What is an aneurysm. What causes an aneurysm. Who is at risk for an aneurysm. What are the symptoms of an aneurysm. How are different types of aneurysms categorized. What are the most common locations for aneurysms. How does atherosclerosis contribute to aneurysm formation.

Understanding Aneurysms: A Comprehensive Overview

An aneurysm is a potentially dangerous medical condition characterized by a bulging, weak area in the wall of a blood vessel. While aneurysms can occur in any blood vessel, they most commonly develop in arteries. The severity and potential complications of an aneurysm largely depend on its location, size, and underlying cause.

Key Characteristics of Aneurysms

• Typically occurs in arteries rather than veins
• Can be categorized by location, shape, and cause
• May be asymptomatic or cause various symptoms depending on the affected area
• Potentially life-threatening if ruptured

Are all aneurysms immediately life-threatening? Not necessarily. While any aneurysm has the potential to rupture and cause severe complications, many remain stable for years without causing symptoms. However, early detection and proper management are crucial for preventing potentially catastrophic outcomes.

Common Locations of Aneurysms in the Human Body

Aneurysms can develop in various parts of the body, each presenting unique challenges and potential complications. Understanding the most common locations helps in recognizing symptoms and seeking timely medical attention.

Prevalent Aneurysm Sites

1. Brain (cerebral aneurysm)
2. Aorta (aortic aneurysm)
3. Neck
4. Intestines
5. Kidney
6. Spleen
7. Blood vessels in the legs (iliac, femoral, or popliteal aneurysm)

Which type of aneurysm is the most common? The aortic aneurysm, particularly those occurring in the abdominal region, is the most frequently encountered type. The aorta, being the largest artery in the body, is responsible for carrying oxygenated blood from the heart to the rest of the body, making it susceptible to aneurysm formation.

Types of Aortic Aneurysms

• Thoracic aortic aneurysm: Occurs in the chest cavity
• Abdominal aortic aneurysm: Develops in the abdomen

Underlying Causes and Risk Factors of Aneurysms

The exact cause of aneurysms is not fully understood, but several factors contribute to their formation. Atherosclerosis, or hardening of the arteries, is believed to play a significant role in many cases. However, the causes can vary depending on the location and type of aneurysm.

Causes of Different Aneurysm Types

Abdominal Aortic Aneurysm (AAA):

• Atherosclerosis (especially in the infrarenal aortic region)
• Genetic disorders
• Giant cell arteritis
• Infection

Cerebral Aneurysm:

• Congenital factors
• High blood pressure
• Atherosclerosis
• Head injury

Common Iliac Artery Aneurysm:

• Atherosclerosis
• Pregnancy
• Infection
• Injury after lumbar or hip surgery

Femoral and Popliteal Artery Aneurysm:

• Atherosclerosis
• Injury
• Congenital disorders

How does atherosclerosis contribute to aneurysm formation? Atherosclerosis weakens the arterial walls by causing plaque buildup, reducing elasticity, and promoting inflammation. This weakening makes the affected areas more susceptible to bulging and aneurysm formation over time.

Identifying Risk Factors for Aneurysm Development

Understanding the risk factors associated with aneurysms is crucial for prevention and early detection. These factors can be divided into two categories: those that cannot be controlled and those that can be modified through lifestyle changes and medical intervention.

Non-Modifiable Risk Factors

• Advanced age
• Male gender
• Family history of aneurysms
• Genetic predisposition

Modifiable Risk Factors

• High cholesterol levels
• Hypertension (high blood pressure)
• Smoking
• Diabetes
• Obesity

Can lifestyle changes reduce the risk of aneurysm formation? Yes, adopting a healthy lifestyle can significantly lower the risk of developing aneurysms. This includes maintaining a balanced diet, regular exercise, quitting smoking, managing stress, and controlling chronic conditions such as hypertension and diabetes.

Recognizing Aneurysm Symptoms: A Critical Guide

Aneurysms can be asymptomatic, making them challenging to detect without medical imaging. However, when symptoms do occur, they often vary depending on the location of the aneurysm. Pain is the most common symptom across all types of aneurysms.

