bubble_chart Overview

Intracranial aneurysm refers to an abnormal bulging part of the arterial wall, which is the most common cause of spontaneous subarachnoid hemorrhage. The etiology is not well understood, but congenital aneurysms account for the majority. It can occur at any age, but is most common between 40 and 66 years old. 80% occur in the anterior half of the circle of Willis. Clinically, it is characterized by spontaneous cerebral hemorrhage, cerebrovascular spasm, oculomotor nerve palsy, and other focal symptoms. The "rupture" of an aneurysm is often the main cause of severe symptoms or even death. Due to significant improvements in diagnostic capabilities and advances in surgical and other treatment methods, aneurysms in any location can now be accurately treated.

bubble_chart Clinical Manifestations

1. Hemorrhagic symptoms: A ruptured aneurysm most commonly causes subarachnoid hemorrhage, presenting with sudden onset of severe headache, nausea, vomiting, impaired consciousness, and psychiatric disturbances. Meningeal irritation signs are frequently observed. It may also lead to intracranial hematoma, resulting in hemiplegia and consciousness disorders.
2. Non-hemorrhagic symptoms: These arise from the aneurysm's compression of adjacent nerves and blood vessels, often related to the size and location of the aneurysm.
   1. Internal carotid-posterior communicating artery aneurysms typically cause ipsilateral oculomotor nerve palsy, ptosis, pupillary dilation, external strabismus, and even visual impairment.
   2. Anterior communicating artery aneurysms: Often disrupt hypothalamic function, especially during hemorrhage, manifesting as consciousness disorders, cognitive impairment, gastrointestinal bleeding, etc.
   3. Middle cerebral artery aneurysms may occasionally trigger epilepsy or mild hemiplegia.
   4. Vertebrobasilar artery aneurysms can cause asymmetric limb paralysis, pyramidal tract signs, and even symptoms like dysphagia and hoarseness.

bubble_chart Diagnosis

1. The onset is acute, with typical symptoms and signs of subarachnoid hemorrhage.
2. There may be focal symptoms such as oculomotor nerve palsy.
3. Head CT can show hematoma and subarachnoid hemorrhage, while CT and magnetic resonance angiography can reveal aneurysms.
4. Cerebral angiography can confirm the location and morphology of the aneurysm.

bubble_chart Treatment Measures

1. Medical treatment: Refer to the treatment of "spontaneous subarachnoid hemorrhage."
2. Surgical treatment: Craniotomy for direct surgery and indirect surgery.
3. Endovascular intervention: The goal is to introduce foreign material into the aneurysm cavity to promote thrombosis and occlusion within the aneurysm.

Intracranial aneurysms are mostly congenital, with late onset, and the initial symptom is often spontaneous intracranial hemorrhage. If sudden headache is accompanied by oculomotor nerve palsy on one side, this condition should be considered. Medications have no direct effect on aneurysms, and craniotomy for direct aneurysm clipping is the best treatment. Depending on the situation, endovascular intervention may also be chosen to occlude the aneurysm. For proper diagnosis and treatment of this condition, it must be handled by well-equipped hospitals and experienced specialists—this is crucial. The first episode of hemorrhage may improve with medical treatment, but the timing must be seized for definitive treatment. Do not delay, lest the opportunity be lost.

bubble_chart Cure Criteria

1. Cure: Stirred pulse tumor removed or disappeared, symptoms resolved, able to resume normal work.
2. Improvement: Indirect surgery or stirred pulse tumor not removed, clinical symptoms significantly improved, partially able to resume work.
3. No cure: Stirred pulse tumor untreated, symptoms show no improvement.