Prevention
Aneurysm, AVM & Related Vascular
information
Welcome to my home page
My name is Ann Jarick, I live in Brisbane. In April 2002,
I had been having several tests to see why I was loosing sight in my left
eye. After several test's I was diagnosed with having a giant aneurysm.
The description given, centred the aneurysm within the left suprasellar
cistern, it had abroad based origin from the poster omedial and measured
1.3cm x 1.3cm x 1.9cm. (behind the eye on the artery leading to the brain).
The aneurysm was pressing on the optic nerve. After learning about this
life threatening situation I needed to know more about my condition, the
doctors gave me a general out line as to what to expect, however, I decided
to seek information from the web. Having being diagnosed, and understanding,
the seriousness of the aneurysm and knowing the possibilities of
it rupturing set my life in a spin. I became extremely stressed out mainly
because of the unknown factor, would I survive until surgery? Firstly,
there was the decision by the doctors whether to coil the aneurysm or to
surgically clip the artery.
After having to wait three months, I was admitted to Royal Brisbane Hospital and doctor's coiled the aneurysm in a five and a half hour operation. I recovered extremely well and still continuing in good health. I am to have regular checkups to ensure all is still in tact and no leakage's. Because of it being such a large aneurysm there is still some doubt if the amount of coiling done, was totally sufficient.As there must be other people in similar circumstances wanting to know what an aneurysm is, along with all the information surrounding the implications of surgery, recovery from surgery and in some cases not surviving. It was then I decided to compile information I had collated into a web page for others seeking the same information I needed to know.In searching for answers, I found other interesting connections to aneurysm's such as AVM's and other related medical conditions that may be of interest to viewers.I hope the information I have collected will give you an insight into what an aneurysm is, where they occur in the body, and that it has allowed you to understand the serious nature of the ever increasing medical condition. Aneurysm's do not have the same public awareness as cancer or heart attacks but with research being conducted in UK, USA, Canada and Australia, this awareness is being lifted.
I would like to also dedicate this web page to Dr. Ken Mitchell, the doctor who had the courage to attempt and coil my very large aneurysm. I am truly grateful for his skill and success and I will be forever in his debt, and speical thanks to my family and Fiona Simpson, for all their love and support. I must also stress I am not a medical practioner , all care has been taken to compile this information, however, no gurantee is given re medical condition, diagnosis, treatment and options etc., these must be confirmed by a medical practioner.
Thank you for taking the time to visit and if there is anything you would like to add with a personal story, then please e-mail me at kirajar@optusnet.com.au EmailMe.
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Prevention
Natural Remedies
Research
1. Aneurysm information
Aortic Aneurysm
3. Carvenous Malformation
5. Vein of Galin Arteriovenous fistula
7. About me.
Appendix -
Prevention
How can I prevent an aneurysm? Know if you are at risk and take appropriate steps to keep an aneurysm from forming. If you have a family history of stroke or heart disease, make changes in your diet and lifestyle to improve your overall health. Keeping your mind and body relaxed may prevent an aneurysm from worsening. Exercise regularly, and if you smoke, stop.
Stress Management can reduce blood pressure, exercises such as:
Tai chi, slow walking and meditation can all contribute to a healthier
body and mind and the mind is the strongest healer of all.
View the Reference (http://webmd.lycos.com/content
/article/1680.54611)
Natural remedies
Homoeopathy: For small relatively benign aneurysm or as a preventative for someone at high risk of developing an aneurysm, a professional homoeopath might recommend Baryta carbonic to tone and strengthen arterial walls.
Health Inc. have reported that a deficiency in copper could be a
contributing factor to weakening arteries.
View the Reference (http: Yet to be added.)
Research
Who is most at risk? Abdominal aortic aneurysm (AAA) - (pronounced
Triple A) is aboutfour times more common in men than in women and more
common among Caucasian men than African-American men. AAA is the third
leading cause of sudden death in men in the U.S.A an estimated 2.7 million
Americans over the age of 60 currently have AAA. View
the Reference (http://www.maavm.org/site/index.cfm?content_id=7).
British Medical Journal has further information has information
on trial screening for abdominal aortic aneurysm in women View
the Reference(http://bmj2002;325;1123-1124(16 November))
Radiation limits narrowing of arteries after stent, 150,0000 patients in US per year suffer from artery narrowing after placement of stent.
