Title Aneurizme Willisova arterijskog kruga Title (english) Circle of Willis aneurysms Author Marko Zorić Mentor Goran Mrak (mentor)Committee member Josip Paladino (predsjednik povjerenstva)Committee member Tomislav Meštrović (član povjerenstva)Committee member Goran Mrak (član povjerenstva)Granter University of Zagreb Defense date and country 2015-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Aneurizme su abnormalna proširenja stijenke arterija. Moždane arterije su uz aortu najčešće mjesto nastanka aneurizmi. Po izgledu najčešće su vrećaste (sakularne) a po veličini mogu biti male, srednje, velike i gigantske. Nastaju najčešće u području prednje cirkulacije AcoA, MCA i ACA točnije oko 90% slučajeva, dok se samo 10% nalazi u području stražnje cirkulacije. Češće su kod žena, kod osoba s nasljednim bolestima poremećaja sinteze vezivnih vlakana, a rizični čimbenici za nastanak su pušenje, hipertenzija, neprimjerena upotreba alkohola itd. One su uglavnom asimptomatske, simptomi počinju tek prilikom rupture i kad nastane SAH. To je ozbiljno stanje koje nastaje izlijevanjem arterijske krvi iz aneurizme i može biti praćeno jakim glavoboljama, parezom kranijalnih živaca, rigiditetom nuhalne regije i u najtežim i opsežnim krvarenjima dolazi do poremećaja svijesti sve do kome. Dijagnoza se postavlja uz uzimanje anamneze i detaljnog neurološkog statusa pomoću radioloških pretraga. Koriste se: CT, CTA i DSA koji se smatra „zlatnim standardom“ jer može otkriti jako male aneurizme i jako mala krvarenja. Nakon što se postavi dijagnoza SAH-a pacijenta se hospitalizira, i daju se blokatori Ca2+-kanala jer oni smanjuju vazosapazam što predstavlja najozbiljniju komplikaciju nakon SAH-a. Također se primjenjuje 3H liječenje (hemodilucija, hipertenzija, hipervolemija) nakon što se aneurizma zatvori endovaskularno (coilling) ili kirurški (clipping). Koji princip odabrati ovisi o iskustvu tima (neurokirurg i interventni neuroradiolog), obliku i veličini aneurizme, stanju pacijenta i komorbiditetima.
Abstract (english) Aneurysms are abnormal widening of the arterial wall. The are most common in the the cerebral arteries and the aorta. They have most commonly sacullar shape and depending on their size they can be divided into: small, medium, large and gigantic. Mostly they occur on ACA, AcoA and MCA in about 90% of all cases. The rest mostly occur on VA and BA. Aneurysms are more likely at women and some risks facotrs such as smoking, abuse of alcohol, high blood pressure are related with them but also some inheritery diseases like Ehlers-Dahnlos etc. They are asimptomatic until they rupture and cause subarachnoid hemorthage(SAH). This is a very serious medical condition which can be present with strong headaches „the strongest ever“, nuchal rigidity, palsy of cranial nerves and even coma in heavier cases of SAH. The diagnose is made with proper neurological examination and radiological diagnostics. The golden standard is DSA but CT, CTA or MRI are also used. After the diagnose the patient is moved to intensive care unit for further tratment, mostly 3H(hipertension, hipervolemia and hemodilution) te use of Ca2+- blocators has been described as very useful for avoding of vasospasm which can cause great complication afterwards. The last step is to decide which type of treatment to choose: endovascular(coilling) or surgical(clipping). The choice depends on many factors for instance the team(neurourgeon and neuroradiologist), the size, location and shape of the aneursym, the severity of the condition of the patient and comorbidities.
Keywords
sakularna aneurizma
subarahnoidalno krvarenje
digitalna subtrakcijska angiografija
endovaskularno liječenje
kirurško liječenje
Keywords (english)
saccular aneursyms
subarachnoid hemorrhage
digital subtraction angiography
coilling
clipping
Language croatian URN:NBN urn:nbn:hr:105:880383 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2016-08-10 08:03:32
