Vascular Diseases of the Brain

Aneurysm (vein bubbles)

The diseases we call aneurysms which resembles bubbles are usually caused by a weakening of the arteries, in other words, weakening of the vein wall of the arteries, for many reasons. A cerebrovascular aneurysm may develop secondary to cigarette smoking, hypertension, diabetes, and atherosclerosis, but may also be associated with some diseases which are hereditary (such as polycystic kidney disease) that may occur in some patients. The most feared condition in patients with the aneurysm is bleeding. This may sometimes be due to a sudden rise in blood pressure or be unexpectedly even in sleep. The brain aneurysm bleeding is bleeding into the brain and around brain space which filled with cerebrospinal fluid, ie the subarachnoid space. Therefore, they called as subarachnoid hemorrhage (SAH). It is usually life-threatening. Therefore, the necessary treatment and follow-up of patients diagnosed with an aneurysm should be done immediately.

Symptoms:

  1. Headache: Severe headaches can be observed especially in patients with bleeding.
  2. Mental fog and coma: This situation is observed in patients with bleeding and can be life-threatening. Sometimes the patient can lose consciousness in seconds and goes into a coma.
  3. Different types of paralysis, weakness in the arms and legs, speech disorders, urinary, and Gaita incontinence may occur due to hemorrhage.
  4. Depending on the pressure of the aneurysm, the eyelid may fall and cross-eye may occur
  5. Seizures (less frequent)

Diagnosis: The brain aneurysm bleeding is bleeding into the brain and around brain space which filled with cerebrospinal fluid, ie the subarachnoid space. It is immediately and always a life-threatening event. The patient is often encountered in emergency clinics. The first requested examination is Computed Tomography of the Brain (CT). Here, the location and amount of bleeding, as well as other accompanying pathologies in the brain such as hydrocephalus can be detected. After detection of the bleeding, CT-angiography or MR-angiography may be performed to see the vascular structures. One of the most sensitive examinations to evaluate vascular structures is DSA (digital subtraction angiography). With this radiological imaging, the vessels that feed the brain (artery) and let the blood (veins and sinuses) can be seen with all the details and, if available, with vascular pathologies such as an aneurysm.

Treatment: In the surgical treatment, the aneurysm is seen by opening the skull, it is peeled off from the tissues and the neck of the aneurysm is closed to prevent the filling of blood to the aneurysm and the bleeding. In endovascular therapy, the aneurysm inside the brain is filled with special metals by entering like doing the DSA from the inguinal artery, thus preventing the blood from filling and bleeding. The type of treatment is selected after evaluation based on the location and size of the aneurysm, general health status of the patient, patient’s choice, and other conditions.

Follow-up: At the third postoperative month, angiography is performed to confirm the complete closure of the aneurysm. Then clinical follow-up is performed once every three months.

Arteriovenous malformation (AVM)

The diseases that we call AVM are caused by the direct connection between the arteries and veins without capillaries. Since it looks like a glomus appearance, it is also called a glomerulus. It is generally thought that AVMs are congenital and may grow throughout one’s life. In AVMs, the most feared condition is bleeding as well as in aneurysms. In AVMs, cerebral hemorrhage may be into the brain tissue, or more frequently, around into space which filled with cerebrospinal fluid, ie the subarachnoid space. Aneurysm also can be seen with AVM. This situation is usually life-threatening. Patients who are diagnosed with AVM should consult with the neurosurgeon and have the necessary treatment and follow-up.

Symptoms:

  1. Headache: Severe headaches can be observed especially in patients with bleeding.
  2. Seizures: Especially young adults may consult to the doctor with incipient seizures.
  3. Depending on the locations of AVMs, different types of paralysis cases, weakness in the arms and legs, speech disorders, visual disturbances, urinary, and fecal incontinence may occur.
  4. Mental fog and coma can be observed in patients with bleeding and may be life-threatening. Sometimes the patient can lose his/her consciousness in seconds and go into a coma.
  5. Some of the patients have no complaints at all and are detected by chance.

Diagnosis: AVM bleeding is occurred around into space which filled with cerebrospinal fluid, ie the subarachnoid space. Patients are encountered in emergency clinics frequently, and sometimes in neurology clinics with seizures, sometimes in a polyclinic with a simple symptom, sometimes coincidentally. Both lesion and bleeding may be seen in CT or brain MRI. CT-angiography or MR-angiography may be performed to see the vascular structures. One of the most sensitive examinations to evaluate vascular structures is DSA (digital subtraction angiography). With this radiological imaging, the vessels that feed the brain (artery) and let the blood (veins and sinuses) and AVMs can be seen with all the details and, if available, with vascular pathologies such as an aneurysm.

Treatment: AVMs are evaluated according to their locations and sizes. Those with low grade can be usually surgically removed. Stereotactic radiosurgery can be applied to large and deeply located AVMs which cannot be removed by surgery. AVMs can be closed over time with radiation treatments such as Gamma knife or Ciber knife. In the endovascular treatment, the AVM inside the brain is filled with special metals by entering through the inguinal artery and thus filling and bleeding of the blood is prevented. It can be applied to large and deeply located AVMs which cannot be removed by surgery. The type of treatment is selected after evaluation based on the location and size of the AVM, general health status of the patient, patient’s choice, and other conditions.

Follow-up: At the third postoperative month, angiography is performed to confirm the complete closure of the AVM. Then clinical follow-up is performed once every three months.

Cavernous angioma (cavernoma)

Cavernom or cavernous malformation is a vascular anomaly of the brain. In this disease, there are abnormal and swollen veins whose image resembles blackberry. Cavernomas may also cause bleeding, such as other vascular anomalies. However, cavernoma hemorrhages are usually small, different from the aneurysm and AVM hemorrhages, and appear in the form of blood leakage around the lesion. Massive bleeding is rarely seen.

Symptoms: The most common symptoms are headache and seizures. Other complaints are seen rarely. Depending on the location of the cavernomas, different types of paralysis, weakness of arms and legs, speech disorders, loss of vision, etc. may be. Although hemorrhages are rarely life-threatening, cavernoma hemorrhages located in the brainstem may sometimes be life-threatening.

Diagnosis: Although CT is important for the evaluation of the bleeding condition, MRI is essential for the diagnosis of cavernoma. Angio methods have no place for cavernoma diagnosis and can only be used to differentiate from other vascular lesions in suspicious cases.

Treatment: Patients diagnosed incidentally and patients with mild clinical signs or without clinical signs at all may be monitored by intermittent MRI. Surgical treatment should be preferred for cavernomas with bleeding. Surgical removal of cavernomas is the first treatment option. The option of stereotactic radiosurgery can only be used to reduce the possibility of bleeding in cavernomas and to reduce the frequency of seizures in patients with seizures. It doesn’t destroy the cavernoma. The type of treatment is selected after evaluation based on the location and size of the cavernoma, general health status of the patient, patient’s choice, and other conditions.

Follow-up: MRI is performed to the patient once every three months.