The results of a trial directed by the Harvard Clinical Research Institute and the Cardiovascular Data Analysis Centre indicate there may be an effective alternative to placement of the stent to prevent artery narrowing after angioplasty. That alternative is intracoranary radiation therapy, or "brachytherapy". This technology information is available to be read at View the Reference (http://www.researchmatters.harvard.edu/story.php?article_id=197)
Research Group at Brunel University, Uxbridge, Middlesex (M J Buxton Health Economics) (martin.buxton@brunel.ac.uk) found in a four year study that screening for aortic aneurysm's was acceptable to the NHS (UK)threshold, However, over a ten year period the cost effectiveness would improve substantially, the predicted ratio at ten years falling to around a quarter of the four year bracket.View the Reference (http://bmj.com/cgi/content/abstract/325/7373/1135?maxtoshow).
Aneurysm's
1 Aneurysm Information
Aneurysm Overview
An aneurysm often produces either, no symptoms or mild symptoms, eg., headache or back pain, the majority give no symptoms at all.
Other symptoms may occur:
An aneurysm is a bulging out of a section of the wall of a blood
vessel. It forms where the wall has weakened. Aneurysm's can be a complication
from high blood pressure (hypertension), it can be an inherited condition
or due to a build-up of plaque. View
the Reference (http://www.healthcentreonline.com.aneurysm)
If left untreated an aneurysm may tear or rupture. Ruptures are very painful and can cause massive internal bleeding. The patient should be treated within minutes in order to have a chance of survival. If an aneurysm ruptures in the brain, it could cause haemorrhagic stroke. If an aneurysm burst in the chest, there is only a 20 percent chance of survival. Early diagnosis and treatment are critical.
There are a number of different types of aneurysm's, which include the following:
Symptoms
What causes aneurysm's, and why do they rupture?
Aneurysm's form in an area of the blood vessel wall that is already weakened or has a defect. The exact cause of the formation of the aneurysm' s is not well understood.
Hypertension is thought to contribute to rupture. In addition, cigarette smoking has been associated with aneurysm formation and rupture, however, they also occur in non smokers and can run in families. There are no other clear causative factors that instigate a rupture. A person, who is found to have an unruptured aneurysm, will need to make a decision as to how to proceed. To make an informed choice, one has to understand the natural history of unruptured aneurysm's. A number of studies have reported an annual risk of rupture between0.05% to3% per year. Certain characteristics of the patient and of the aneurysm itself can help the physician provide a more accurate estimate.
What are the consequences of the rupture of an aneurysm?
The consequences of aneurysmal rupture depend on the severity of the bleed. The outcomes range from only having a headache to having different degrees of neurological deficits, including being in a persistent vegetative state, to death. Approximately 50% of people die following an aneurysmal bleed.
Should an unruptured aneurysm be treated?
The recommendation to treat or not to treat an unruptured aneurysm needs to be individually tailored. Among the factors taken into consideration include age, general health, location and size of the aneurysm. This decision is facilitated by a frank discussion with a neurosurgeon who specialises in the management of these complex lesions.
What are the options?
The options include:
a) No follow-up. This might be chosen for elderly patients.
b) X-ray follow-up at set intervals. This might be recommended for small lesion. The only caveat is that a small aneurysm can rupture. However, it appears that the small the aneurysm the less likely it is to rupture.
c) If treatment is chosen, two modalities can be chosen from:
surgical clipping (open surgery via a craniotomy) and endovascular coiling,
passing a catheter through a large vessel in the groin as a facilitator
for coils to block the aneurysm. A discussion with the patient after
careful review of the x-rays to define the anatomy is first and for most.
Treating an aneurysm before it ruptures is much simpler than following
a bleed, as well as it eliminates the damage caused from the bleed.
However, treatment of the aneurysm has its associated range of complications,
and this needs to be entered into consideration.
View
the Reference (http://www.alink.org/site/background.php)
Signs and Symptoms of
a Cerebal Aneurysm
The majority of brain aneurysm's have no symptoms. When aneurysm's become symptomatic is usually due to one of two reasons: rupture or mass effect.
b) Aneurysm's may also become symptomatic as they grow
in size. Similar to a tumour, aneurysm's may cause symptoms as they
compress the brain. The resulting symptoms depend on the area of
the brain that is compressed.
