This document discusses a case of a 35-year-old male I/V drug abuser who was admitted to the hospital with headaches and loss of consciousness. An angiography revealed not one but three aneurysms in his brain vessels, one of which had already burst. The neurosurgeon, Dr. Vineet Saggar, successfully clipped two of the aneurysms in the same surgery. I/V drug abuse is identified as a potential cause of multiple aneurysms. Cerebral aneurysms are a weakening and ballooning of brain blood vessels that can rupture and cause bleeding in the brain. The most common treatments are surgical clipping or endovascular coiling to secure the aneurysm.

1. INTRACRANIAL ANEURYSMS
DR VINEET SAGGAR
M.B.B.S, MS, MCH(NEUROSURGEY)
CONSULTANT DEPARTMENT OF NEUROLOGICAL A
SPINAL SURGERY
IVY SUPERSPECIALITY HOSPITAL SEC-71, MOHAL
PUNJAB

2. I.V DRRUG ABUSE – A CAUSE OF
MULTIPLE ANEURYSMS IN BRAIN?
- Neurovascular surgery( surgery of blood vessels in brain)
is technically most demanding of neurosurgical procedures
- A rare neurovascular surgery was performed at ivy
hospital few days back
- A 35 years old male I/V drug abuser was admitted in our
hospital with headache followed by loss of consciousness.
.Patient had experienced similar episode few days back
which was ignored by local general practitioner and he
was discharged on analgesics

3.  Before coming to us he was seen by
neurosurgeons in tricity and was refused
treatment due to risk involved in the surgery
 We did angiography of brain vessels and
found not one but three ANEURYSMS(
Balloon like dilatation in wall of brain vessels)
in his brain vessels , one of which has burst
causing massive hemorrhaged in his brain

4. Plain Ct Head showing Diffuse
Sub Arachnoid Haemmorage

5. CT Angio Brain showing Multiple
aneurysms LT MCA, RT Pcom and ANT
choroidal Artey aneurysms

7. POST OP SCAN

8. POST OP SCAN WITH CLIPS IN
SITU

9.  Two of the Aneurysms on the right side were
clipped in the same surgery By Dr Vineet
Saggar and patient was Discharged after two
weeks with advice of surgery on opposite side
after six weeks.

10. Patient Just before
Discharge

11. WHAT ARE ANEURYSMS
 A cerebral or brain aneurysm is a
cerebrovascular disorder in which weakness
in the wall of a cerebral artery or vein causes a
localized dilation or ballooning of the blood
vessel.
 The general incidence of aneurysms in the
population at large is of the order of 1%-2%
 Multiple aneurysms occur in 0.2% of the
population

13. SIGNS AND SYMPTOMS
 Most common symptom is sudden severe
headache that can last from several hours to
days
 nausea and vomiting
 drowsiness and/or coma

14.  The ruptured aneurism (hemorrhage) may
also damage the brain directly, usually from
bleeding into the brain itself. This is called a
“hemorrhagic stroke.” This can lead to:
 weakness or paralysis of an arm or leg
 trouble speaking or understanding language
 vision problems
 seizures

15. CAUSES
 Aneurysms may result from congenital
defects(MOST COMMON CAUSE),
 Preexisting conditions such as high blood
pressure and atherosclerosis (the buildup of fatty
deposits in the arteries), or head trauma.
 Cerebral aneurysms occur more commonly in
adults than in children but they may occur at any
age.
 They are more common in women than in
men, by a ratio of 3 to 2.

16. TREATMENT
Currently there are two treatment options for
securing intracranial aneurysms:
 Surgical clipping
or
 Endovascular coiling

17. ANEURYSM CLIPS

18. SURGERY V/S COILING
 Although endovascular coiling is associated
with a shorter recovery period as compared
to surgical clipping, it is also associated with a
significantly higher recurrence rate after
treatment
 Also coiling may not be the best options in
patients with giant aneurysms , wide neck
aneurysms or patients with massive bleed or
large clots in brain as was in our case .

19. A YOUNG 25 YEAR MALE WITH
ANEURYSM RUPTURE -A
candidate for Surgery

20. POST OP SCAN WITH ANEURYSM
CLIP IN SITU

21. POST OP PIC OF PATIENT
DURING RECOVERY

22. AFTER CRANIOPLASTY

23.  Dr. Vineet Saggar (MCh)
Neuro Surgeon / Spinal Surgeon
Chandigarh, Mohali -
Ivy Hospital Sector 71
+91-9855990990
http://www.neurosurgeoninchandigarh.com
http://neurosergeonhead.blogspot.in
http://www.facebook.com/neuro.surgeon.7186
 http://www.linkedin.com/pub/dr-
vineet/56/2a9/863
 https://twitter.com/drvineetsaggar
 http://www.slideshare.net/neurosergeonhead