Tętniak mózgu - zarys tematu

Tętniak mózgu - zarys tematu

Czym jest tętniak mózgu?

Tętniak mózgu jest wypukłym, słabym obszarem w ścianie tętnicy, która dostarcza krew do mózgu. W większości przypadków tętniak mózgu nie daje żadnych objawów i przechodzi niezauważony. W rzadkich przypadkach tętniak mózgu pęka, uwalniając krew do czaszki i powodując udar.

Kiedy pęka tętniak mózgu, dochodzi w efekcie do krwotoku podpajęczynówkowego. W zależności od wielkości krwotoku, wynikiem może być uszkodzenie mózgu lub śmierć.

Tętniak mózgu jest najczęściej zlokalizowany w sieci naczyń krwionośnych przy podstawie mózgu, zwanej kołem Willisa.

Co powoduje pojawienie się tętniaka mózgu?

Dana osoba może odziedziczyć tendencję do tworzenia się tętniaków lub też tętniaki mogą rozwijać się na skutek twardnienia tętnic (miażdżyca tętnic) i starzenia się. Niektóre czynniki ryzyka, które mogą prowadzić do tętniaka mózgu, można kontrolować, innych natomiast nie. Następujące czynniki mogą zwiększyć u ciebie ryzyko rozwinięcia się tętniaka lub, jeśli już go masz, mogą zwiększyć ryzyko pęknięcia.

Historia rodzinna. U osób, w rodzinach których występują tętniaki mózgu, występuje dwukrotnie większe prawdopodobieństwo pojawienia się tętniaka, niż u innych.
Wcześniejszy tętniak. Około 20% pacjentów z tętniakami mózgu ma ich więcej niż jeden.
Płeć. U kobiet występuje dwukrotnie większe prawdopodobieństwo pojawienia się tętniaka mózgu lub krwotoku podpajęczynówkowego niż u mężczyzn.
Rasa. U Afroamerykanów dwukrotnie częściej dochodzi do krwotoków podpajęczynówkowych niż u ludzi białych.
Nadciśnienie. Ryzyko wystąpienia krwotoku podpajęczynówkowego jest większe u ludzi, którzy w swojej historii mają podwyższone ciśnienie (nadciśnienie).
Palenie. Poza tym, że palenie tytoniu jest przyczyną nadciśnienia, może również znacząco zwiększyć ryzyko pęknięcia tętniaka mózgu.

Jakie są objawy?

Większość tętniaków mózgu nie daje żadnych objawów i można je odkryć w czasie badań pod kątem innych, zazwyczaj niezwiązanych czynników. W innych przypadkach niepęknięty tętniak będzie powodował problemy przez nacisk na różne obszary mózgu. W takim przypadku dana osoba może cierpieć z powodu silnych bólów głowy, nieostrego widzenia i niewyraźnego mówienia oraz bólów w szyi, w zależności od uciskanych obszarów mózgu i rozmiaru tętniaka. Jeśli masz którykolwiek z poniższych objawów lub zauważasz je u kogoś, kogo znasz, natychmiast skonsultuj się z lekarzem.

Objawy pękniętego tętniaka mózgu często pojawiają się nagle. Mogą one obejmować:

nagły, silny ból głowy (czasem opisywany jako "uderzenie pioruna" – ból bardzo różny od zwykłego bólu głowy),
ból w szyi,
nudności i wymioty,
wrażliwość na światło,
omdlenia lub utratę przytomności,
napady.

W jaki sposób diagnozuje się tętniaka mózgu?

Ponieważ niepęknięty tętniak mózgu nie daje żadnych objawów, wiele z nich odkrywa się u ludzi, którzy są leczeni z innego powodu.

