The rupture of aneurysm appears suddenly and is accompanied by violent symptoms. It is the third leading cause of cardiovascular death after myocardial infarction and stroke. It is a vital emergency.
A ruptured aneurysm is scary. Because, it comes suddenly and results in internal bleeding and severe symptoms. It’s a real emergency. Ruptured aneurysms are the third leading cause of cardiovascular death after myocardial infarction and stroke, according to theInserm. There may be aneurysm ruptures in different arteries of the bodyeven if it is at the level of the cerebral artery (we speak ofcerebral aneurysm) and of the aorta (the largest artery in the body) most often. What are the first signs of a ruptured aneurysm? What are the results ? Is it deadly? What is the average age? How to treat it?
What is the definition of a ruptured aneurysm?
“The aneurysm corresponds to abnormal dilation of a portion of an artery. THE arteries (aorta, carotid artery, femoral artery, abdominal artery, cerebral artery…) are vessels whose wall is formed of three layers. When the middle layer, the media, weakens, the vessel expands and, above a certain size, threatens to break : this is called the aneurysm rupture, explains Professor Paul Menu, cardiac surgeon and spokesperson for the French Federation of Cardiology (FFC). Since the arteries are everywhere in the body, the risks and consequences are very different depending on the location of the aneurysm”. An aneurysm can occur on all the routes of the different arteries. Thus, there exists 3 preferred locations aneurysm in man
- aneurysm cerebral: dilation of the wall of an artery in the brain
- aneurysm aortic (or abdominal): enlargement of the wall of the aorta (part that crosses the abdomen)
- aneurysm thoracic: dilatation of the aorta (part that crosses the thorax)
What is a ruptured brain aneurysm?
Brain aneurysms are most common aneurysms (they account for about 20% of all aneurysms). Generally located at the base of the brain, they cause intracranial hemorrhage during a rupture. Ruptured aneurysms are a life-threatening emergency due to the high risk of death.
What is a ruptured thoracic aneurysm?
Thoracic aortic aneurysm is the second most common type of aneurysm. It corresponds to the dilation of the thoracic aorta, the body’s main artery, which brings blood from the heart to all parts of the body.
What is a ruptured aortic (abdominal) aneurysm?
The aorta is the main artery of the body which starts from the heart and crosses the thorax and the abdomen to irrigate all the organs (in particular digestive and urinary). We speak of a ruptured aortic aneurysm when the wall of the abdominal aorta has dilated so much that it cracks, which triggers significant internal bleeding.
What are the (first) signs of a ruptured aneurysm?
The aneurysm is usually asymptomatic. On the other hand, a ruptured aneurysm is a characteristic event, sudden and serious, with:
- An intense and violent headache, which appears suddenly
- A stiffness in the neck
- Sudden visual disturbances
- Often nausea and vomiting
- Increased sensitivity to light and noise
- Confusion or disorientation, sometimes accompanied by problems with balance or speech
- Sometimes a loss of consciousness (in the most serious cases: the patient falls into a coma)
- Pain in the stomach or back in the event of a ruptured abdominal aneurysm
What is the average age of a ruptured aneurysm?
The prevalence of ruptured aneurysms increases with age, but it is impossible to give a precise figure because most patients do not notice their disease until the moment of rupture. The peak of aneurysm ruptures would be observed around 45 years old.
What are the consequences of a ruptured aneurysm?
A ruptured aneurysm is dangerous and can be deadly. The ruptured aneurysm”has consequences on the territory vascularized by the ruptured artery. Again, the severity of the aneurysm rupture depends on the site,” says our expert. Often, the hemorrhage has caused a sort of clot which prevents the fluid from flowing out. As it is constantly produced, there can be an accumulation of this liquid around the brain, which is thus compressed. “If no intervention is performed and that the brain is really compressed, death occurs in a few minutes”says Professor Emmanuel Houdart, neuroradiologist at the Lariboisière hospital in Paris.
The consequences of a ruptured aneurysm are extremely variable from one individual to another.
