Saccular Aneurysms

An aneurysm can be defined as dilatation's in the lumen of the vessels of the brain caused by a weakness of all vessel wall layers. A Saccular aneurysm has rounded-berry like projections commonly arising from the Circle of Willis or the middle cerebral artery. Saccular Aneurysms are most often congenital in origin which gradually developed over a period of time; and as arterial pressure increases it weakens and then ultimately balloons out the vessel wall. This happens most frequently at bifurcation points.


Most Saccular Aneurysms do not present with any manifestations until they have ruptured. However, once they rupture, it is most often fatal.



Causes and Conditions Related to Saccular Aneurysms:
Trauma
Cocaine abuse
High-Flow states associated with Fistulas.
Infections
Tumors
Conditions related with increased rates of Saccular Aneurysms.
Polycystic Kidney Disease.
Coarctation of the aorta
Anomalous vessels
FMD
Connective Tissue disorders
High-Flow States
Vascular Malformations
Spontaneous Dissections


Signs and symptoms of saccular aneurysms are closely related to that of every other intercranial aneursym.

Pt's often state having the worst headache of their lives.
Cranial neuropathies
vision loss
seizures
TIA

The greatest cause of death from Saccular Aneurysms result from either trauma or vasospasms which are often related to the use of vasodilators or anticoagulants.

As the result of a Saccular Aneurysm a Subarachnoid Hemorrhage can occur:

A Saccular Aneurysm that has resulted in a Subarcharnoid Hemorrhage is most commonly graded on the Hunt and Hess scale. This scale measures the clinical severity of the hemorrhage. It ranges from a 0-5 with 0 being no rupture and 5 being a deep coma with morbid appearance of presenting patient. The Fisher scale is also highly used among health care providers because it describes that amount of blood seen on a noncontrasted head CT. It ranges from a scale of 1 - 4 with 1 being no blood detected and 4 being intracerebral or intraventricular clots.

DX and TX

MRA
MRV
CTA - Head CT with and without Contrast.

The most common treatment option for Saccular Aneurysms is Cerebral Surgeries to remove the clot or in efforts to drain blood that may have occured from a rupture.

http://emedicine.medscape.com/article/252142-overview