Symptoms by Aneurysm Location

Brain Aneurysm (Cerebral Aneurysm):

• Severe headache (often described as the “worst headache of life”)
• Neck pain
• Nausea and vomiting
• Blurred or double vision
• Sensitivity to light
• Seizures
• Confusion or loss of consciousness

Aortic Aneurysm:

• Deep, constant pain in the abdomen or chest
• Back pain
• Feeling of fullness after minimal food intake
• Pulsating sensation near the navel (for abdominal aortic aneurysms)

Peripheral Aneurysm (e.g., in the legs):

• Pulsating mass in the affected area
• Pain or tenderness
• Swelling or edema
• Numbness or tingling sensation
• Muscle weakness

Why is immediate medical attention crucial when experiencing sudden, severe pain? Sudden, intense pain could indicate a rupturing aneurysm, which is a life-threatening emergency requiring immediate medical intervention. Prompt treatment can significantly improve the chances of survival and reduce the risk of severe complications.

Diagnostic Approaches for Aneurysm Detection

Accurate diagnosis of aneurysms is essential for proper treatment and management. Medical professionals employ various diagnostic techniques to identify, locate, and assess the severity of aneurysms.

Common Diagnostic Methods

1. Computed Tomography (CT) Scan: Provides detailed cross-sectional images of blood vessels and surrounding tissues.
2. Magnetic Resonance Imaging (MRI): Offers high-resolution images without using ionizing radiation.
3. Angiography: Involves injecting contrast dye into blood vessels to visualize their structure on X-rays.
4. Ultrasound: Non-invasive method used primarily for detecting abdominal aortic aneurysms.
5. Cerebrospinal Fluid (CSF) Analysis: Used in suspected cases of brain aneurysms to detect blood in the CSF.

How do doctors determine the best diagnostic approach for suspected aneurysms? The choice of diagnostic method depends on various factors, including the suspected location of the aneurysm, the patient’s overall health, and the availability of imaging technologies. Often, a combination of techniques is used to obtain a comprehensive assessment.

Treatment Options and Management Strategies for Aneurysms

The treatment of aneurysms varies depending on their size, location, and the patient’s overall health. Management strategies range from watchful waiting to surgical intervention.

Conservative Management

• Regular monitoring through imaging studies
• Blood pressure control
• Smoking cessation
• Lifestyle modifications to reduce risk factors

Surgical Interventions

Endovascular Repair:

• Minimally invasive procedure
• Involves inserting a stent graft through a small incision in the groin
• Commonly used for aortic aneurysms

Open Surgery:

• Traditional surgical approach
• Involves removing the aneurysm and replacing the affected blood vessel with a graft
• May be necessary for complex cases or when endovascular repair is not suitable

Clipping and Coiling (for Brain Aneurysms):

• Clipping: Placing a tiny metal clip at the base of the aneurysm to stop blood flow
• Coiling: Inserting tiny platinum coils into the aneurysm to promote clotting and seal it off

What factors influence the choice between conservative management and surgical intervention? The decision depends on the aneurysm’s size, growth rate, location, and the patient’s overall health and risk factors. Smaller, stable aneurysms may be monitored, while larger or rapidly growing aneurysms often require surgical treatment to prevent rupture.

Preventing Aneurysms: Lifestyle Modifications and Risk Reduction

While some risk factors for aneurysms are beyond our control, many can be mitigated through lifestyle changes and proactive health management. Implementing these strategies can significantly reduce the risk of aneurysm formation and progression.

Key Prevention Strategies

1. Maintain a healthy blood pressure: Regular monitoring and medication if necessary
2. Quit smoking: Smoking cessation programs and support groups can be beneficial
3. Adopt a heart-healthy diet: Rich in fruits, vegetables, whole grains, and lean proteins
4. Regular exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity per week
5. Manage stress: Practice relaxation techniques such as meditation or yoga
6. Control cholesterol levels: Through diet, exercise, and medication if needed
7. Maintain a healthy weight: Obesity increases the risk of aneurysms and related complications
8. Limit alcohol consumption: Excessive alcohol intake can contribute to hypertension
9. Regular medical check-ups: Especially important for those with a family history of aneurysms

Can dietary supplements help prevent aneurysms? While no specific supplement has been proven to prevent aneurysms directly, some studies suggest that omega-3 fatty acids and antioxidants may support overall cardiovascular health. However, it’s essential to consult with a healthcare provider before starting any supplement regimen, as some may interact with medications or have unintended effects.

