A brain aneurysm also referred to as a cerebral aneurysm or an intracranial aneurysm IA.

Description

A brain aneurysm also referred to as a cerebral aneurysm or an intracranial aneurysm (IA), is a weak bulging spot on the wall of a brain artery very much like a thin balloon or weak spot on an inner tube. Over time, the blood flow within the artery pounds against the thinned portion of the wall and aneurysms form silently from wear and tear on the arteries. As the artery wall becomes gradually thinner from the dilation, the blood flow causes the weakened wall to swell outward. This pressure may cause an aneurysm to rupture and allow blood to escape into the space around the brain. A ruptured brain aneurysm commonly requires advanced surgical treatment.

Types of a cerebral aneurysm

There are three types of cerebral aneurysms:

  • A saccular aneurysm. A saccular aneurysm is a rounded sac containing blood that is attached to the main artery or one of its branches.  Also known as a berry aneurysm (because it resembles a berry hanging from a vine), this is the most common form of a cerebral aneurysm.  It is typically found on arteries at the base of the brain.  Saccular aneurysms occur most often in adults and are found in about 2 to 3 percent of the population.
  • A fusiform aneurysm. A fusiform aneurysm balloons or bulges out on all sides of the artery.
  • A mycotic aneurysm. A mycotic aneurysm occurs as the result of an infection that can sometimes affect the arteries in the brain. The infection weakens the artery wall, causing a bulging aneurysm to form.

Size

Aneurysms are also classified by size: small, large, and giant.

  • Small aneurysms are less than 11 millimeters in diameter (about the size of a large pencil eraser).
  • Large aneurysms are 11 to 25 millimeters (about the width of a dime).
  • Giant aneurysms are greater than 25 millimeters in diameter (more than the width of a quarter).

Pathophysiology of Brain Aneurysm

The pathogenesis of cerebral aneurysms is related inherently to structural aberrations of the cerebrovasculature, although the etiology of these abnormalities may be diverse. The integrity of the internal elastic lamina is compromised, with associated elastic defects in the adjacent layers of the tunica media and adventitia. Muscular defects of the tunica media and minimal support of adjacent brain parenchyma augment the pathologic potential of chronic hemodynamic stress on the arterial wall. Focal turbulence and discontinuity of the normal architecture at vessel bifurcations may account for the propensity of saccular aneurysm formation at these locations. Distal aneurysms may be smaller compared with proximal sites, yet the risk of rupture may be dissimilar due to the relatively thinner parent artery wall thickness.

Causes

Currently, the cause of cerebral aneurysms is not clearly understood. Brain aneurysms are associated with several factors, including smoking, hypertension, and family history (genetic). The ultimate cause of a brain aneurysm is an abnormal degenerative (breaking down) change (weakening) in the wall of an artery and the effects of pressure from the pulsations of blood being pumped forward through the arteries in the brain. Certain locations of an aneurysm may create greater pressure on the aneurysm, such as at a bifurcation (where the artery divides into smaller branches).

Inherited risk factors associated with aneurysm formation may include, but are not limited to, the following:

  • Alpha-glucosidase deficiency. A complete or partial deficiency of the lysosomal enzyme, alpha-glucosidase. This enzyme is necessary to break down glycogen and to convert it into glucose.
  • Alpha 1-anti-trypsin deficiency. A hereditary disease that may lead to hepatitis and cirrhosis of the liver or emphysema of the lungs
  • Arteriovenous malformation (AVM). An abnormal connection between an artery and a vein.
  • Coarctation of the aorta. A narrowing of the aorta, which is the main artery coming from the heart.
  • Ehlers-Danlos syndrome. A connective tissue disorder (less common).
  • The family history of aneurysms
  • Female gender
  • Fibromuscular dysplasia. An arterial disease, cause unknown, that most often affects the medium and large arteries of young to middle-aged women.
  • Hereditary hemorrhagic telangiectasia. A genetic disorder of the blood vessels in which there is a tendency to form blood vessels that lack capillaries between an artery and vein.
  • Klinefelter syndrome. A genetic condition in men in which an extra X sex chromosome is present.
  • Noonan’s syndrome. A genetic disorder that causes abnormal development of many parts and systems of the body.
  • Polycystic kidney disease (PCKD). A genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys. PCKD is the most common medical disease associated with saccular aneurysms.
  • Tuberous sclerosis. A type of neurocutaneous syndrome that can cause tumors to grow inside the brain, spinal cord, organs, skin, and skeletal bones.

Risk factors of Brain Aneurysm

Several things, including your medical history and lifestyle, can increase your odds of a brain aneurysm.