View
the Reference (http://www.webmd.lycos.com/content/article/1680.54612)
(http://www.webmd.lycos.com/content/article/1680.54611)
(http://www.health.adelaide.edu.qu/paed-neury/vascular.html)
Children's Aneurysm
Diagnosis
Diagnosing a Cerebral Aneurysm
Detection of an aneurism is difficult if the aneurysm is unruputred. The best way to detect the catheter (tube) is inserted through an artery in the wrist or the groin. Once in place the physician can take the angiograms.
Non invasive ways of detecting an unruptured aneurysm are also being developed. This includes the standard magnetic resonance imaging (MRI) and a magnetic resonance angiogram (MRA).
If an aneurysm has ruptured, a painless CAT scan may be used to see
the extent of the resulting bleeding in the brain. To determine whether
the bleeding has travelled through the cerebrospinal fluid(CSF) around
the brain and spinal cord, a CSF may be taken through a spinal tap.
Finally an ellectroncephalogram (EEG) may be ordered to investigate the
cause of any seizures. (Heart CentreOnline, Inc.)
View
the Reference (http://www.heartcenteronline.com/myheartdr/common/articles.cfm?Artid=606)
Aortic Aneurysm
The aorta is the largest artery in the body. It starts at the heart and passes through the chest to the abdomen. Aortic aneurysm's can develop anywhere along the aorta. Once an aneurysm has started to develop, it slowly grows in diameter over a period of several years. As an aneurysm grows larger, the wall of the artery thins. When the strength of the aneurysm wall becomes too weak the wall can break, resulting in a ruptured aneurysm. Blood loss from a ruptured aneurysm is usually large and rapid. In most cases, aortic aneurysm's cause no symptoms until they rupture; at which point they cause sudden, severe abdominal and/or back pain. Sometimes patients experience loss of consciousness, and shock, due to severe blood loss. Despite best efforts, most patients die soon after aneurysm rupture. View the Reference(http://www.webmd.lycos.com/content/article/1680.53536)
Although any weak blood vessel can be affected, aneurysm's usually form in the abdominal or thoracic portions of the aorta, the main blood vessel that carries blood from the heart, or in the arteries nourishing the brain. Aneurysm's in any of these places are serious, while those more peripheral locations such as the leg are often less hazardous.
The gravest threat an aneurysm poses is that it will burst and cause a stroke or life-threatening massive bleeding (haemorrhage). If an aneurysm ruptures, the patient must be treated within minutes in order to have a chance of survival. For example, if an aneurysm burst in the chest, there is only a 20% chance of survival.
Diagnosing Aortic AneurysmEarly diagnosis and treatment are critical. Because there is no symptoms, regular routine examinations are strongly encouraged so that a doctor can regularly test for warning signs of a more serious problem. But, even if it doesn't ruputure, a large aneurysm can impede circulation and contribute to the formation of blood clots.
Aortic aneurysm is located on the wall of the aorta. Typically, the widened part of the aorta is considered to be, an aneurysm when it is more than 1.5 times its normal size. They are often due to the build-up of plaques due to hardening of the arteries or atherosclerosis. Aortic aneurysm's may also be an inherited condition or a complication of high blood pressure (hypertension).
Penetrating wounds and infections can also lead to an aneurysm. Some types, such as berry aneurysm's, are the result of congenital, or inherited, weakness in artery walls.
Surgery
There are a number of questions that need to be addressed with surgery.
You can expect the neurosurgeon to review the risks and benefits of surgery.
Doctors can only predict what you can realistically expect. Each
patient and their situation is individual. However, from the patients point
of view, the surgery can be frightening, extremely stressful and with the
knowledge that you may or may not survive, brings up all emotional feelings
as to what will the outcome be after surgery. Each person is different,
each persons expectations are different and because of the uniqueness of
each aneurysm where it is in the body, makes it difficult for the
patient ,their family or loved ones as well as the doctor, to predict the
outcome. Intense skill and care is taken by all the surgical staff.
