Description, Causes and Risk Factors:
A small saccular aneurysm of a cerebral artery that resembles a berry. Such aneurysms can rupture causing a subarachnoid hemorrhage.
A berry aneurysm is a type of cerebral or brain aneurysm that occurs when there is a weak area in the wall of a blood vessel in the brain that balloons out and fills with blood. Most berry aneurysms do not show any symptoms until they become too large or rupture; however, when symptoms are present, they include pain in the eye, numbness and severe headache.
Berry aneurysms are congenital in nature and result in a weakness of the blood vessel wall. Weak or thinned parts of the cerebral vasculature are vulnerable to the increased hydrostatic pressure caused by hypertension and will bulge out. Berry aneurysms tend to have a lack of tunica media and elastic lamina around its dilated location. In addition, some parts of the brain vasculature are inherently weak: particularly areas along the Circle of Willis, where small communicating vessels link the main cerebral vessels. These areas are particularly susceptible to berry aneurysms. These aneurysms can form in both the anterior circulation and the posterior circulation in the brain. Typical sites include the junctures or bifurcation of the major cerebral blood vessels: the internal (anterior circulation), and the vertebral artery and basilar artery (posterior circulation).
The risk factors for developing berry aneurysms include any condition that causes hypertension or any condition that causes weakening of blood vessel walls. Conditions causing hypertension include atherosclerosis, renal disease, vasculitis, or drugs that induce hypertension (such as cocaine). Conditions that cause weakening of blood vessel walls include genetic or acquired malformation of a blood vessel, genetic disorders of connective tissue, head trauma, and infections. Between 10 and 30% of patients with autosomal dominant polycystic kidney disease will develop berry aneurysms.
Prevalence of berry aneurysm in the asymptomatic general population has been reported over a wide range (0.2 - 8.9%) when examined angiographically, and in 15 - 30% of these patients, multiple aneurysms are found.
A familial tendency to aneurysms is also well recognised, with patients who have more than one affect first degree relative affected having a 17 - 44% chance of themselves having an aneurysm.
Symptoms may include:
Diplopia (double vision).
Loss of vision.
Eye and neck pain.
Sentinel or warning headaches. These are headaches that are caused by leakage of blood into the brain for days up to weeks prior to the aneurysm's rupture (only a small percentage of patients experience a sentinel headache before rupture).
Symptoms of a ruptured aneurysm are:
Confusion and/or stupor.
Sudden mood swings (impulsivity, irritability, poor temper control).
Dysarthria (speech impediment).
Eyelids dropping, especially unilaterally (ptosis).
Movement disorders (ataxia), especially unilaterally.
Sudden, severe headache.
Berry aneurysms can be imaged in a variety of methods:
Magnetic resonance angiography (MRA).
Digital subtraction angiography (DSA).
Computed tomographic angiography (CTA).
Each of these confers certain advantages and disadvantages, although in general digital subtraction angiography, especially with 3D acquisitions, is considered the gold standard in most institutions.
If an unruptured berry aneurysm has been discovered in the brain of a patient, there are surgical procedures that can treat the aneurysm. One of them is microvascular clipping, where the surgeon goes into the brain and cuts off blood flow to the aneurysm. Once this surgery is performed, the clip remains in the patient and prevents any future bleeding. It has been proven to be highly effective, because most aneurysms that are clipped do not return.
Another, related procedure is called occlusion. In this surgical procedure, the entire artery involved with an aneurysm is clamped off (occluded). After this is done, a small blood vessel is used to reroute the blood away from the afflicted artery. There are also other forms of treatment for berry aneurysms.
People who have been diagnosed with a berry aneurysm, or any kind of aneurysm, should take steps to control high blood pressure, including smoking cessation and avoidance of cocaine and other drugs that elevate blood pressure.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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