概述
脑动脉瘤
脑动脉瘤
动脉瘤是在动脉壁的薄弱部位形成的凸起。动脉瘤壁可能较薄，以至于可能破裂。图示为一位动脉瘤未破裂的女性患者。小图则显示典型的动脉瘤肿胀。
脑动脉瘤的危险性
动脉瘤可能在无症状的情况下潜伏在体内，但可以通过筛查发现，来尽早挽救生命。
单击此处查看信息图，了解更多信息
脑动脉瘤是脑部血管中出现的隆起或鼓胀。它通常看起来像挂在茎上的浆果。
脑动脉瘤可能渗漏或破裂，导致血液流进大脑（出血性卒中）。破裂的脑动脉瘤通常发生在大脑和覆盖大脑的薄组织之间的空间。这种类型的出血性卒中被称为蛛网膜下腔出血。
动脉瘤破裂很快就会危及生命，所以需要及时就医。
但大多数脑动脉瘤既不会破裂，也不会产生健康问题或引起症状。这类动脉瘤通常会在检测其他病情时被发现。
在某些情况下可能需要对未破裂的脑动脉瘤进行治疗，并且治疗可能有助于防止日后出现破裂。请咨询照料者，以确保您了解适合您具体需求的最佳方案。
症状
破裂动脉瘤
突发剧烈头痛是破裂动脉瘤的主要症状。这种头痛常被描述为经历过“最严重的头痛”。
破裂动脉瘤的常见体征和症状包括：
- 突发剧烈头痛
- 恶心和呕吐
- 落枕
- 视力模糊或复视
- 对光敏感
- 癫痫发作
- 眼睑下垂
- 失去意识
- 意识混乱
“漏血”动脉瘤
在某些情况下，动脉瘤可能会漏出少量血液。这种漏血（前哨出血）可能仅导致：
漏血后通常会发生更严重的破裂。
未破裂的动脉瘤
未破裂的脑动脉瘤可能没有任何症状，尤其是在体积很小的情况下。然而，较大的动脉瘤即使未破裂，也可能压迫脑组织和脑神经，从而导致：
- 一只眼睛的上面或者后面感到疼痛
- 瞳孔散大
- 视力改变或复视
- 面部一侧麻木
何时就诊
如果您出现以下情况，请立即就医：
如果您身边有人抱怨突然出现严重头痛或失去意识或癫痫发作，请拨打 911 或当地的急救电话。
因动脉壁变薄而出现脑动脉瘤。动脉瘤通常在动脉的分叉处或分支处形成，因为这些区域的血管比较薄弱。
虽然动脉瘤可能出现在大脑的任何地方，但最常见于大脑底部的动脉。
动脉瘤是血管壁的异常隆起或膨胀。
“一部分患者的动脉瘤会破裂。破裂的挑战在于它不可预测。”
Bernard Bendok 医生说，破裂的动脉瘤是医疗紧急情况，可能造成致命性脑出血。
“典型表现是某人出现一生中最严重的头痛。”
迅速进行治疗至关重要。治疗包括开放性手术，或者创伤较小的手术，比如用金属线圈和/或支架封闭血管中破裂的动脉。
Bendok 医生说，1% 到 2% 的人口患有动脉瘤，但其中只有少数患者会发生动脉瘤破裂。有动脉瘤家族史者、多囊性肾病或结缔组织疾病患者以及抽烟人群更容易发生动脉瘤破裂，应考虑筛查。如果发生动脉瘤破裂，迅速进行治疗才能挽救生命。
病因
脑动脉瘤的病因尚不明确，但是一些因素可能会增加您的风险。
风险因素
许多因素都会导致动脉壁薄弱，并增加患脑动脉瘤或动脉瘤破裂的风险。与儿童相比，脑动脉瘤在成人中要常见得多，与男性相比，在女性中更为常见。
其中一些风险因素是随着时间而形成；另一些是在出生时就出现。
随时间变化而发展的风险因素
其中包括：
- 年龄较大
- 抽烟
- 高血压
- 药物滥用，尤其是使用可卡因
- 酗酒
有些类型的动脉瘤可能发生在头部受伤（夹层动脉瘤）或某些血液感染（真菌性动脉瘤）后。
出生时存在的风险因素
某些情况（出生日期）可能与患脑动脉瘤的风险升高有关。这些包括：
- 遗传性结缔组织病，比如使血管变弱的埃勒斯-当洛斯综合征
- 多囊性肾病，一种遗传性疾病，可使肾脏中形成充满液体的囊状结构，并且通常会导致血压增加
- 异常动脉狭窄（主动脉缩窄），即将富氧血液从心脏输送到身体的大血管
- 脑部动静脉畸形（脑动静脉畸形），一种脑内动脉与静脉之间的异常连接，中断了其间的正常血流
- 脑动脉瘤家族史，尤其是一级亲属（例如父母、兄弟姐妹或子女）
并发症
当脑动脉瘤破裂时，出血通常只持续几秒钟。血液会对周围细胞造成直接损害，而出血会损害或杀死其他细胞。它也会增加颅骨内部的压力。
如果血压过高，对大脑的供血和供氧可能会中断，导致失去意识甚至死亡。
动脉瘤破裂后可能出现的并发症包括：
在 Mayo Clinic 治疗
July 03, 2022
- Williams LN, et al. Management of unruptured intracranial aneurysms. Neurology Clinical Practice. 2013;3:99.
