Unilateral Anomalous Profunda Femoris Artery: An Anatomical ...
Aneurysm: Signs And Symptoms
An aneurysm is an abnormal bulging in the wall of an artery or vein that fills with blood. Arteries are blood vessels that send oxygenated blood from the heart to the rest of the body. Aneurysms can happen in any artery or vein throughout the body, including the brain, heart, intestines, abdomen, and occur when part of the vessel wall is thinned or weakened. Most small aneurysms don't cause any symptoms until they are large, start leaking blood, or ruptures.
Aneurysms can happen at any age but are more common during the ages of 30 to 60. Symptoms depend on where it occurs in the body and how large the aneurysm is. Some common symptoms include sudden headache, pain in the abdomen, neck or chest, blurry vision, skin discoloration, among many others.
Most common aneurysms are typically the size of a small berry. If an aneurysm bursts, symptoms can happen suddenly and require immediate medical attention.
Aneurysm symptoms are based on location and whether the aneurysm is large or has ruptured. Common symptoms you can experience during a aneurysm include: Sudden headache Abdomen or back pain Discoloration of the lower extremities Dizziness Blurry vision Confusion Types of aneurysms are defined by their location. Symptoms will vary on whether the aneurysm has burst, or if it is large and pressing up against other parts of your body. Cerebral Aneurysm Symptoms Cerebral aneurysms occurs in arteries in the brain. They can affect any area of the brain, but they usually form in arteries at the base of the skull. If a cerebral aneurysm becomes large enough it can press up against brain tissue. Pressure on brain nerves caused by a large aneurysm can cause the following symptoms: Pain behind the eyes Paralysis on one side of the face Pupil dilation Drooping eyelids (ptosis) Double vision or blurry vision More severe symptoms can occur if an aneurysm in the brain bursts or leaks blood. This is known as a subarachnoid hemorrhage. The brain damage caused by this type of bleeding is known as a stroke. The primary symptoms of a burst or leaking cerebral aneurysm include: A sudden headache that can last hours or days Double vision Nausea and/or vomiting Neck stiffness Light sensitivity Seizures Loss of consciousness or coma Weakness or paralysis of arms or legs In some cases, death Aortic Aneurysm Symptoms An aortic aneurysm happens in the aorta, the main artery that sends blood away from your heart to the rest of your body. Aortic aneurysms are the most common type of aneurysms. An aneurysm that happens in the chest is known as a thoracic aneurysm, while one that happens below the chest is known as an abdominal aortic aneurysm. Symptoms of thoracic aortic aneurysms include: Abdominal aortic aneurysms are more common than thoracic aneurysm. Symptoms of abdominal aneurysms include: Throbbing pain in the back or side Pain in the groin Pain buttocks or legs Discoloration of lower extremities Popliteal Artery Aneurysm Symptoms This type of aneurysm happens in the popliteal artery, which is one of the major arteries of the leg and is located behind your knee. Most popliteal artery aneurysms are asymptomatic. Symptoms usually present themselves when the aneurysm is enlarged and puts pressure on structures in the leg including nerves and veins. Common popliteal artery aneurysm symptoms include: Leg pain Paresthesia (the feeling of "pins and needles" on your skin) Muscle weakness Thrombosis (blood clots) Pulsating mass in the back of your knee Splenic Artery Aneurysm Symptoms This type of aneurysm happens in the splenic artery, the artery that provides major blood flow into the spleen. Splenic artery aneurysms represent 60 to 70% of aneurysm cases in the visceral arteries, which are the arteries that provide blood to parts of the body like the kidneys, spleen, livers, and intestines. Symptoms of a splenic artery aneurysm are: Abdominal pain that in some cases radiates up to the left shoulder Internal hemorrhage (internal bleeding) Hematemesis (vomiting blood) There are no specific differences in aneurysm symptoms between men and women. However, there are differences in the type of aneurysms that affect men and women. Cerebral aneurysms are more common in women than in men. According to a 2022 review published by the American Heart Association, showed that women have a 1.4 times higher risk of having a brain aneurysm rupture than men. The study, which analyzed the data from 9940 patients, showed that on average, women had larger sized brain aneurysms, increasing the likelihood of bursting. While cerebral aneurysms are more common in women, abdominal aortic aneurysms are more common in men. A 2020 study found that the rate of abdominal aortic aneurysm rupture was higher in men (68%) versus women (32%). This higher rate of abdominal aortic aneurysm rupture was correlated with higher rates of smoking in men. It is important to note that data is limited and more studies need to be done to determine the cause of these sex-based differences. Aneurysm symptoms happen quickly soon after becoming large or bursting. A ruptured aneurysm can cause serious health concerns and, if not treated quickly, can be life-threatening. If you experience a sudden and very painful headache you should seek immediate medical