Jeśli twój lekarz uważa, że masz tętniaka mózgu, możesz przejść następujące badania:

Tomografia komputerowa (CT). Tomografia może pomóc w wykryciu krwotoku w mózgu.
Angiografia tomografii komputerowej (CTA). CTA jest dokładniejszą metodą oceny stanu naczyń krwionośnych, niż standardowa tomografia CT. CTA wykorzystuje kombinację skanowania CT, specjalnych technik komputerowych i kontrastu (barwnika) wstrzykiwanego do krwi w celu uzyskania obrazu naczyń krwionośnych.
Angiografia rezonansu magnetycznego (MRA). Podobnie do CTA, w metodzie MRA wykorzystuje się pole magnetyczne i pulsowanie energii fal radiowych w celu uzyskania obrazu naczyń krwionośnych wewnątrz ciała. Podobnie jak w przypadku CTA i angiografii mózgu, kontrast często stosuje się w badaniach MRA, aby naczynia krwionośne ukazały się wyraźniej.
Angiogram mózgu. W czasie badania rentgenowskiego wprowadza się cewnik przez naczynie krwionośne w pachwinie lub ramieniu i przesuwa naczyniami krwionośnymi do mózgu. Następnie wstrzykuje się barwnik do tętnicy mózgowej. Podobnie jak w badaniach opisanych powyżej, barwnik pozwala zobaczyć w promieniach rentgena wszelkie problemy z tętnicą, w tym tętniaki. Chociaż to badanie jest bardziej inwazyjne i wiąże się z większym ryzykiem, niż poprzednie, jest najlepszym sposobem na zlokalizowanie małych (mniejszych niż 5 mm) tętniaków mózgu.

Czasami można stosować nakłucie lędźwiowe, jeśli lekarz podejrzewa pęknięty tętniak z krwotokiem podpajęczynówkowym.

Jak się go leczy?

Przed podjęciem decyzji o najlepszej terapii, twój doktor rozważy szereg czynników. Te, które zadecydują o rodzaju leczenia to między innymi: twój wiek, rozmiar tętniaka, inne czynniki ryzyka oraz twój ogólny stan zdrowia.

Ponieważ ryzyko pęknięcia małego (mniejszego niż 10 mm) tętniaka jest niskie, a operacja tętniaka mózgu jest często ryzykowna, twój lekarz może zalecić raczej obserwację, niż operację chirurgiczną. Jednakże jeśli twój tętniak jest duży lub wywołuje ból albo inne objawy, albo jeśli wcześniej miałeś już pęknięty tętniak mózgu, lekarz może zalecić operację.

Poniższe operacje są stosowane do leczenia tętniaków mózgu, zarówno pękniętych, jak i niepękniętych:

Embolizacja spiralami. W czasie tej procedury wprowadza się małą rurkę do chorej tętnicy i umieszcza ją w pobliżu tętniaka. Następnie maleńkie metalowe spiralki są wprowadzane przez rurkę do tętniaka, zmniejszając w nim ciśnienie i redukując ryzyko pęknięcia. Ta procedura jest mniej inwazyjna i uważana za bezpieczniejszą niż zaciśnięcie operacyjne, chociaż może nie być tak efektywna w redukowaniu ryzyka późniejszego pęknięcia. Należy ją przeprowadzać w dużym szpitalu, gdzie wykonuje się wiele takich zabiegów.
Zaciśnięcie operacyjne. Operacja ta wiąże się z umieszczeniem małego metalowego zacisku wokół podstawy tętniaka, aby odizolować go od normalnego krążenia krwi. Zmniejsza to ciśnienie w tętniaku i zapobiega jego pęknięciu. To, czy tę operację można przeprowadzić, zależy od lokalizacji tętniaka, jego rozmiaru i twojego ogólnego stanu zdrowia.

Niektóre tętniaki tworzą taką wypukłość, że trzeba je wyciąć, a końce naczynia krwionośnego zszyć, ale to zdarza się bardzo rzadko. Czasami tętnica jest za krótka, żeby ją zszyć i trzeba użyć kawałka innej.

Tętniaki, które zaczęły krwawić są poważnym zagrożeniem, które w wielu przypadkach doprowadziło do śmierci lub kalectwa. W takich przypadkach stosuje się hospitalizację i intensywną opiekę, aby zmniejszyć ciśnienie w mózgu i zachować oddychanie oraz funkcje życiowe (takie jak ciśnienie krwi) oraz przeprowadzić leczenie zapobiegające ponownym krwotokom.

Skomentuj artykuł:

Grzegorz
2012-08-12 21:42:12

Dobry artykuł! Fajnie, że opisana została diagnostyka i embolizacja.
Szkoda, że nie ma praktycznych porad jak tą diagostykę wykonać :(.
Więcej o tętniaku mózgu można znaleźć tutaj: http://tetniak-mozgu.com/tetniak-mozgu-objawy-leczenie.html.

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