View the Reference(http:/www.westga.edu/~wmaples/planning.html)
View the Reference(http://www.alink.org/site/faq.php)
View
the Reference (http://www.tbi.org/)
Recovery
Recovery depends on the outcome of the surgery. Successful out come may have little or no side affects depending upon where the aneurysm is in the body. Headaches, may be a direct result of trauma to the brain. If an AVM or brain aneurysm ruptures and bleeds into the brain, the blood will be very irritating to the brain tissue. However, this irritation presents as headaches and many people complain of headaches many years after surgery.
A complaint from a lot of patients is itching along the incision,
especially prior to the metal staples or sutures being removed. A
"clicking" sound at the bone flap site may be heard by some patients.
This will disappear as the edges of the bone heal. It may take six
to twelve months for complete healing to occur. View
the Reference (http://www.westga.edu/~wmaples/planning.html)
View
the Reference (http:www.tpi.org/)
Medication
Aspirin is usually prescribed, this is entirely up to the procedure the patient has experienced. Any trauma to the brain sets the stage for seizure activity, and anticonvulsants to prevent or control seizures may be prescribed. Steroids are potent medications that rapidly reduce swelling, and as any surgery causes swelling, there is concern as to the outcome. Brain surgery as there is difficulty with the brain being housed in bone and has no where to expand unlike the stomach or other parts of the body where expansion is possible. Strict adherence to prescription of steroids is important, and must be taken exactly as prescribed.
After Surgery Outcomes
Fear. Many patients have the fear that they have experienced one aneurysm or AVM surgery and may be a potential target for another. Fear is perfectly normal. Follow up angiograms may have these fears lessened. However, there is no guarantees, only heightened awareness to seek prevention.
Fatigue, this is the most common complaint. After the initial healing period (six weeks or so) patients continue to experience fatigue even with the slightest activity leaves them exhausted.
Short term memory loss, patients experience problems with memory this is universal complaint after brain surgery.
Depression and Anger. AVM's or brain aneurysm's can have devastating consequences, they seem to strike at patients in the prime of life. As aneurysm's and AVM's are usually undetected, suddenly patients go from fit and healthy in their eyes, to an invalid. This has devastating results to emotions. Patients can experience a sudden grieving, not only for heir condition but for the outcome because of the condition. Anger, depression, anxiety and stress all play havoc with patients as well as carers. These feelings are perfectly normal, sometimes however, when a placid patient becomes aggressive or depressed, they lash out at their nearest and dearest in their recovery and it is important for the families to understand they are still recovering from their traumatic experience.
Dizziness is another common complaint after brain surgery.
Rehabilitation for some people with deficits after brain surgery
is common and recovery in a hospital may not be possible. It maybe
necessary to transfer to a rehabilitation centre where expert skills may
assist the patient recover. Doctors conservatively will comment "what
you are able to regain in a year is what you are left with" Don't believe
them. The outcome depends on the individual, their spirit and family or
friends support. The main healing process is experienced in the first
twelvemonths after surgery but people continue to improve for many years
there after. One man who was in a coma for six months and had three separate
brain surgeries, was told he would 'never do things independently again'.
After thirteen years improvement was still being noticed. Motto here is
never give up hope. View
the Reference (http://www.wetga.edu/~wmaples/planning.html)
2 Arterio-Venous Malformations [AVM'S.]
Anterior communication artery Aneurysm
Vascularmalformations
The normal vascular organization is that arteries divide into arterioles which merge with capillary bed, following that the capillaries drain into venules and then eventually into main venous channels. In abnormal situations as in artery-venous malformation there is direct connection between the arterioles and the venules, without an intervening capillary bed. As a result there is rapid blood flow or fistula between the arterial and the venous system. There are different types of vascular malformations.
As mentioned above there is a direct connection between the arterial and the venous system with the creation of fast blood flow through the bed of the malformation. Because of the rapid blood flow there is a thickening of the walls of the veins or arterialisation of the venous system. The vascular malformations are more common in the supra-tentorial region and particularly in the area of the middle Cerebal artery distribution. They are congenital and considered as Haematomas. On examination of large series of autopsies, vascularmalformations were found in about 4% of the examined cases. View the Reference (http://www.alink.org/site/faq.php)Natural history
Children are at a higher risk of haemorrhage from arterio vascular malformation than adults. There are not adequate studies to give an adequate natural history of untreated vascular malformation. In adults it is estimated that there is a risk of haemorrhage of 4 to 6% per year In children it is recommended that the malformation should be treated when discovered.