attention. Some symptoms to keep a lookout for in combination of a sudden and severe headache include: Double vision Nausea and vomiting Stiff neck Sensitivity to light It is important to note that not all aneurysms develop into large aneurysms that burst. Usually, small aneurysms are seen in the brain or the aorta during diagnostic testing for other medical conditions. Screenings for aneurysms are recommended for individuals over the ages of 65, those who have a family history of aneurysms or high blood pressure, and people who have a history of smoking. If your healthcare provider finds a small aneurysm in your body during a screening, they can determine if preventive measures like surgery or prescribing some blood thinning medicine are needed. Aneurysms are abnormal bulges on artery walls that fill up with blood and can burst if they become large enough. While most small aneurysms do not cause any symptoms, large aneurysms and ruptured aneurysms can cause a series of health concerns. Symptoms depend on where the aneurysm is in your body. Aneurysms can cause many symptoms, including cause a sudden and severe headache, blurry vision, pain in the chest and abdomen, and seizures. In some cases, a burst aneurysm can cause a coma or death. Symptoms usually happen suddenly, therefore it is essential that you reach out to your healthcare provider immediately if you experience a combination of any of these symptoms. Screening for aneurysms for people over the age of 65 and those who have a family history of aneurysms is recommended to help catch aneurysms early and potentially take preventive measures, if needed.Exercise Induced Critical Ischaemia Of The Upper Limb Secondary To A Cervical Rib
AbstractThe case is reported of a 32 year old woman with acute on chronic upper limb ischaemia due to thrombus from a cervical rib that had compressed the right subclavian artery of her dominant hand after use of a rowing machine. If not detected early, this condition can be debilitating especially in the young. A multidisciplinary approach is advisable to ensure a satisfactory outcome.
A 32 year old woman attended the emergency department complaining of a three day history of forearm pain in her dominant right hand, which prevented her from sleeping. She had recently taken up an exercise programme, using a rowing machine, after pregnancy. Musculoskeletal pain was diagnosed, and a short course of non-steroidal anti-inflammatory drugs and physiotherapy were prescribed. She was a smoker (10 cigarettes a day) and was taking the oral contraceptive pill.
She returned to the emergency department on three occasions over a six week period. At the time of admission she complained of the same pain and numbness, which had worsened over the preceding four days. She had also had rest pain for the preceding 72 hours. The brachial artery pulse was barely palpable but the radial pulse was absent. A radial artery Doppler ultrasound signal was weakly audible. An intravenous heparin infusion was started.
x Ray fluoroscopy revealed a cervical rib on the right side and a smaller left cervical rib. Colour duplex ultrasound scanning now showed no arterial flow distal to the axillary artery. Angiography showed occlusion distal to the subclavian artery. Recombinant tissue plasminogen activator (r-TPA) was given for 24 hours, which was successful in restoring flow in the axillary and brachial artery to the elbow, but the patient continued to have severe pain in the forearm.
She proceeded to have a brachial embolectomy, which showed that the brachial artery was full of thrombus that extended to the palm. The ulnar artery appeared normal. A radial artery embolectomy and vein patch graft was then performed. Completion angiography confirmed collateral arterial flow to the fingers but not to the palmar arches. Radial and ulnar Doppler signals were present.
Three days later the Doppler signals were not audible. This may have been partly due to inadequate anticoagulation and to thrombus in the palmar arches. On further exploration it was found that the radial and ulnar arteries were occluded and there was intimal damage to the radial artery. Distal and proximal thrombectomy, on table r-TPA infusion, and radial artery vein patch grafting were repeated in a final attempt to improve the blood flow to her dominant hand. Doppler ultrasound showed a good radial artery signal and a weak ulnar artery signal.
One month later, at excision of the right cervical rib, it was apparent that the subclavian artery had been lifted to a very high and kinked position. There was no evidence of aneurysm formation.
The patient was discharged two weeks after admission with slight cyanosis of the pulps of her fingers and minimal paraesthesia in the radial two and a half fingers.
She returned three months later for magnetic resonance angiography of the right arm, which showed that the radial and ulnar artery were occluded. The interosseous artery was patent and provided collaterals to the palmar arch. The brachial artery was occluded above the elbow. She then underwent sympathectomy with good symptomatic relief and was able to carry out normal housework despite some arm claudication. Six months later she is asymptomatic and taking a calcium channel blocking drug (nifedipine) and is due to have prophylactic excision of a left cervical rib.