The Role of Genetic Counseling

For individuals with a family history of aneurysms, genetic counseling can be an invaluable tool in understanding and managing risk. Genetic counselors can:

• Assess family medical history
• Recommend appropriate genetic testing
• Provide information on inheritance patterns
• Offer guidance on preventive measures and screening options

Living with an Aneurysm: Coping Strategies and Long-term Outlook

Receiving an aneurysm diagnosis can be overwhelming, but with proper management and support, many individuals lead fulfilling lives. Understanding the condition and developing effective coping strategies are crucial for maintaining quality of life and emotional well-being.

Emotional and Psychological Impact

Living with an aneurysm can lead to:

• Anxiety about potential rupture
• Depression
• Fear of physical activities or exertion
• Relationship strain due to health concerns
• Financial stress from medical expenses

How can patients effectively manage the emotional challenges of living with an aneurysm? Seeking support through counseling, support groups, and open communication with loved ones can significantly improve emotional well-being. Additionally, learning stress-management techniques and focusing on controllable aspects of health can help reduce anxiety.

Long-term Management and Monitoring

Ongoing care for aneurysm patients typically involves:

1. Regular imaging studies to monitor aneurysm size and stability
2. Medication management for blood pressure control
3. Lifestyle modifications to reduce risk factors
4. Periodic consultations with vascular specialists or neurosurgeons
5. Emergency preparedness planning

Physical Activity and Exercise Guidelines

Maintaining an active lifestyle is essential for overall health, but patients with aneurysms may need to modify their exercise routines. Guidelines typically include:

• Avoiding high-intensity or contact sports
• Focusing on low-impact activities like walking, swimming, or cycling
• Gradually increasing exercise intensity under medical supervision
• Monitoring heart rate and blood pressure during physical activity
• Staying hydrated and avoiding overexertion

Can patients with aneurysms travel safely? In most cases, patients with stable, monitored aneurysms can travel safely. However, it’s crucial to consult with a healthcare provider before planning long trips, especially to remote areas. Patients should carry medical information, including details about their condition and emergency contact numbers.

Advances in Aneurysm Research and Treatment

Ongoing research in aneurysm management offers hope for improved outcomes and quality of life. Recent advancements include:

• Development of more advanced imaging techniques for early detection
• Improvements in minimally invasive surgical procedures
• Investigation of genetic factors to identify high-risk individuals
• Exploration of new medications to stabilize aneurysm growth
• Research into biomarkers for predicting aneurysm rupture risk

As medical knowledge and technology continue to advance, the prognosis for aneurysm patients improves. However, early detection, proper management, and adherence to treatment plans remain crucial for optimal outcomes.

Aneurysm | Cedars-Sinai

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What is an aneurysm?

An aneurysm is a bulging, weak area
in the wall of a blood vessel. It may occur in any blood vessel, but most often develops
in an artery rather than a vein. An aneurysm can be categorized by its location, shape,
and cause. 

An aneurysm may be found in many areas of the body, such as:

• Brain (cerebral aneurysm)
• Aorta (aortic aneurysm)
• Neck
• Intestines
• Kidney
• Spleen
• Blood vessels in the legs (iliac, femoral, or popliteal
  aneurysm)

 The most common types of an
aneurysm is in the aorta. The aorta is the largest artery in the body. The aorta carries
oxygenated blood from the heart to the body. A thoracic aortic aneurysm is s type
that
occurs in the chest cavity. An abdominal aortic aneurysm occurs in the abdomen. 

What causes an aneurysm?

An aneurysm may be caused by
factors that result in the breakdown of the artery wall. The exact cause isn’t fully
known. Atherosclerosis (hardening of the arteries) may be part of the cause.

Other causes of aneurysms are
related to where they occur. Examples may include:

Who is at risk for an aneurysm?

You are at higher risk for an
aneurysm if you have atherosclerosis.

Risk factors you can’t control
include:

• Older age
• Male
• Family history
• Genetic factors

Risk factors you can control
include:

• High cholesterol
• High blood pressure
• Smoking
• Diabetes
• Obesity

What are the symptoms of an aneurysm?

Aneurysms may have no symptoms. If
there are symptoms, they will depend on the location of the aneurysm in the body.
Pain
is the most common symptom. This is true no matter where the aneurysm is.

Symptoms that may occur with
different types of aneurysms may include:

The symptoms of an aneurysm may
look like other medical conditions or problems. See your healthcare provider for more
information.

How is an aneurysm diagnosed?

What tests you’ll need depends on
the location of the aneurysm. Along with a complete medical history and physical exam,
tests for an aneurysm may include:

• CT scan.