Presentations
[in children]
About 70% of children present with intracranial haemorrhage. There is severe explosive headache with variable degree of consciousness. Examination would show severe neck stiffness and focal neurological signs depending on the site of the haemorrhage.
Epilepsy is another presentation, which result from gliosiso of the brain tissue as a result of chronic ischaemia. 10 to15% of children would present with seizures.
Presentations
[in adults]
Lumbar puncture is an unnecessary investigation as the haemorrhage could be easily visualised by CT scan as well as MRI. MRI arteriography and venography is a good tool to visualise the malformation and its feeding vessels. Angiography is necessary for a more detailed study of the malformation.
Management
In acute presentation there is raised intracranial pressure as a result of blood clot formation and oedema. However, it is advised before evacuating blood clot that angiography or MRI arteriography should be performed to see the location of the malformation in relation to the blood clot. Following that surgical evacuation of the blood clot and excision if possible of the malformation should be carried out.
There are other non-surgical methods of treatment of vascularmal formations. In deep seated malformation radio surgery issued in AVM's smaller than 2 1/2cms. Radio surgery is focused and localised irradiation of the lesion. Alternatively embolisation of the lesion alone as a primary management for before focal irradiation or surgical excision could be performed.
Spetzler et alproposed agrading system for arterio-venous malformations. They based their grading on three features of the malformation
These malformations are more common in adults, less frequently
they present in children under the age of 18 years. They are
more likely to present with seizures than focal neurological symptoms or
signs long term symptom as headaches, which may or may not be accompanied
by haemorrhage. Haemorrhages are usually minor and not catastrophic
as in arterio-venou malformation.They are common in cerebal hemisphere
but they can also occur in the brain stem and cerebellum as well as the
spinal cord. Multiple lesions are occasionally seen.
Pathology
The malformation is a well-circumscribed discreet mass. It is comprised of vascular channel lined by a single layer of endothelium and lacking the full compliment of mature vessel wall component. The vessel walls are thickened with frequent calcification. There is a loose connection tissue in between the vascular channels. Around the lesion, there are gliotic neural tissue resulting from ischaemia and haemorrhages.
Diagnosis
cases are easily diagnosed by MRI, showing areas of chronic haemorrhage around the lesion.
Management
In view of the recurrent haemorrhage, single symptomatic lesion that is in an accessible location should be removed. It is recommended that incidental lesions in children should also be considered for excision because of the risk of recurrent haemorrhage. In multiple surgical excisions is not recommended except for those that are easily accessible.
Surgical excisions of lesions in brain stem and basal ganglia should
be considered cautiously against the possibility of significant post operative
deficits.
View
the Reference(www.health.adelaide.edu.qu/paed-neury/vascular.html)
4. VENOUS MALFORMATIONS
In the true sense of the word, these are not malformations but compensatory
enlargement or anomalies of the venous system. There are incidental
findings that can occur both in the brain and the spinal cord. They could
be seen in association with cavernous malformations. They are usually
asymptomatic and surgical intervention is not recommended. View
the Reference (http://www.health.adelaide.edu.qu/paed-neury/vascular.html)
5. VEIN OF GALEN ARTERIOVENOUSFISTULA
This is a form of arterio-venous malformation, where there is a direct
communication between arteries and the veins in the region of the Vein
of Galen. This malformation is also called Vein of Galen aneurysm
due to the fact there is a large dilation of the vascular bed in the region
of the Vein of Galen. The malformation lies deep to the splenium.
The basal vein and the internal Cerebal veins merge to form the Vein
of Galen, which eventually drain into the straight sinus and the inferior
sagittal sinus.
View
the Reference (http://www.health.adelaide.edu.qu/paed-neury/vascular.html)
Clinical Presentation
This malformation can present in the neonatal age with increasing head circumference ,and cardiac output as a result of increased flow at the site of the fistula.
In childhood and adolescent, the child presents with increasing head circumference, delayed development and seizures. Bruit occasionally could be heard over the occiput.