- Thompson BG, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:2368.
- Cerebral aneurysm fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/cerebral_aneurysm/detail_cerebral_aneurysm.htm. Accessed April 11, 2017.
- Cerebral aneurysm. American Association of Neurological Surgeons. http://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cerebral-Aneurysm. Accessed April 11, 2017.
- Daroff RB, et al. Intracranial Aneurysms and Subarachnoid Hemorrhage. In: Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed April 11, 2017.
- Singer RJ, et al. Unruptured intracranial aneurysms. https://www.uptodate.com/home. Accessed April 11, 2017.
- Maciel CB, et al. Seizures and epileptiform patterns in SAH and their relation to outcomes. Journal of Clinical Neurophysiology. 2016;33:183.
- Brown RD (expert opinion). Mayo Clinic, Rochester, Minn. April 27, 2017.
- Brown RD, et al. Screening for brain aneurysm in the Familial Intracranial Aneurysm study: Frequency and predictors of lesion detection. Journal of Neurosurgery. 2008;108:1132.
- Chalouhi N, et al. Differential sex response to aspirin in decreasing aneurysm rupture in humans and mice. Hypertension. 2016;68:411.
- Lanzino G (expert opinion). Mayo Clinic, Rochester, Minn. April 27, 2017.
- Brinjikji W, et al. Endovascular treatment of intracranial aneurysms with flow diverters: A meta-analysis. Stroke. 2013;44:442.
- Brinjikji W, et al. Estimating the proportion of intracranial aneurysms likely to be amenable to treatment with the pipeline embolization device. Journal of Neurointerventional Surgery. 2013;5:45.
- Stryker Neurovascular. Safety and Effectiveness of an Intracranial Aneurysm Embolization System for Treating Large or Giant Wide Neck Aneurysms (SCENT). ClinicalTrials.gov. http://www.clinicaltrials.gov/ct2/show/NCT01716117?term=aneurysm&rank=1.Accessed April 21, 2017.
- Theilen E, et al. Concomitant coiling reduces metalloproteinase levels in flow diverter-treated aneurysms but anti-inflammatory treatment has no effect. NeuroIntervental Surgery. 2017;9:307.
- Khurana VG, et al. The presence of tandem endothelial nitric oxide synthase gene polymorphisms identifying brain aneurysms more prone to rupture. Journal of Neurosurgery. 2005;102:526
- Mackey J, et al. Affected twins in the familial intracranial aneurysm study. Cerebrovascular Diseases. 2015;39:82
- Wiebers DO, et al. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362:103.
- Kallmes DF, et al. Aneurysm study of pipeline in an observational registry (ASPIRe). Interventional Neurology. 2016;5:89.
- Becske T, et al. Long-term clinical and angiographic outcomes following pipeline embolization device treatment of complex internal carotid artery aneurysms: Five-year results of the pipeline for uncoilable or failed aneurysms trial. Neurosurgery. 2017;80:40.
- Brinjiki W, et al. Treatment of ruptured complex and large/giant ruptured cerebral aneurysms by acute coiling followed by staged flow diversion. Journal of Neurosurgery. 2016;125:120.
- Singer RJ, et al. Clinical manifestations and diagnosis of aneurysmal subarachnoid hemorrhage. https://www.uptodate.com/home. Accessed April 20, 2017.
- Singer RJ, et al. Treatment of aneurysmal subarachnoid hemorrhage. https://www.uptodate.com/home. Accessed April 20, 2017.
- Reynold MR, et al. The safety of vasopressor-induced hypertension in subarachnoid hemorrhage patients with coexisting unruptured, unprotected intracranial aneurysms. Journal of Neurosurgery. 2015;123:862.
- Rinaldo L, et al. Elderly age associated with poor functional outcome after rupture of anterior communicating artery aneurysms. Journal of Clinical Neuroscience. 2016;34:108.
- Dai D, et al. Histopathological findings following pipeline embolization in a human cerebral aneurysm at the basilar tip. Interventional Neuroradiology. 2016;22:153.
- Kerezoudis P, et al. Predictors of 30-day perioperative morbidity and mortality of unruptured intracranial aneurysm surgery. Clinical Neurology and Neurosurgery. 2016;149:75.
- Zhao B, et al. Stent-assisted coiling versus coiling alone of poor-grade ruptured intracranial aneurysms: A multicenter study. Journal of NeuroInterventional Surgery. 2017;9:165.
- Sorenson T, et al. Trials and tribulations: An evidence-based approach to aneurysm treatment. Journal of Neurosurgical Sciences. 2016;60:22.
- Becske T, et al. Pipeline for uncoilable or failed aneurysms: Results from a multicenter clinical trial. Radiology. 2013;267:858.
- Wiebers DO, et al. Unruptured intracranial aneurysms — risk of rupture and risks of surgical intervention. The New England Journal of Medicine. 1998;339:1725.
相关
产品与服务