► A third of patients die before reaching the hospital.
► Another third gets away with a temporary fatigue but no lasting signs.
► Another third survives, with various consequences. “It can range from memory problems to a vegetative state, passing through hemiplegia, explains Professor Emmanuel Houdart. These sequelae are often linked to vasospasm (constriction of the arteries) and infarction hemorrhagic that they can induce. The extent of the haemorrhage also comes into play.” And even for those who get away with it, a long rest will be necessary before being able to return to work (3 to 6 months or even part-time therapy for a year).
What is the difference between a ruptured aneurysm and a stroke?
Ischemic cerebrovascular accident (CVA) is caused byblockage of a blood vessel in the brain due to a clot or by rupture of a vessel. While ruptured aneurysm is caused by the wall of an artery rupturing. That said, “ruptured brain aneurysm is one of the causes of stroke hemorrhagic“, adds Professor Menu.
What causes a ruptured aneurysm?
The origin of the aneurysm is not well known. Nevertheless, certain risk factors are known to increase the risk of developing an aneurysm, such as:
- High blood pressureparticularly hypertensive flare-ups (significant and abrupt rise in blood pressure) “Hypertension multiplies the risk of aneurysm by 7”, says our interlocutor.
- Diabetes which can weaken the walls of the arteries
- Tobacco use (the products contained in tobacco that are inhaled can cause oxidation of the walls of the arteries, which can weaken them)
- Overweight or obesity
- The stress
Can a ruptured aneurysm be treated?
Rupture of an aneurysm is considered an absolute medical emergencybecause of its risk of rapid death and the sequelae it can cause. You have to call the Samu (15) so that the person can be medically taken care of as quickly as possible. During the call, it is advisable to insist on the violence and the intensity of the symptoms. “After that, our job is to prevent the aneurysm from rebleeding. At the same time, we will treat the consequences of the hemorrhage on the brain. This usually involves takingcerebral anti-edematous to reduce brain swelling and sometimes by performing a cerebrospinal fluid drainage“, explains Emmanuel Houdart. To prevent the aneurysm from rebleeding:
► In approximately 70% of cases the technique used is that of embolizationmuch lighter than conventional surgery. “It is go through the inside of the arteries and not the outside, to plug the aneurysm with small platinum spirals. These small wires are introduced through a small catheter that is slipped into the arteries. It is introduced at the level of the femoral artery (in the thigh).” The operation is performed by a neuroradiologist. It leaves no scars and you recover much more easily than from surgery. After the embolization, the patient will be monitored regularly for the first few years, to check that the platinum wires do not “pack”. This happens very rarely, but if it does, you have to repeat it to rule out any risk of new bleeding.
► In about 30% of cases, embolization is not possible or not desirable for various reasons and doctors then resort to conventional surgery. The technique then consists of clipping the aneurysm : it is thus separated from the rest of the circulation and therefore dried up in blood. The surgery requires opening the cranial box, which always carries risks and creates additional trauma to the brain.
What to do after the operation?
The consequences of a ruptured aneurysm are recognized as a Long term affection (ALD). “It may even be a work accident if the rupture took place during working hours”, emphasizes Professor Houdart. A follow-up control must be ensuredwith a CT scan at three months and an follow-up arteriography after one year. “There is no no risk of recurrence strictly speaking. Once you are cured, it is permanent and life expectancy is not reduced. But in a few rare cases, the coils placed in the aneurysm can settle. We may then have to intervene again.” If after a year, nothing has changed, a new MRI is prescribed after three years. A follow-up may be offered afterwards, depending on the patient.
What are the chances of survival in the event of a ruptured aneurysm?
“Without action, breakdown of the wall (aneurysm) leads to arterial rupture and death in 80% of cases“, specifies Inserm.
Thanks to Pr Paul Menu, heart surgeon and spokesperson for the French Federation of Cardiology (FFC) and Professor Emmanuel Houdart, neuroradiologist at Lariboisière Hospital in Paris.