Investigations
MRI and MRA would reveal a vascular mass deep to the splenium of
the corpuscallosum.
This could be confirmed by Cerebal Angiography.
Treatment
The hydrocephalusis treated by a shunting procedure. Definitive treatment of the malformation is mainly using interventional neuro/radiology to occlude the fistula.
Untreated cases have a poor prognosis and it is recommended that
all fistulae be treated. Cases that are diagnosed late with
patients presenting with severe neurological deficits should be treated
conservatively.
View
the Reference (http://www.health.adelaide.edu.qu/paed-neury/vascular.html)
Moyamoya is a rare disorder of uncertain cause that leads to
irreversible blockage of the main blood vessels to the brain as they
enter into the skull. The name comes from the Japanese and
means `puff of smoke". This naming is due to the appearance of the lesion
on an angiogram. This is a lesion that tends to affect children and adults
in the third to fourth decades of life. In children, it tends to
cause strokes and/or seizures. In adults, it tends to cause bleeding or
strokes. The process of blockage[vascular occlusion] once it begins,
tends to continue despite any known medical management unless treated with
surgery. The repeated strokes can lead to severe functional impairment
or even death, so that it is important to recognise these lesions
and treat them early.
Once a diagnosis is suspected by CT or MRI, the next step is usually an angiogram to confirm the diagnosis and to see the anatomy of the vessels involved. Often nuclear medicine studies such as SPECT [single photon emission computerized to myography] are used to demonstrate the decreased blood and oxygen supply to areas of the brain involved with moyamoya disease. The next step is for the neurosurgeon to decide what type of operation is best suited for the child. There are many operations that have been developed for the condition, but currently the most favoured are: EDAS,EMS,STA-MCA and multiple burr holes.
The EDAS (encephaloduroarteriosynangiosis) procedure requires dissecting a scalp artery over a course of several inches and then making a small temporary opening in the skull directly beneath the artery. The artery is then sutured to the surface of the brain and the bone replaced.
In the EMS [encephalomyosynagiosis]operation, the temporal is muscle which is in the temple region of the forehead, is dissected and through an opening in the skull placed onto the surface of the brain.
Other operations include: the STA-MCA [superficial temporalartery-middlecerebalartery] in which a scalp artery is directly sutured to a brain surface artery; and a procedure in which multiple small holes [burrholes] are placed in the skull to allow for growth of a new vessel into the brain from the scalp.
All of these operations have in common the concept of a blood and oxygen starved brain reaching out to grasp and develop new and more efficient means of bringing blood to the brain and by passing the areas blockage. The risks of the surgery seem to be more due to the risk of being under several anaesthesia for an extended period of time then to actual surgical manipulations.
The moyamoya vessels and the involved brain are very sensitive to
changes in blood pressure, blood volume and relative amount of carbon dioxide
in the blood. When awake, the child's brain is able to regulate these factors
fairly well. However, under general anaesthesia these parameters are much
harder to artificially control and this can lead to bleeding or strokes.
It is crucial for surgery that the anaesthesilogist have experience in,
managing these children as the type of anaesthesia they require is very
different from the standard anaesthic children get for most any other type
of neurosurgical procedure.The long term outlook for children with treated
moya-moya seems to be good. While symptoms may seem to improve almost
immediately after surgery, it will take probably 6-12 months before
new vessels can develop sufficiently. Once major strokes or bleeding take
place, even with treatment the child maybe left with permanent loss of
function so it is very important to treat this condition prompt.
View
the Reference (www.health.adelaide.edu.qu/paed-neury/vascular.html)
My
special music
It has been necessary for me due to an increase in my stress levels, to learn meditation. I found several wonderful CD' s and tapes that have helped me to relax.
One of my favourite C'D is a Native American`Night songs and Lullabies of the Native American Flute'(PO Box 781211SanAntonio.TX78278) I personally purchased this while in Los Angeles but I have further been able to obtain other music from the same group through National Greographics in Australia
Several wonderful tracks from Tony O'Connor PO Box 361 Paddington
Qld .Australia 4065
have also enabled me to relax and meditate.
About Me.
Reference on the Web
Last Revised: Jan 23 2003