That includes atherosclerosis, a disease in which fat builds up inside the wall of your arteries (blood vessels that deliver oxygen-rich blood throughout your body). Other things that can come into play:

  • Diseases affecting your blood or blood vessels
  • High blood pressure
  • Injury or trauma to your head
  • Infection
  • Cancer or tumors in head and neck
  • Abnormalities at birth, such as tangled blood vessels in your brain
  • The family history of brain aneurysms
  • Alcohol consumption, especially binge drinking
  • Smoking
  • Drug abuse such as cocaine or amphetamines

Symptoms of Brain Aneurysm

Ruptured aneurysm

A sudden, severe headache is the key symptom of a ruptured aneurysm. This headache is often described as the “worst headache” ever experienced.

Common signs and symptoms of a ruptured aneurysm include:

  • Sudden, extremely severe headache
  • Nausea and vomiting
  • Stiff neck
  • Blurred or double vision
  • Sensitivity to light
  • Seizure
  • A drooping eyelid
  • Loss of consciousness
  • Confusion

‘Leaking’ aneurysm

In some cases, an aneurysm may leak a slight amount of blood. This leaking (sentinel bleed) may cause only a:

  • Sudden, extremely severe headache
  • A more severe rupture often follows leaking.

An unruptured aneurysm

An unruptured brain aneurysm may produce no symptoms, particularly if it’s small. However, a larger unruptured aneurysm may press on brain tissues and nerves, possibly causing:

  • Pain above and behind one eye
  • A dilated pupil
  • Change in vision or double vision
  • Numbness of one side of the face

Complications of Brain Aneurysm

Complications that can develop after the rupture of an aneurysm include:

  • Re-bleeding. An aneurysm that has ruptured or leaked is at risk of bleeding again. Re-bleeding can cause further damage to brain cells.
  • After a brain aneurysm ruptures, blood vessels in your brain may narrow erratically (vasospasm). This condition can limit blood flow to brain cells (ischemic stroke) and cause additional cell damage and loss.
  • When an aneurysm rupture results in bleeding in the space between the brain and surrounding tissue (subarachnoid hemorrhage) — most often the case — the blood can block circulation of the fluid surrounding the brain and spinal cord (cerebrospinal fluid). This condition can result in an excess of cerebrospinal fluid that increases pressure on the brain and can damage tissues (hydrocephalus).
  • Subarachnoid hemorrhage from a ruptured brain aneurysm can disrupt the balance of sodium in the blood. This may occur from damage to the hypothalamus, an area near the base of the brain.

A drop in blood sodium levels (hyponatremia) can lead to swelling of brain cells and permanent damage.

Diagnosis and Test

A brain aneurysm is usually diagnosed using an MRI scan and angiography (MRA), or a CT scan and angiography (CTA).

An MRI scan is usually used to look for aneurysms in the brain that haven’t ruptured. This type of scan uses strong magnetic fields and radio waves to produce detailed images of your brain.

A CT scan is usually preferred if it’s through an aneurysm has ruptured and there’s bleeding on the brain (subarachnoid hemorrhage). This type of scan takes a series of X-rays, which are then assembled by a computer into a detailed 3D image.

In some cases, a ruptured aneurysm is not picked up by a CT scan. If a CT scan is negative but your symptoms strongly suggest you have a ruptured aneurysm, a test called a lumbar puncture will usually be carried out.

A lumbar puncture is a procedure where a needle is inserted into the lower part of the spine to remove a sample of the fluid (cerebrospinal fluid) that surrounds and supports the brain and spinal cord. This fluid can be analysed for signs of bleeding

Angiogram is an invasive procedure in which a catheter is inserted into an artery and passed through the blood vessels to the brain. Once the catheter is in place, contrast dye is injected into the bloodstream and x-rays are taken.

Treatment and Medications

Treatment for a symptomatic aneurysm is to repair the blood vessels. Clipping and coiling are two treatment options.

Clipping

A neurosurgeon can operate on the brain by cutting open the skull, identifying the damaged blood vessel and putting a clip across the aneurysm. This prevents blood from entering the aneurysm and causing further growth or blood leakage.

Coiling

An interventional neurologist, neurosurgeon, or interventional radiologist can thread a tube through the arteries, as with an angiogram, identify the aneurysm, and fill it with coils of platinum wire or with latex. This prevents further blood from entering the aneurysm and resolves the problem.

Both these options have the risk of damaging the blood vessel and causing more bleeding, damaging nearby brain tissue, and causing the surrounding blood vessels to go into spasm; depriving brain tissue of blood supply and causing a stroke.

