An unruptured aneurysm

An unruptured aneurysm

Abstract

The term aneurysm refers to the weakening or the enlargement of the walls of the artery that creates a bulging or the enlargement of the arterial wall. Most of the aneurysm does not show dangerous symptoms, but the severe stage can rapture that leads to life-threatening internal bleeding. An unruptured aneurysm is characterized by sudden server headache, which is the key symptom, often described as the worst headache. Other common signs and symptoms include difficulty speaking, loss of balance, and visual disturbances. It is vital noting that most aneurysms do not show symptoms and are not dangerous, but at the severe stage, some can rapture and lead to life-threatening internal bleeding.

Keywords: Unruptured, aneurysm, arterial

Introduction

An unruptured aneurysm is the ballooning in a blood artery in the brain that creates a bulge or the enlargement of the arterial walls. The key symptom of the unruptured aneurysm is a sudden severe headache, loss of balance, difficulty speaking, and visual disturbances. The unruptured aneurysm is also likely to cause internal bleeding. The risk of this disease developing and rapturing varies from individuals. However, high blood pressure and smoking are the major risk factors for the development of this disease. Some types of the aneurysm may require surgical treatment to prevent rapture. Operations will only be done to the patient if it is life-threatening. There has been a significant increase in unruptured aneurysm detection due to the use of CT in clinical practice.

Method

The study examines the health journals that look into the key elements or aspects of the aneurysm. The various investigations that relate to the facts about the unruptured aneurysm to examines the prevalence rate and other issues of the condition like the vital signs and symptoms, the prognosis, and the elements of the patient education.

Results

According to the review of the various health journals on the disease that were taken into consideration for the study, the unruptured aneurysm can be life-threatening and often dangerous if not detected during tests in good time. According to research, the prevalence in the adult population is between 1% and 5%; however, 50-80% of all aneurysm do not rapture in the person’s lifetime.  An unruptured aneurysm is common in women than men with a ratio of 3:1. Although the actual cause of this condition is yet to be established, particular factors and conditions are essential in the disease’s higher prevalence. For instance, tissue damages in significant arteries do play a crucial role in the disease. The arteries can, in this way, be harmed by the blockages of deposits such as that of the fatty acids. Such  deposits do trigger the action of the heart to pump even faster and harder than usual to pump the blood past the greasy buildup. This stress can, in some cases, damage the arteries as a result of the higher pressure that is created.

Pathophysiology

Their location in the body classifies an aneurysm, the brain and heart arteries are the common sites of a severe aneurysm. The bulge is likely to take two main shapes, the swelling on both sides of the blood vessels commonly referred to as fusiform aneurysm and the saccular aneurysm that bulges only on one side. The characteristic finding is the decrease in the tunica media, the artery’s middle muscular layer that causes structural defects. These defects, together with the hemodynamic factors, can lead to an aneurysm. The condition is often accompanied by sudden and severer headaches and or other symptoms that are possibly related to a ruptured kind of aneurysms. It often imparts for the vto give the various test to establish if the patient experienced bleeding between the spaces of the brain to differentiate this vfrom a stroke

Genetics

The critical risk factor for this disease is the family history, patients with at least one affected family member have approximately 4% risk of having the unruptured aneurysm, whereas patients with two or more affected first-degree family members have 8%-10% risk of having the disease. However, it does not occur among the people below 50 years; an aneurysm is common among persons above 50 years. It was also noted that approximately 5% to 15% of cases of stroke are related to the unruptured aneurysm.

Biochemistry

A computerized tomography (CT) scan is usually the first test to detect the bleeding in the brain, and a cerebrospinal fluid test can also detect bleeding. The present guidelines recommend screening with the intracranial magnetic resonance imaging for people having immediate relatives suffering from the disease.

Clinical implication

UA may have incidental findings due to complaints that are not related to the disease or detection as they grow and compress the adjacent structures in the brain. These compressions may cause visual field defects, hemiparesis, or seizure. However, other cranial nerves may be involved, this includes the trochlear, and the abduces nerves. The real cause of the aneurysm is not known, but a range of factors may increase one’s risk of getting affected.

