Aneurysmal rerupture

Aneurysmal rerupture

Types of brain aneurisms:

• saccular ("berry") aneurism (can be giant)
• fusiform aneurism (can be giant)
• dissecting aneurism
• mycotic aneurism

Classification based on aneurisms size:

• ≤6 mm – small aneurism
• 7 to 12 mm – medium aneurism
• 13 to 24 mm – large aneurism
• ≥25 mm – giant aneurism

Life-threatening complication in patients with cerebral artery aneurysms is its re-rupture. Re-rupture of cerebral artery aneurysm in patients may occur in the first 3 weeks after the first case of its break with subarachnoid hemorrhage. According to statistics, the frequency of rerupture of the aneurysm patients ranged from 10 to 30%.

Repeated cerebral artery aneurysm rupture causes severe disability and even death of the patient. To avoid this complication, there are numerous clinical trials of antifibrinolytic drugs for various of these patients, but data on their effectiveness in preventing recurrent intracerebral hemorrhages are contradictory.

It should be remembered that the use of antifibrinolytic drugs can cause an ischemic stroke patient, presumably due to spasm of the arteries in the brain (cerebral vasospasm). Further clinical observations will help determine the relationship between the number of streamed aneurysm rupture of blood and its localization in the subarachnoid space with the frequency of re-rupture of the aneurysm and symptomatic spasm of cerebral arteries (cerebral vasospasm). For this purpose, widely used magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain over time.

The patient can develop a spasm of cerebral arteries (cerebral vasospasm), able to provoke ischemic stroke from exposure to blood streamed, located in the liquor space of the base of the brain (basal cisterns) in the arterial wall. In the event of complications such unfavorable prognosis regardless of whether the patient is administered antifibrinolytic drugs or not.

Clear evidence of efficacy in prophylactic antifibrinolytic therapy available. But given the danger of the consequences of repeated cerebral artery aneurysm rupture, the specialists use of aminocaproic acid. Aminocaproic acid is assigned to it in the form of intravenous injections (30 g per day) from patients admition and before clipping surgery for a ruptured aneurysm, but not longer than 3 weeks. If the patient after rerupture of the aneurysm has a tendency to develop expressed symptomatic spasm of cerebral arteries (symptomatic vasospasm) aminocaproic acid does not apply.