i.v drrug abuse – a cause of multiple aneurysms in brain

DR VINEET SAGGAR M.B.B.S, MS, MCH(NEUROSURGEY) CONSULTANT DEPARTMENT OF NEUROLOGICAL AND SPINAL SURGERY IVY SUPERSPECIALITY HOSPITAL SEC-71, MOHALI. PUNJAB

INTRACRANIAL ANEURYSMS

I.V DRRUG ABUSE – A CAUSE OF MULTIPLE ANEURYSMS IN BRAIN?- Neurovascular surgery( surgery of blood vessels in brain)

is technically most demanding of neurosurgical procedures - A rare neurovascular surgery was performed at ivy

hospital few days back- A 35 years old male I/V drug abuser was admitted in our

hospital with headache followed by loss of consciousness. .Patient had experienced similar episode few days back which was ignored by local general practitioner and he was discharged on analgesics

Before coming to us he was seen by neurosurgeons in tricity and was refused treatment due to risk involved in the surgery

We did angiography of brain vessels and found not one but three ANEURYSMS( Balloon like dilatation in wall of brain vessels) in his brain vessels , one of which has burst causing massive hemorrhaged in his brain

Plain Ct Head showing Diffuse Sub Arachnoid Haemmorage

CT Angio Brain showing Multiple aneurysms LT MCA, RT Pcom and ANT choroidal Artey aneurysms

POST OP SCAN

POST OP SCAN WITH CLIPS IN SITU

Two of the Aneurysms on the right side were clipped in the same surgery By Dr Vineet Saggar and patient was Discharged after two weeks with advice of surgery on opposite side after six weeks.

Patient Just before Discharge

WHAT ARE ANEURYSMS

A cerebral or brain aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.

The general incidence of aneurysms in the population at large is of the order of 1%-2%

Multiple aneurysms occur in 0.2% of the population

SIGNS AND SYMPTOMS

Most common symptom is sudden severe headache that can last from several hours to days

nausea and vomiting drowsiness and/or coma

The ruptured aneurism (hemorrhage) may also damage the brain directly, usually from bleeding into the brain itself. This is called a “hemorrhagic stroke.” This can lead to:

weakness or paralysis of an arm or leg

trouble speaking or understanding language

vision problems seizures

CAUSES

Aneurysms may result from congenital defects(MOST COMMON CAUSE),

Preexisting conditions such as high blood pressure and atherosclerosis (the buildup of fatty deposits in the arteries), or head trauma.

Cerebral aneurysms occur more commonly in adults than in children but they may occur at any age.

They are more common in women than in men, by a ratio of 3 to 2.

TREATMENT

Currently there are two treatment options for securing intracranial aneurysms:

Surgical clipping or Endovascular coiling

ANEURYSM CLIPS

SURGERY V/S COILING

Although endovascular coiling is associated with a shorter recovery period as compared to surgical clipping, it is also associated with a significantly higher recurrence rate after treatment

Also coiling may not be the best options in patients with giant aneurysms , wide neck aneurysms or patients with massive bleed or large clots in brain as was in our case .

A YOUNG 25 YEAR MALE WITH ANEURYSM RUPTURE -A candidate for Surgery

POST OP SCAN WITH ANEURYSM CLIP IN SITU

POST OP PIC OF PATIENT DURING RECOVERY

AFTER CRANIOPLASTY

Dr. Vineet Saggar (MCh)

Neuro Surgeon / Spinal SurgeonChandigarh, Mohali - Ivy Hospital Sector 71+91-9855990990http://www.neurosurgeoninchandigarh.com http://neurosergeonhead.blogspot.in http://www.facebook.com/neuro.surgeon.7186

http://www.linkedin.com/pub/dr-vineet/56/2a9/863

https://twitter.com/drvineetsaggar   http://www.slideshare.net/neurosergeo

nhead