Speaking of bombs
everyone knows about it from news, movies, and novels
Its power is huge
Its destructive power and lethality are very strong
If it is not discovered and eliminated in time
the consequences will be disastrous
But
if this bomb is not timed, The bomb
grows in our brains. What consequences will
have on our bodies?
Guests in this issue
Shanghai Fifth People's Hospital Affiliated to Fudan University
Director of Neurosurgery Chief Physician
Li Jun
Why is cerebral aneurysm said to be a "time bomb in the brain"?
Cerebral aneurysm is not actually a tumor. It is a balloon-shaped, spindle-shaped or dissection-like vascular abnormality formed on the blood vessel wall due to congenital or acquired wall structural defects in the arterial vessel wall due to the impact of blood flow. . It can be single or multiple at the same time. Because the aneurysm wall is weak, cerebral aneurysms may rupture and bleed under the continuous impact of blood flow. However, we cannot know when or under what circumstances it will break. So, to us, a brain aneurysm is a ticking time bomb in the brain.
Is brain aneurysm what we often call stroke ?
Let’s start with cerebral hemorrhage . Cerebral hemorrhage is a major category of stroke, including intraparenchymal hemorrhage, subarachnoid hemorrhage, etc. Cerebral aneurysms are the leading cause of subarachnoid hemorrhage. Cerebral aneurysm itself is not a stroke, but it is one of the high-risk factors for hemorrhagic stroke. Once it ruptures, it can lead to subarachnoid hemorrhage, intraventricular hemorrhage or cerebral hemorrhage. If the size of aneurysm continues to increase, it may also compress the cranial nerves and cause neurological dysfunction. For example, some aneurysms can compress the oculomotor nerve that controls the eyeball, causing oculomotor nerve paralysis, eyelid ptosis, , and eye movement disorders.
The most common cause of ruptured brain aneurysm is subarachnoid hemorrhage, which accounts for 2%-7% of all strokes, but accounts for 27% of stroke deaths.
Is the incidence of brain aneurysm high?
Based on the population, its annual incidence rate is about 7%, which means that 7 out of 100 adults may have a cerebral aneurysm.
Cerebral aneurysms can occur at any age, but the incidence rate is highest in the 50-69 age group, accounting for approximately 2/3 of the total prevalence. Women are slightly more likely to have it than men, with the former accounting for 56%. Among patients with bleeding, about 1/3 died before treatment, another 1/3 died in the hospital, and only 1/3 survived after treatment. However, survival can also be divided into completely self-care, partial self-care, inability to take care of oneself, and coma or vegetative state, which are very different. It can be seen that cerebral aneurysm is still one of the most common cerebrovascular diseases that cause death and disability in humans today. Cerebral aneurysm rupture and bleeding have seasonal and diurnal tendencies. For example, when autumn and winter overlap with winter and spring, they are more likely to occur in the early morning and at night. It may be related to blood pressure fluctuations, vasoconstriction and increased blood pressure caused by seasonal and temperature fluctuations.
What are the high-risk groups?
At present, as the incidence of hyperglycemia , hyperlipidemia, diabetes and cardiovascular and cerebrovascular diseases is getting higher and higher, cerebral vascular diseases that can kill people instantly have begun to occur more frequently, high blood pressure , diabetes, high blood pressure, etc. Patients with dyslipidemia, long-term headaches, or a family history of the disease are at greater risk of developing cerebral aneurysm. Therefore, examinations such as brain CT angiography or magnetic resonance angiography (MRI) should be carried out in a routine physical examination.
This disease is more common in women, and it also occurs in young people.
What factors in life are the causes of cerebral hemangioma?
Worry, tension, excitement, sudden increase in blood pressure, urination and defecation, exertion, late pregnancy, childbirth, physical labor, sexual life, etc. are only the predisposing factors for aneurysm rupture. More often than not, bleeding occurs suddenly with no obvious trigger.
Can an ordinary physical examination detect it?
Generally speaking, it is necessary to examine intracranial blood vessels. There are three inspection methods:
. Computed tomography angiography (CTA); . Magnetic resonance angiography (MRA); 3. Digital subtraction angiography (DSA) . Among the three methods of
, DSA is the most accurate method, followed by CTA, and then MRA. However, DSA is a traumatic examination; CTA is not invasive, but requires the injection of contrast agent ; MRA is not invasive and does not require the injection of contrast agent. As a screening method, you can choose CTA or MRA. If a cerebral aneurysm is found during CTA or MRA, generally speaking, it is best to do DSA for confirmation. With the continuous development of medical examination technology, the detection rate of cerebral aneurysms by CTA and MRA is getting closer and closer to that of DSA. Therefore, screening for brain aneurysms is easy and very important.
When symptoms appear, you need to be more vigilant?
(1) Compression symptoms: This is the most common and typical early symptom of patients with brain aneurysms. Generally speaking, as long as the patient has an aneurysm in the brain, there will be varying degrees of compression. Moreover, the compression symptoms will become more and more severe as the size of the aneurysm body increases. After the tumor increases, headache may occur. It is located in the orbit of the diseased side and is pulsating. It may also cause symptoms such as exophthalmos, ptosis, limited eyeball abduction, motor aphasia, mental disorder, and epistaxis.
(2) Subarachnoid hemorrhage: If a cerebral aneurysm ruptures, it usually leads to the symptoms of subarachnoid hemorrhage. At this time, the accompanying symptoms include severe headache, nausea and vomiting, etc.
(3) Premonition of rupture: If the aneurysm expands, the patient will often feel headache, eye pain, vision loss, nausea and other symptoms. The appearance of these symptoms is likely to be a sign of rupture of the cerebral aneurysm. Patients must pay attention to it. Otherwise, brain bleeding will have serious consequences.
(4) Pain: Patients with cerebral aneurysm will have particularly obvious local pain in the early stages of the disease. Moreover, there may also be symptoms such as neck stiffness, dizziness, or sensory impairment .
During an acute attack, if unknown symptoms such as sudden pain in the head, nausea, coma, numbness of the limbs, and inability to open the eyes occur, great attention should be paid to it, and brain CT and other examinations should be performed in the hospital to find out the cause in time. Once a cerebrovascular disease such as an aneurysm is discovered, perform surgery immediately and never "wait".
Reporter: Gao Shanshan
Editor: Jin Jing Mao Haiping