Scientific Analysis

The two articles which were considered for the study were Scientific World Journal and Medical News Today. The first article was the most appropriate since it was more detailed and properly organized. The essential elements of the unruptured aneurysm in the report were well stipulated, and this made it simple to comprehend. The second article was equally important. However, it did not dig deeply into the critical elements of the disease as the first article.

Answered questions

The answered question is about the prevalence rate of the disease among women and men and genetically inheritance of the disease among the family members. However, most scientific studies are still aiming at how the rupture risk is affected by location, size, and the age younger than 50 years.  The other unanswered question with the UA is the prevalence rate based on the element of gender. Most scientific studies on the same have not been able to explain which the disease has a considerably higher prevalence in women compared to men.

Conclusion

An unruptured aneurysm is a condition that is common among people above the ages of 50years, mostly adults. An unruptured aneurysm is being detected at a higher rate because the increased use of the imaging services. The unruptured aneurysm can produce no signs mainly if it is small. There are limited historical data that is available for patients with unruptured aneurysm, however, understanding the natural history of the aneurysm is considered necessary in making decisions in the treatment of the disease.

References

1. Briganti F, Napoli M, Tortora F, Solari D, Bergui M, Boccardi E, Cagliari E, Castellan L, Causin F, Ciceri E, Cirillo L. Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis. Neuroradiology. 2012 Oct 1;54(10):1145-52.
2. Brown Jr RD, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. The Lancet Neurology. 2014 Apr 1;13(4):393-404.
3. Heiskanen O. Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. Journal of neurosurgery. 1981 Oct 1;55(4):524-6.
4. Inagawa T, Hirano A. Autopsy study of unruptured incidental intracranial aneurysms. Surgical neurology. 1990 Dec 1;34(6):361-5.
5. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms—the risk of rupture and risks of surgical intervention. New England Journal of Medicine. 1998 Dec 10;339(24):1725-33.
6. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms—the risk of rupture and risks of surgical intervention. New England Journal of Medicine. 1998 Dec 10;339(24):1725-33.
7. Jou LD, Lee DH, Morsi H, Mawad ME. Wall shear stress on ruptured and unruptured intracranial aneurysms at the internal carotid artery. American Journal of Neuroradiology. 2008 Oct 1;29(9):1761-7.
8. Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: the probability of and risk factors for aneurysm rupture. Journal of neurosurgery. 2000 Sep 1;93(3):379-87.
9. Leech PJ, Stokes BA, Apsimon T, Harper C. Unruptured aneurysm of the anterior spinal artery presenting as paraparesis: a Case report. Journal of neurosurgery. 1976 Sep 1;45(3):331-3.
10. Lin N, Cahill KS, Frerichs KU, Friedlander RM, Claus EB. Treatment of ruptured and unruptured cerebral aneurysms in the USA: a paradigm shift. Journal of neurointerventional surgery. 2018 Jul 1;10(Suppl 1):i69-76.
11. Mackey J, Brown RD, Moomaw CJ, Sauerbeck L, Hornung R, Gandhi D, Woo D, Kleindorfer D, Flaherty ML, Meissner I, Anderson C. Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts: differences in multiplicity and location. Journal of neurosurgery. 2012 Jul 1;117(1):60-4..
12. McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, Albuquerque FC. The barrow ruptured aneurysm trial. Journal of neurosurgery. 2012 Jan 1;116(1):135-44.