DISCUSSIONThoracic outlet syndrome or thoracic outlet compression syndrome is due to compression of the subclavian vessels or brachial plexus in the region of the thoracic outlet. Congenital causes include cervical ribs and anomalous first ribs or fibromuscular bands. Acquired causes are blunt trauma, clavicular deformities, scalene musculotendonous hypertrophy, and subclavian artery aneurysms.1
Thoracic outlet syndrome is the cause in less than 5% of patients with upper extremity ischaemia. Of these, a cervical rib is the most common cause, especially in fit young people.2 About 70% of cases of thoracic outlet syndrome are associated with neurological symptoms, and, when vascular injury occurs, venous problems—for example, axillary vein thrombosis—are more common than arterial.
Although thoracic outlet syndrome is very rare, it is important to bear it in mind. It is becoming more common in athletes, especially swimmers, who perform repetitive overhead movements and those who perform hyperabduction movements.3 There is also evidence in athletes that there is axillary artery compression by the head of the humerus during abduction.4
These arterial injuries, especially in athletes, affect young and otherwise healthy and active people. If not diagnosed early, they can be severely debilitating, have significant morbidity, and may ultimately lead to amputation. One must have high clinical suspicion when confronted with a patient complaining of unilateral upper limb sensory and/or motor symptoms, especially after exercise that involves hyperabduction. Unfortunately, in this case, the patient had not received a proper initial physical assessment with a follow up plan, and returned with an acute on chronic ischaemic limb which was resistant to attempts at thrombectomy. In patients with acute arm pain, initial assessment should include examination of peripheral pulses and brachial artery blood pressure in both arms. Revascularisation of an ischaemic limb in a young patient may result in a compartment syndrome and thus may require prophylactic fasciotomy to avoid secondary muscle damage, ischaemic contractures, and further functional disability. Successful management of these patients involves a multidisciplinary approach. Close liaison with radiology, vascular, physiotherapy, and rehabilitation services is essential to ensure a satisfactory functional outcome. At follow up, most patients are asymptomatic with a patent arterial system or at least significantly improved.5
Take home messageRepetitive movement in young athletes can lead to upper limb neurovascular injury
Acute/chronic upper limb ischaemia (or deep venous thrombosis) should prompt evaluation for a cervical rib
The initial emergency assessment and treatment of thoracic outlet syndrome is the same as for acute upper limb ischaemia from any cause
Vascular complications associated with cervical ribs can be limb threatening
Nichols AW. The thoracic outlet syndrome in athletes. J Am Board Fam Pract1996;9:346–55.
Aburahma AF, White JF. Thoracic outlet syndrome with arm ischaemia as a complication of cervical rib. W V Med J1995;91:92–4.
Richardson AB. Thoracic outlet syndrome in aquatic athletes. Clin Sports Med1999;18:361–78.
Durham JR, Yao JS, Pearce WH, et al. Arterial injuries in the thoracic outlet syndrome. J Vasc Surg1995;21:57–69.
Hood DB, Kuehne J, Yellin AE, et al. Vascular complications of thoracic outlet syndrome. Am Surg1997;63:913–17.
Brain Aneurysms
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A brain aneurysm is an area of weakness in a brain blood vessel that over time can grow larger and thinner. Aneurysms are dangerous because they can grow and eventually rupture allowing blood to leak out of the vessel. When aneurysms bleed, the blood accumulates in the fluid space under the brain and this is called a subarachnoid hemorrhage. Aneurysms that bleed are life-threatening and should be treated urgently as it is a life-threatening emergency. Brain aneurysms that are discovered before they have bled are often treated to prevent rupture.
Brain aneurysms are relatively common. Approximately 10–12 million people in the U.S. Have brain aneurysms and about 27,000 new aneurysms are discovered each year (Brisman, Song & Newell, 2006). However, not all aneurysms are high risk to rupture and it is important to speak with a cerebrovascular neurosurgeon about your particular aneurysm.
The cerebrovascular neurosurgeons at Baylor Medicine and Baylor St. Luke's Medical Center in Houston, Texas, specialize in the diagnosis and treatment of brain aneurysms and other brain blood vessel disorders. Our doctors have national reputations as leaders in the field of aneurysm treatment. Each brain aneurysm is different and our doctors provide great expertise managing these potentially dangerous lesions.
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