I.v drrug abuse – a cause of multiple aneurysms in brain
INTRACRANIAL ANEURYSMSDR VINEET SAGGARM.B.B.S, MS, MCH(NEUROSURGEY)CONSULTANT DEPARTMENT OF NEUROLOGICAL ASPINAL SURGERYIVY SUPERSPECIALITY HOSPITAL SEC-71, MOHALPUNJAB
I.V DRRUG ABUSE – A CAUSE OFMULTIPLE ANEURYSMS IN BRAIN?- Neurovascular surgery( surgery of blood vessels in brain)is technically most demanding of neurosurgical procedures- A rare neurovascular surgery was performed at ivy hospital few days back- A 35 years old male I/V drug abuser was admitted in our hospital with headache followed by loss of consciousness. .Patient had experienced similar episode few days back which was ignored by local general practitioner and he was discharged on analgesics
Before coming to us he was seen by neurosurgeons in tricity and was refused treatment due to risk involved in the surgery We did angiography of brain vessels and found not one but three ANEURYSMS( Balloon like dilatation in wall of brain vessels) in his brain vessels , one of which has burst causing massive hemorrhaged in his brain
Plain Ct Head showing DiffuseSub Arachnoid Haemmorage
WHAT ARE ANEURYSMS A cerebral or brain aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel. The general incidence of aneurysms in the population at large is of the order of 1%-2% Multiple aneurysms occur in 0.2% of the population
SIGNS AND SYMPTOMS Most common symptom is sudden severe headache that can last from several hours to days nausea and vomiting drowsiness and/or coma
The ruptured aneurism (hemorrhage) may also damage the brain directly, usually from bleeding into the brain itself. This is called a “hemorrhagic stroke.” This can lead to: weakness or paralysis of an arm or leg trouble speaking or understanding language vision problems seizures
CAUSES Aneurysms may result from congenital defects(MOST COMMON CAUSE), Preexisting conditions such as high blood pressure and atherosclerosis (the buildup of fatty deposits in the arteries), or head trauma. Cerebral aneurysms occur more commonly in adults than in children but they may occur at any age. They are more common in women than in men, by a ratio of 3 to 2.
TREATMENTCurrently there are two treatment options for securing intracranial aneurysms: Surgical clipping or Endovascular coiling
SURGERY V/S COILING Although endovascular coiling is associated with a shorter recovery period as compared to surgical clipping, it is also associated with a significantly higher recurrence rate after treatment Also coiling may not be the best options in patients with giant aneurysms , wide neck aneurysms or patients with massive bleed or large clots in brain as was in our case .
A YOUNG 25 YEAR MALE WITHANEURYSM RUPTURE -Acandidate for Surgery