13. Xiang J, Yu J, Choi H, Fox JM, Snyder KV, Levy EI, Siddiqui AH, Meng H. Rupture Resemblance Score (RRS): toward risk stratification of unruptured intracranial aneurysms using hemodynamic–morphological discriminants. Journal of neurointerventional surgery. 2015 Jul 1;7(7):490-5.
14. Miura Y, Ishida F, Umeda Y, Tanemura H, Suzuki H, Matsushima S, Shimosaka S, Taki W. Low wall shear stress is independently associated with the rupture status of middle cerebral artery aneurysms. Stroke. 2013 Feb;44(2):519-21.
15. Van Rooij WJ, Sluzewski M, van der Laak C. Flow diverters for unruptured internal carotid artery aneurysms: dangerous and not yet an alternative for conventional endovascular techniques.
16. Murthy SB, Shah S, Rao CP, Bershad EM, Suarez JI. Treatment of unruptured intracranial aneurysms with the pipeline embolization device. Journal of Clinical Neuroscience. 2014 Jan 1;21(1):6-11.
17. Inamasu J, Watabe T, Ganaha T, Yamada Y, Nakae S, Ohmi T, Imizu S, Kaito T, Ito K, Nishiyama Y, Hayashi T. Clinical characteristics and risk factors of chronic subdural haematoma associated with clipping of unruptured cerebral aneurysms. Journal of Clinical Neuroscience. 2013 Aug 1;20(8):1095-8.
18. Huang ZQ, Meng ZH, Hou ZJ, Huang SQ, Chen JN, Yu H, Feng LJ, Wang QJ, Li PA, Wen ZB. Geometric parameter analysis of ruptured and unruptured aneurysms in patients with symmetric bilateral intracranial aneurysms: a multicenter CT angiography study. American Journal of Neuroradiology. 2016 Aug 1;37(8):1413-7.
19. Zhang Y, Yang X, Wang Y, Liu J, Li C, Jing L, Wang S, Li H. Influence of morphology and hemodynamic factors on rupture of multiple intracranial aneurysms: matched-pairs of ruptured-unruptured aneurysms located unilaterally on the anterior circulation. BMC neurology. 2014 Dec;14(1):253.
20. Murayama Y, Takao H, Ishibashi T, Saguchi T, Ebara M, Yuki I, Arakawa H, Irie K, Urashima M, Molyneux AJ. Risk analysis of unruptured intracranial aneurysms: prospective 10-year cohort study. Stroke. 2016 Feb;47(2):365-71.
21. Moyes PD. Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms. Journal of neurosurgery. 1971 Sep 1;35(3):291-5.
22. Naggara ON, Lecler A, Oppenheim C, Meder JF, Raymond J. Endovascular treatment of intracranial unruptured aneurysms: a systematic review of the literature on safety with emphasis on subgroup analyses. Radiology. 2012 Jun; 263(3):828-35.
23. Nakagawa T, Hashi K. The incidence and treatment of asymptomatic, unruptured cerebral aneurysms. Journal of neurosurgery. 1994 Feb 1;80(2):217-23.
24. UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. New England Journal of Medicine. 2012 Jun 28;366(26):2474-82.
25. Ujiie H, Sato K, Onda H, Oikawa A, Kagawa M, Takakura K, Kobayashi N. Clinical analysis of incidentally discovered unruptured aneurysms. Stroke. 1993 Dec;24(12):1850-6.
26. Wardlaw JM, White PM. The detection and management of unruptured intracranial aneurysms. Brain. 2000 Feb 1;123(2):205-21.
27. Wiebers DO, International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. The Lancet. 2003 Jul 12;362(9378):103-10.
28. Mehan WA, Romero JM, Hirsch JA, Sabbag DJ, Gonzalez RG, Heit JJ, Schaefer PW. Unruptured intracranial aneurysms conservatively followed with serial CT angiography: could morphology and growth predict rupture?. Journal of neurointerventional surgery. 2014 Dec 1;6(10):761-6.
29. Etminan N, Beseoglu K, Barrow DL, Bederson J, Brown Jr RD, Connolly Jr ES, Derdeyn CP, Hänggi D, Hasan D, Juvela S, Kasuya H. Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group. Stroke. 2014 May;45(5):1523-30.
30. Figueiredo EG, Welling LC, Preul MC, Sakaya GR, Neville I, Spetzler RF, Teixeira MJ. Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms. Journal of Clinical Neuroscience. 2016 May 1;27:34-9.