Aneurysm rupture

Oral nimodipine is recommended in subarachnoid hemorrhage to prevent delayed cerebral ischemia. Delayed cerebral ischemia occurs 4 to 14 days after the initial aneurysm rupture and is a common cause of neurologic deficits and death. A meta-analysis of 12 studies was conducted and concluded that oral nimodipine 60 mg every 4 hours for 21 days following aneurysmal SAH reduced the risk of a poor outcome and delayed cerebral ischemia.40... 

Amodiaquine, metabolism of, 570, 571 Amyloid cascade hypothesis, 68 Amyloid deposits, 77-78 Aneurysm rupture, 380 Angiogenesis, 220... 

The endovascular procedure is most frequently used to treat infrarenal AAAs that are a leading cause of death in the older population, As our population ages, we will encounter AAAs more frequently than ever before. An aneurysm is defined by a size greater than 5 cm or 2.5 times the normal diameter of the native artery. Most aneurysms begin below the renal arteries and end close to the iliac bifurcation. More complicated AAAs exist involving the suprarenal aorta and visceral vessels and extending into the iliac arteries. The prevalence of AAAs is 3% to 10% for patients older than 50 years (I). They occur more frequently in men and reach a peak incidence close to the age of 80 years. AAA rupture is associated with an 80% to 90% mortality rate and therefore the focus of AAA treatment is on intervening before the aneurysm ruptures elective repair has mortality rate of less than 5%. 

Chadan N, Thierry A, Sautreaux JL, Gras P, Martin D, Giroud M. Rupture aneurysmale et toxicomanie a la cocaine. [Aneurysm rupture and cocaine addiction.] Neurochirurgie 1991 37(6) 403-5. 

Oyesiku NM, Colohan AR, Barrow DL, Reisner A. Cocaine-induced aneurysmal rupture an emergent negative factor in the natural history of intracranial aneurysms Neurosurgery 1993 32(4) 518-26. 

Insertion of a ventricular catheter can be life saving in patients with cerebellar hemorrhage and hydrocephalus. In patients with supratentorial hemorrhage and hydrocephalus, however, the benefits of cerebrospinal fluid (CSF) diversion are less certain. In patients with extensive intraventricular hemorrhage secondary to deep intraparenchymal or aneurysmal rupture, drainage of CSF is performed in some centers. Systematic reviews of observational studies suggest that this procedure may be helpful, especially when it is combined with instillation of fibrinolytic drugs. However, randomized trials are needed (Lee et al. 2003 Fountas et al. 2005). 

Headache may be the only symptom in SAH or there may be accompanying symptoms that may also be seen with other causes of sudden-onset headache and so are not diagnostic. Patients are often irritable and photophobic. Loss of consciousness occurs in around half the patients but may only be brief. Nausea and vomiting are less common. Partial or generalized seizures occasionally occur at the onset period since these do not occur in perime-sencephalic hemorrhage or in thunderclap headache, their presence is a strong indicator of aneurysmal rupture (Pinto et al. 1996). 

Brouwers JAM, Wijdicks EFM, van Gijn J (1992). Infarction after aneurysm rupture does not depend on distrihution or clearance rate of hlood. Stroke 23 374-379... 

Niemann DB, Wills AD, Maartens NF et al. (2003). Treatment of intracerebral hematomas caused by aneurysm rupture coil placement followed by clot evacuation. Journal of Neurosurgery 99 843-847 Olafsson E, Gudmundsson G, Hauser WA (2000). Risk of epilepsy in long-term survivors of surgery for aneurysmal subarachnoid hemorrhage a population-based study in Iceland. Epilepsia 41 1201-1205... 

A 43-year-old man developed a false aneurysm of the popliteal artery after a penetrating injury from an acupuncture needle (118). The aneurysm ruptured spontaneously, but the patient was successfully managed by vascular surgery. 

ADPKD families haye a strong family history of intracranial artery aneurysm rupture. Hypertension is an early and frequent manifestation and gross hematuria is a common presenting symptom. 

Subarachnoid hemorrhage—Bleeding into the subarachnoid space, where cerebrospinal fluid resides. It is often due to an aneurysm rupture or trauma. 

Vulnerability to injury Ischemia Arrhythmia Cell dropout Aneurysm rupture... 

Although the incidence of serious complications such as colonic, lumbosacral plexus, or buttock necrosis is low after IIA embolization, the incidence of claudication and sexual dysfunction is high enough to warrant preservation of the IIA circulation if possible. In final analysis, the decision whether to embolize an IIA or not should be weighed against the potential risks and benefits of the other therapeutic alternatives. The risk of development of such symptoms as claudication or sexual dysfunction may outweigh the hazards of IIA revascularization or aneurysm rupture and death if no action is taken. 

When an aneurysm ruptures, the patient s blood escapes the vessel under arterial pressure, which results in rapid blood loss. The prognosis for a patient with a ruptured AAA is low. The initial mortahty rate for patients whose ruptures occur outside a hospital setting is approximately 50%, and the survival rate decreases by about 1% per minute when there are additional delays (O Connor, 2011). Ruptures are beheved to occur when the wall tissue strength is exceeded by the mechanical stress acting on the aneurysm wall. This tension can be calculated using the Laplace Law for wall tension ... 

Torsello et al. (2011) also compared the use of the Endurant in off-label conditions and according to the Instructions for use (IFU). The patients chosen for the off-label use were all nonoperative candidates, or were a high risk for surgical repair. One hundred and twenty-one patients were treated according to the IFU, 56 off-label (OL). Technical success (successful installation of the device) was seen in all but two patients. Clinical success was defined as a lack of aneurysm rupture, expansion more than 5 mm, type I or III endoleak, infection or thrombosis, and death. This was achieved in 96.7% of the IFU patients and 96.4% of OL patients (all those who were classed as a technical success). There was one aneurysm-related death in the OL group as a result of rupture from a type I endoleak. Otherwise there was... 

Mertens et al. (2011) looked at the long-term results of patients treated with the Zenith Flex stent graft. They analyzed 143 patients for overall survival, intervention-free survival, aneurysm rupture rates, early and late postoperative complications and endoleaks. At 5 years, 72.1% of patients and at 8 years 50.9% had survived. By 8 years 9% of patients (six total) had experienced a late aneurysm rupture, with three fatalities. Forty-seven patients experienced endoleaks, 18 of which were type 1,25 had one or more type II endoleaks (33 cases in total) and three type III one of these required a conversion to open repair and another required a bypass, indicating a defect in the stent graft material rather than an incomplete seal between the aortic limb stubs and the extensions. There was also one case of endotension and six cases of stent fracture. The authors in this study concluded that the Zenith Flex endograft is an excellent device with good long-term results and low aneurysm-related mortality. 

O Connor, R. E. (2011). Emergent management of abdominal aortic aneurysm rupture Retrieved 3/6/2013, 2013, from http //emedicine.medscape.com/article 7756735 overview aw2aab6b3... 

Shape memory PU has been proposed as a candidate for aneurysm coils [106]. An intracranial aneurysm can go undetected until the aneurysm ruptures, causing... 

In fact, as was shown by Hillman (2001), the rupture of an AVM is as devastating as that of an aneurysm. While aneurysm rupture is more lethal than AVM rupture (21% vs 9%), a good outcome is obtained less frequently in AVM than in aneurysm ruptures (49% vs 56%), due to the high incidence of parenchymal hematoma. 

Fig. 5.21. Aneurysm rupture during coiling of an acutely ruptured basilar tip aneurysm. Angio-CT (Flat-detector) before...

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