Treating Aneurysm with Open Surgery

For the majority, minimally-invasive surgery is the first line of treatment. If your aneurysm cannot be repaired with these procedures, open surgery may be necessary. Surgical clipping is a procedure where the surgeon removes a section of the skull – a procedure called a craniotomy – and places a metal clip across the base of the aneurysm. The section of the skull is put back in its original place then closed. Once an aneurysm is fixed, you will be closely monitored and re-checked to ensure you recover well and the aneurysm doesn’t return.

Prevention of Brain Aneurysm

You can’t always prevent brain aneurysms, but you can lower your risk by not smoking and reducing high blood pressure.

Smoking

If you smoke, stopping can significantly reduce your risk of developing a brain aneurysm.

High blood pressure

Having high blood pressure can also significantly increase your chance of developing a brain aneurysm.

You can help reduce high blood pressure by:

  • Eating a healthy diet – in particular, cutting down on salt and eating plenty of fruit and vegetables
  • Moderating your alcohol intake – men and women are advised not to regularly drink more than 14 units a week
  • Maintaining a healthy weight – even losing just a few pounds will make a big difference to your blood pressure and overall health
  • Exercising regularly – being active and taking regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition
  • Cutting down on caffeine – it’s fine to drink tea, coffee and other caffeine-rich drinks as part of a balanced diet, but it’s important these drinks aren’t your only source of fluid

Gunmen kill priest and injured colleagues on their way back from church in pakistan.

Gunmen killed a Christian cleric and wounded his colleague as they were driving home from church in Pakistan’s northwestern city of Peshawar on Sunday (Jan 30), police said.

Pastor William Siraj died instantly in the ambush, church authorities said.

No one immediately claimed responsibility for the shooting in a city where a twin suicide bombing killed scores of people outside a church in 2013 – one of the deadliest attacks on the country’s Christian minority.

Azad Marshall, the most senior bishop in the protestant Church of Pakistan, condemned the attack and tweeted: “We demand justice and protection of Christians from the Government of Pakistan.”

Pakistan’s northwestern areas bordering Afghanistan have seen a rise in militant attacks on security forces in recent days, most of them claimed by Tehreek-e-Taliban Pakistan (TTP), a group which associates itself with the Afghan Taliban.

The attackers opened fire on the car carrying Pastor Siraj and the Rev Patrick Naeem in the city’s Chamkani area, church officials said.

Naeem was out of danger and being treated, a spokesman for the city’s Lady Reading hospital said.

Bishop Azad said both were clergy of the Diocese of Peshawar in the Church of Pakistan, which is a union of protestant churches including the Methodists and the Anglicans.

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US senators are very close to reaching a deal on legislation to sanction Russia over its actions on Ukraine.

US senators are very close to reaching a deal on legislation to sanction Russia over its actions on Ukraine, including some measures that may take effect before any invasion, two leading senators said on Sunday (Jan 30).

Senators Bob Menendez and James Risch, the chairman and top Republican on the Senate Foreign Relations Committee, said they hoped to move forward on the bill this week.

I would describe it as that we are on the one-yard line, Menendez said on CNN’s State of the Union, using an American football reference meaning very close to the goal.

There is strong bipartisan resolve to support Ukraine and to punish Russia if it invades Ukraine, Menendez said. Asked if an agreement will be reached this week, he said, I believe that we will get there.

Russia has been building up its forces on Ukraine’s borders for months and has demanded NATO pull troops and weapons from eastern Europe and bar the former Soviet state from ever joining the US-led military alliance.

Ukrainian President Volodymyr Zelenskiy supports immediate action and has criticized the West for waiting to impose more damaging sanctions.

The Senate bill would target the most significant Russian banks and Russian sovereign debt, as well as provide more U.S. military assistance to Ukraine.

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British police said on Sunday they had arrested Greenwood on suspicion of rape and assault.

British police said on Sunday they had arrested a man on suspicion of rape and assault, hours after Manchester United suspended footballer Mason Greenwood following online accusations that the 20-year-old had assaulted a woman.

Greater Manchester Police said in a statement that a man was arrested after social media images and videos were posted by a woman reporting incidents of physical violence.

An investigation was launched and following enquiries we can confirm a man in his 20s has since been arrested on suspicion of rape and assault,” the police said.

The man, who was not named but was described as in his 20s, was being held in custody for questioning, the police added.

The allegations against Greenwood, including video, photographs and a voice note, were posted on Instagram on Sunday morning and later deleted.

“Mason Greenwood will not return to training or play matches until further notice,” United said in a statement to Reuters.

The club earlier said that they “do not condone violence of any kind.

