Aneurysms and its MLI

Presenter : Dr Gopal G Hargi

PG in FM&T
Guides: Dr A.S.Shetty & Dr
K.S.Gurudut
 An aneurysm is an abnormal, weak spot on a blood vessel wall
that causes an outward bulging, likened to a bubble. These
weak spots can involve all walls of the blood vessel (a
fusiform aneurysm), form a bulge on just one wall (saccular)
or separate the vessel walls (dissecting). .
 Permanent localised dilatation of a blood vessel occurring due
to congenital or acquired weakening or destruction of the
vessel wall.
congenital defect of the arterial wall
result of disease
injury
 >90% affecting abdominal aorta
Infra-renal segment in ~95%
Male : Female ratio 4:1
More common in western countries
5% over 50s, 15% over 80s
Associated with iliac aneurysms in 30%
Associated with popliteal aneurysms in 10%
 Most aneurysms are caused by degenerative disease affecting
the vessel (atherosclerosis)
Structural weakness & Haemodynamic forces
Damage to, and loss of intima
Reduction in the elastin and collagen content of the media
Collagen; tensile strength, adventitia
Elastin; recoil capacity, media
OTHER CAUSES

Congenital
Marfans syndrome
Post-stenotic
Coarctation of the aorta, Cervical rib, Popliteal artery entrapment syndrome
Traumatic
Inflammatory
Takayasos disease, Behcets disease
Mycotic
Bacterial endocarditis, syphilis
Pregnancy associated
Splenic, cerebral, aortic, renal, iliac & coronary
 Abdominal aortic aneurysm causes:
Atherosclerosis - accumulation of fatty deposits
(cholesterol) on the artery walls.
Smoking - this is a major risk factor in the development of
aortic aneurisms. Smoking contributes to
atherosclerosis, hypertension and the
acceleration of aneurysm growth.
Hypertension - poorly controlled.
Vasculitis (infection in the aorta) - this is an uncommon
cause, and seems to run in families.
Cocaine use - Cocaine users had more than four times the
risk of coronary artery aneurysms as non-users.
 Types of aneurysm
Classification is based on location / etiology /gross appearance
1.location
2.depending upon specific nature of damage
3.depending upon gross appearance
 Classification

Composition of wall- true

false
Depending on shape- succular
fusiform
cylindrical
varicose
racemose
Based on pathology- atherosclerotic
syphilitic
dissecting
berry
formation of a sac an outward bulging
or pouch on one of the blood vessel
side of the blood wall in all
vessel wall directions.

aneurysm is one that

has burst and caused
bleeding into the
surrounding tissues.
 According to location
aortic aneurysm Thoracic.
Abdominal
Other types: Peripheral Aneurysms .
Cerebral aneurysm
aortic arch aneurysm
Descending aortic
aneurysm
Dissecting
aneurysm
 cerebral aneurysm causes:

Weakness in the artery wall (usually present since birth)

Hypertension
Arteriosclerosis
Most develop at the branches in arteries
commonly form at the base of the brain - but can form
anywhere in the brain.
 Intracranial berry aneurysms are the most common kind of
aneurysm in the brain.
Their incidence is 1 in 10000 people per year
They have a mortality rate of 7090%.
Highest incidence is between 3060 years of age.
It is slightly more common in women.
They are never seen in pediatric population.
Its not named for Thadeus J. Berry.
 called berry aneurysms because they are often the size of a
small berry.
Berry aneurysms- sacculur /2mm-2cm or > / 95% of
cerebral aneurysms / liable for rupture
They appear red , shiny and translucent
rare in childhood
> in frequency in adults and middle life
> incidence with asso PKD & COA
Most cerebral aneurysms produce no symptoms until they
become large, begin to leak blood, or rupture
Locations
85% in anterior part of the Circle of Willis Most common
sites- Anterior cerebral artery and anterior communicating
artery (30-35%) Bifurcation,
division of two branches, of internal carotid and posterior
communicating artery (30-35%),
Bifurcation of middle cerebral artery (20%),
Bifurcation of basilar artery, and
remaining posterior circulation arteries (5%).
SAH commonest presentation
 85% of nontraumatic SAH is (almost) always due to the rupture of a
cerebral aneurysm
vasospasm following the rupture is the most probable cause of death
arterial dilatation of the cerebral arteries are usually to be found in the
subarachnoid space
Causes sudden collapse
not possible to detect the exact localization of the
ruptured berry aneurysm: the rupture may destroy the
aneurysm completely.
rule out other possible cause of intracranial bleeding,
such as vascular malformations, intraventricular
spreading of intracerebral hematomas, neoplasia,
hematological disorders, etc.
 Signs and symptoms of an aneurysm

The signs and symptoms of an aneurysm depend on its type, location,

and whether it has ruptured or is interfering with other structures in the
body.

Aneurysms can develop and grow for years without causing any signs
or symptoms.
 investigations

MRI.
Angiography..
Aortography .
 Medicolegal importance

Lead to sudden death

Iatrogen aneurysm accounts for medical negligence
Aneurysm may be source of emboli
At Autopsy
r/o any other vascular pathology
Toxicological analysis- cocaine , methamphetamine
h/o antihypertensives
Thank you for your attention