend on the location of the aneurysm, whether it breaks open, and what part of the brain it is pushing on, but may include:
Double vision
Loss of vision
Headaches
Eye pain
Neck pain
Stiff neck
A sudden, severe headache is one symptom of an aneurysm that has ruptured. Other symptoms of an aneurysm rupture may include:
Confusion, lethargy, sleepiness, or stupor
Eyelid drooping
Headaches with nausea or vomiting
Muscle weakness or difficulty moving any part of the body
Numbness or decreased sensation in any part of the body
Seizures
Speech impairment
Stiff neck (occasionally)
Vision changes (double vision, loss of vision)
NOTE: A ruptured aneurysm is a medical emergency.
Most cerebral aneurysms go unnoticed until they rupture or are detected by brain imaging.
What are the dangers?
Aneurysms may burst and bleed into the brain, causing serious complications, including hemorrhagic stroke, permanent nerve damage, or death. Once it has burst, the aneurysm may burst again and bleed into the brain, and additional aneurysms may occur. More commonly, rupture may cause a subarachnoid hemorrhage — bleeding into the space between the skull bone and the brain. A delayed but serious complication of subarachnoid hemorrhage is hydrocephalus, in which the excessive buildup of cerebrospinal fluid in the skull dilates fluid pathways called ventricles that can swell and press on the brain tissue. Another delayed postrupture complication is vasospasm, in which other blood vessels in the brain contract and limit blood flow to vital areas of the brain. This reduced blood flow can cause stroke or tissue damage.
How are cerebral aneurysms treated?
Not all cerebral aneurysms burst. Some people with very small aneurysms may be monitored to detect any growth or onset of symptoms and to ensure aggressive treatment of coexisting medical problems and risk factors. Each case is unique, and considerations for treating an unruptured aneurysm include the type, size, and location of the aneurysm; risk of rupture; the individual’s age, health, and personal and family medical history; and risk of treatment.
Two surgical options are available for treating cerebral aneurysms, both of which carry some risk to the individual (such as possible damage to other blood vessels, the potential for aneurysm recurrence and re-bleeding, and the risk of post-operative stroke).
Microvascular clipping involves cutting off the flow of blood to the aneurysm. Under anesthesia, a section of the skull is removed and the aneurysm is located. The neurosurgeon uses a microscope to isolate the blood vessel that feeds the aneurysm and places a small, metal, clothespin-like clip on the aneurysm’s neck, halting its blood supply. The clip remains in the person and prevents the risk of future bleeding. The piece of the skull is then replaced and the scalp is closed. Clipping has been highly effective, depending on the location, shape, and size of the aneurysm. In general, aneurysms that are completely clipped surgically do not return.
A related procedure is an occlusion, in which the surgeon clamps off (occludes) the entire artery that leads to the aneurysm. This procedure is performed when the aneurysm has damaged the artery. An occlusion is sometimes accompanied by a bypass, in which a small blood vessel is surgically grafted to the brain artery, rerouting the flow of blood away from the section of the damaged artery.
Endovascular embolization is an alternative to surgery. Once the individual has been anesthetized, the doctor inserts a hollow plastic tube (a catheter) into an artery (usually in the groin) and threads it, using angiography, through the body to the site of the aneurysm. Using a guide wire, detachable coils (spirals of platinum wire) or small latex balloons are passed through the catheter and released into the aneurysm. The coils or balloons fill the aneurysm, block it from circulation, and cause the blood to clot, which effectively destroys the aneurysm. The procedure may be performed more than once during the person’s lifetime.
People who receive treatment for aneurysm must remain in bed until the bleeding stops. Underlying conditions, such as high blood pressure, must be treated. Other treatment for cerebral aneurysm is symptomatic and may include anticonvulsants to prevent seizures and analgesics to treat headache. Vasospasm can be treated with calcium channel-blocking drugs and sedatives may be ordered if the person is restless. A shunt may be surgically inserted into a ventricle several months following rupture if the buildup of cerebrospinal fluid is causing harmful pressure on surrounding tissue. Individuals who have suffered a subarachnoid hemorrhage often need rehabilitative, speech, and occupational therapy to regain lost function and learn to cope with any permanent disability.
Expectations (prognosis)
The outcome varies. Patients who are in deep comas after an aneurysm rupture generally do not do as well as those with less severe symptoms.
Ruptured cerebral aneurysms are often deadly. About twenty five percent of people die within one day, and another twenty five percent die within about three months. Of those who survive, about twenty five percent will have some sort of permanent disability.
Complications
Increased pressure inside the skull
Loss of movement in one or more parts of the body
Loss of sensation of any part of the face or body
Seizures
Stroke
Subarachnoid hemorrhage
Prevention
There are no known ways to prevent a cerebral aneurysm from forming. People with a diagnosed brain aneurysm should carefully control high blood pressure, stop smoking, and avoid cocaine use or other stimulant drugs. They should also consult with a doctor about the benefits and risks of taking aspirin or other drugs that thin the blood. Women should check with their doctors about the use of oral contraceptives. Controlling risk factors for atherosclerosis may reduce the likelihood of some types of aneurysms. If unruptured aneurysms are discovered in time, they can be treated before they cause problems. Repairing an unruptured cerebral aneurysm is a decision based on many factors (age, general health, size and location).
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