Greenwood has six goals and two assists in 24 matches in all competitions for United this season. He began his career at United’s academy and has played once for the England national team.

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Portugal voted on Sunday (Jan 30) in a close-fought election, with no party expected to win a majority in parliament.

Portugal voted on Sunday (Jan 30) in a close-fought election, with no party expected to win a majority in parliament in a fragmented political landscape that could see the far right make huge gains.

Socialist Prime Minister Antonio Costa is fighting for his political life after a late surge by the centre-right opposition PSD party clawed away his side’s once comfortable poll lead.

The two parties are in a statistical tie according to final surveys.

The prospect of another weak minority government comes as Portugal is trying to boost its tourism-dependent economy which has been badly hit by the coronavirus pandemic.

A stable government is needed for Portugal to make the most of a €16.6-billion (US$18.7 billion) package of EU recovery funds it is due to receive by 2026.

Portugal needs stability after these two difficult years of fighting against the pandemic, Costa, in office since 2015, told a final rally in second-city Porto on Friday.

Sunday’s snap polls were called after two far-left parties that had propped up Costa’s minority government sided with right-wing parties to reject his 2022 draft budget in October

While the survival of the Socialists’ government is at stake, the party is faring better than its peers in many other European nations such as Greece and France where they have been virtually wiped off the map in recent years.

If the Socialists again garner the most votes but fall short of a majority, Costa has said he plans to govern alone by negotiating support from other parties for laws on a case-by-case basis.

Such a government would have “little chance” of lasting until the end of its term in 2026, said Lisbon University politics professor Antonio Costa Pinto.

Under Costa’s watch Portugal, a nation of around 10 million people, has rolled back austerity measures, maintained fiscal discipline and slashed unemployment to pre-pandemic levels.

But PSD leader Rui Rio, 64, says the economy should expand faster. His party proposes corporate tax cuts to spur growth.

Rio has managed to unify the often fractious party since he defeated a leadership challenge last year and his strategy of moving the PSD to the centre appears to be bearing fruit.

Under Rio the PSD defied the odds and booted the Socialists out of office in a regional election in the Azores islands in 2020 and the Lisbon mayor’s office last September.

He is open to forming a coalition with the conservative CDS and the upstart libertarian Liberal Initiative party.

But such a coalition would need the support of far-right party Chega, which polls suggest could emerge as the third-biggest party in parliament, mirroring recent gains for such formations across Europe.

Costa has warned that a PSD-led government would be a hostage to Chega, whose proposals include castrating sex offenders.

Rio accuses Costa of fear-mongering.

He has vowed not to include Chega in a government but has indicated he is willing to head a minority government propped up by support in parliament from the far right.

Turnout in the election stood at 23.3 per cent at noon, according to the interior ministry, compared to 18.8 per cent during the last election in 2019.

The election is taking place amid a surge in new COVID-19 cases and many voters said they came as soon as ballot stations opened to avoid crowds.

It is a question of security There are less people, said Duarte Raposo, a 33-year-old office worker who was one of the first to vote at a school in Almada, a city just south of Lisbon.

It is a duty we should all fulfil, he added.

The authorities are allowing people who are quarantining because of the virus to leave home to cast their ballot, with a recommendation they vote in the slower final hour.

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Britain have recorded 62,399 cases of covid-19.

Britain reported a further 62,399 cases of COVID-19 on Sunday (Jan 30) and 85 more deaths within 28 days of a positive test, government statistics showed.

Those figures do not include cases and deaths from Northern Ireland, which did not provide its numbers in time for inclusion in the daily update, the government said.

That compared with 72,727 cases and 296 deaths reported on Saturday.

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Italy record 104,065 Covid-19 cases on Sunday.

According to a report, it was learnt that Italy have reported 104,065 COVID-19 related cases on Sunday (Jan 30), against 137,147 the day before, the health ministry said, while the number of deaths fell to 235 from 377.

Italy has registered 146,149 deaths linked to COVID-19 since its outbreak emerged in February 2020, the second-highest toll in Europe after Britain and the ninth highest in the world. The country has reported 10.9 million cases to date.

Patients in hospital with COVID-19 not including those in intensive care stood at 19,617 on Sunday, down from 19,636 a day earlier.

There were 95 new admissions to intensive care units, down from 118 on Saturday. The total number of intensive care patients rose to 1,593 from a previous 1,588.

Some 818,169 tests for COVID-19 were carried out in the past day, compared with a previous 999,490, the health ministry said.

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World’s largest cryptocurrency exchange Binance restrict 281 Nigerians.

Binance, the world’s largest cryptocurrency exchange, has restricted the personal accounts of 281 Nigerian users, citing a need to comply with international money laundering laws, its CEO said.

