2. DEFINITION
• Cerebral aneurysm is cerebrovascular disorder in
which weakness in the wall of the cerebral artery
or vein causes a localized dilation or ballooning
of the blood vessels.
INCIDENCE
• Intracranial aneurysm occurs more in women by
a ratio 3:2.
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4. AETIOLOGY
• The actual cause of aneurysm is not known (Idiopathic)
RISK FACTORS
Any condition that weakens the vascular wall may cause cerebral
aneurysm.
• Uncontrolled Hypertension
• Congenital defects of the vessel wall
• Trauma to the head
• Smoking
• Obesity
• Infections
• Atherosclerosis
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5. CLASSIFICATION OF
ANEURYSM
Saccular Aneurysm
Also known as berry aneurysm appear as a round out pouching. It
is the most common form of cerebral aneurysm.
• Fusiform aneurysm
It represent a widening of a segment of an artery around the
entire blood vessel.
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7. PATHOPHYSIOLOGY
Aneurysm means an out pouching of a blood vessel wall that is
filled with blood. When this enlargement occurs it compresses
against the point of weakness and nerves which finally results in
dissolution of the wall and rupture of aneurysm occurs.
Cerebral aneurysm is prone to rupture, which causes blood to
leak into the subarachnoid space, and sometimes into the brain
tissues where it forms a clot resulting in increased intracranial
brain tissue damage.
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9. CLINICAL MANIFESTATIONS
Before a large aneurysm ruptures, the patient may experience ;
• Sudden and unusual severe headache
• Nausea
• Visual impairment
• Vomiting
• Loss of consciousness
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10. CLINICAL MANIFESTATIONS
If an aneurysm ruptures, blood leaks into the space around the
brain. And this is called subarachnoid hemorrhage. The patient
may experience ;
• sudden severe headache that can last for several hours to
days.
• Nausea and vomiting
• Drowsiness
• Seizures
• Visual abnormalities if the aneurysm is adjacent to the
occular motor nerves.
• There may be pain and rigidity at the back of the neck (nuchal
rigidity) due to meningeal irritation.
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11. DIAGNOSTICINVESTIGATIONS
• CT scan and MRI to determines the type, size and location of
the hematoma and the presence or absence of
hydrocephalus.
• Cerebral angiography to confirm the diagnosis.
• Cerebrospinal fluid analysis to rule out other conditions
• Clinical manifestations
• Physical examination.
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12. MEDICALMANAGEMENT
• Anticoagulant e.g. warfarin
• Anticonvulsants e.g. phenytoin
• Histamine antagonist e.g. cimetidine.
• Analgesics
• Antihypertensives
• Oxygen therapy
• Stool softeners e.g. lactulose .
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13. SURGICAL MANAGEMENT
1. Craniotomy is done and here, the base of the aneurysm is
clipped with a specially designed clip. After clipping , a
catheter angiogram can be performed to confirm complete
clipping.
2. Endovascular coiling
This refers to the insertion of platinum coils into the aneurysm,
The goal of the surgery is to prevent bleeding in an unruptured
aneurysm.
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16. NURSING MANAGEMENT
Rest and Sleep
• Ensure bed rest in a quiet and well ventilated room.
• Put patient in a semi –fowlers position and stabilize patient
with pillows.
• Raise padded side rails.
• Administer prescribed oxygen when necessary.
• Elevate the head of the 15-30 degrees to promote venous
drainage to decrease intra cranial pressure.
• All nursing activities should be done in bulk to prevent patient
from been disturbed when sleeping.
• Manage pain to enable patient to rest.
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17. Observations
• Monitor vital signs 4 hourly and record findings or more
frequently as the condition demands
• Monitor the oxygen saturation of the patient
• Monitor the episodes of seizures with a fit chart.
• Assess for signs of increased intracranial pressure such as
restlessness, irregular breathing pattern etc.
• Observe for changes in behavior such as anxiety and fear.
• Strictly monitor fluid intake and output.
• Monitor for the level of consciousness .
• Assess the level of patient’s pain.
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18. Nutrition
• Parenteral / NG tube feeding is done in the acute stage
• Food should be soft and easy to chew.
• Food should be served in bit ,attractively and at frequent
intervals.
• Patient should be served with fruits and vegetables to
enhance free bowel .
• Restrict the intake of alcohol.
• Serve patient with a well mixed healthy diet, serve in bit at
frequent intervals.
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19. Personal hygiene
• Assist patient to maintain his/her personal hygiene needs,
bath, mouth care etc.
• All soiled linen must be change as soon as possible to prevent
pressure sores.
• Treat all pressure areas.
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20. Patient teaching
• Explain the causes of the disease and management to patient
and family.
• Teach patient on the signs of complications, signs of increased
intracranial pressure and the need for care.
• Educate patient to take in soft and easily chewable foods to
prevent increase in intracranial pressure.
• All items must be well arranged for easy passage and within
reach, since there may be vision impairment.
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