Changpeng Zhao said in a letter to Nigerian customers dated Jan. 29 that the decision to restrict some personal accounts was to ensure user safety while more than a third of the affected accounts were restricted at the request of international law enforcement.

Currently, we have resolved 79 cases and continue to work through others. All non-law enforcement-related cases will be resolved within two weeks,” Changpeng Zhao said.

Despite a central bank ban, Nigerians have continued to turn to crypto for business, to protect their savings as the naira currency loses value, and to send payments abroad because it is often hard to obtain U.S. dollars locally.

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President Buhari dragged to court over missing N3.1 billion.

President Muhammadu Buhari has been dragged to court afresh over his failure to probe allegations that N3.1 billion of public funds is missing from the Federal Ministry of Finance.

The litigant is the Socio-Economic Rights and Accountability Project (SERAP).

It also sued Buhari over his failure to ensure the prosecution of those suspected to be responsible, and the recovery of any missing public funds.

The suit followed the grim allegations by the Office of the Auditor-General of the Federation in the 2018 and 2019 annual audited reports that N3.1bn of public funds was missing, misappropriated or unaccounted for.

In the suit number FHC/L/CS/148/22 filed last Friday at the Federal High Court in Lagos, SERAP is seeking an order of mandamus to direct and compel President Buhari to ensure the investigation of the alleged missing N3.1bn of public funds, the prosecution of anyone suspected to be responsible, and the recovery of any missing public money.

SERAP argues that the allegations that over N3bn of public funds are missing amount to a fundamental breach of national anticorruption laws and the country’s international obligations including under the UN Convention against Corruption to which Nigeria is a state party.

According to SERAP, Investigating and prosecuting the allegations, and recovering any missing public funds would serve the public interest, and end the impunity of perpetrators.

SERAP contends that, The consequences of corruption are felt by citizens on a daily basis.

Corruption exposes them to additional costs, and undermines economic development of the country, trapping the majority of Nigerians in poverty and depriving them of opportunities.

Joined in the suit as Respondents are Mr Abubakar Malami, SAN, Minister of Justice and Attorney General of the Federation; and Mrs Zainab Ahmed, Minister of Finance, Budget and National Planning.

The suit filed on behalf of SERAP by its lawyers Kolawole Oluwadare and Ms Adelanke Aremo, read in part: The failure to investigate the allegations of grand corruption in the Ministry of Finance constitutes a grave violation of the duty placed on the authorities to take appropriate measures to promote transparency and accountability in the management of public finances.

President Buhari’s constitutional responsibility to ensure the investigation and prosecution of allegations of corruption, as well as recovery of any missing public funds is contained in Section 15[5] of the Nigerian Constitution, which provides that ‘the State shall abolish all corrupt practices and abuse of power’, and in the Oath of Office in the Seventh Schedule of the Constitution.

According to the report of the Auditor-General for 2018, the Ministry of Finance spent N24,708,090.00 on pre-retirement training but without any document. The consultant hired also failed to quote any price as cost of the training but the Ministry paid N5,670,060.00 to the consultant.

Request for payment from the consultant was dated 20 January 2017 while the first payment voucher in his favour was dated 13 January 2017 (7 days before his request).

The Ministry also reportedly failed to account for N2,885,772,493.27 released to the Ministry from the Service Wide Vote to take care of estacodes and other allowances for representing the Federal Government in meetings, and contribution to Organization for Petroleum Exporting Countries (OPEC).

The money was spent without approval, and any documents. The Auditor-General is concerned that the money may have been mismanaged.

The Ministry also reportedly awarded a contract on 17th May 2017 for N98,540,500.00 without any document, contrary to the Public Procurement Act. The project was not also budgeted for.

There was no evidence of performance of the contract. The Ministry also deducted N9,354,809.52 as WHT and VAT but without any evidence of remittance. The Auditor-General wants the money recovered.

The Ministry also reportedly spent N98,759,299.20 between January December 2017 without any document, contrary to Financial Regulation 601.

According to the 2019 report of the Auditor-General, the Ministry paid N20,466,744.00 as cash advances to staff of ‘You-Win’ between 8 February and 18 December, 2018 but the Ministry has failed to retire the money.

The advances were granted for the purchase of store items, repairs and other services that would have been made through the award of contract. Government lost N2,046,674.40 which would have accrued as taxes had these jobs been undertaken through award of contracts. The Auditor-General wants the money recovered.

The Ministry also reportedly paid N15,471,850.00 to two consultants for capacity building in Kano and Adamawa States but without any supporting document, contrary to.

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