  This imaging test uses X-rays and computer technology to make horizontal
  (axial) images (often called slices) of the body. A CT scan shows detailed images
  of
  any part of the body, including the bones, muscles, fat, and organs. CT scans are
  more detailed than standard X-rays.

• MRI.An MRI uses large magnets, radio waves, and a computer to make detailed images
  of organs and structures in the body. It does not use X-rays.
• Echocardiogram (echo).This procedure evaluates the structure and function of the heart by using sound
  waves recorded on an electronic sensor that makes a moving picture of the heart and
  heart valves.
• Arteriogram
  (angiogram). 
  This is an X-ray image of the blood vessels used to
  evaluate various conditions, such as aneurysm, stenosis (narrowing of the blood
  vessel), or blockages. A dye (contrast) will be injected through a thin flexible tube
  placed in an artery. This dye will make the blood vessels visible on the X-ray.
• Ultrasound.

  An ultrasound uses high-frequency sound waves and a computer to create
  images of blood vessels, tissues, and organs. An ultrasound is used to view internal
  organs as they function. And it is used to assess blood flow through various
  vessels.

How is an aneurysm treated?

Treatment options for an aneurysm
may include:

• Monitoring.Your doctor may monitor the size and rate of growth of your aneurysm with
  ultrasounds every 6 months to 12 months. This is part of a “watchful waiting”
  approach for smaller aneurysms. 
• Managing
  risk factors. 
  Steps such as quitting smoking, controlling blood sugar
  if you have diabetes, losing weight if overweight, and controlling dietary fat intake
  may help to control the progression of the aneurysm. 
• Medicine. Medicine can help control factors such as high cholesterol and high blood
  pressure. 
• Surgical
  repair.
  Surgical repair of the aneurysm can be done with large incisions and grafts or
  with smaller incisions, X-ray images and a stent-graft combination.

What are possible complications of an aneurysm?

The biggest complication of an
aneurysm is that it may tear (dissect) or rupture.  

Because an aneurysm may continue to
increase in size, along with progressive weakening of the artery wall, treatment is
required to prevent rupture of an aneurysm. The larger an aneurysm becomes, the greater
the risk for rupture (bursting). Rupture can cause life-threatening bleeding and
possibly death. Loss of blood flow to the area the artery provides circulation to
can
cause organ and tissue death, which may lead to amputation of the dead tissue.

Living with an aneurysm

Until your aneurysm reaches the
point where it needs to be repaired, it’s very important to follow your healthcare
provider’s advice closely.

• Have ultrasound screenings done as
  often as advised
• Follow advice about diet, exercise,
  and weight control
• Take medicine as prescribed

When should I call my healthcare provider?

If your symptoms get worse or you
have new symptoms, call your healthcare provider right away. Get immediate medical
attention if you have a sudden, severe pain in the area of the aneurysm. This could
be a
sign that the aneurysm has ruptured.

Key points about aneurysms

• An aneurysm is a bulging, weak area of
  an artery wall and can occur anywhere in the body.
• The most common symptom is pain in the
  area of the aneurysm.
• An aneurysm is repaired once it
  reaches a certain size. This is to prevent rupture of the blood vessel.
• Treatment of an aneurysm includes
  controlling risk factors. These include blood pressure, cholesterol, diabetes, and
  stopping smoking. These things may require changes in lifestyle and medicine.

Next steps

Tips to help you get the most from
a visit to your healthcare provider:

• Know the reason for your visit and
  what you want to happen.
• Before your visit, write down
  questions you want answered.
• Bring someone with you to help you ask
  questions and remember what your provider tells you.
• At the visit, write down the name of a
  new diagnosis, and any new medicines, treatments, or tests. Also write down any new
  instructions your provider gives you.
• Know why a new medicine or treatment
  is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated
  in other ways.
• Know why a test or procedure is
  recommended and what the results could mean.
• Know what to expect if you do not take
  the medicine or have the test or procedure.
• If you have a follow-up appointment,
  write down the date, time, and purpose for that visit.
• Know how you can contact your provider
  if you have questions.

Medical Reviewer: Deepak Sudheendra MD

Medical Reviewer: Rita Sather RN

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Aortic Aneurysm | cdc.gov

A thoracic aortic aneurysm happens in the chest. An abdominal aortic aneurysm, which is more common, happens below the chest.

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What is aortic aneurysm?

An aortic aneurysm is a balloon-like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso.

Aortic aneurysms can dissect or rupture:

• The force of blood pumping can split the layers of the artery wall, allowing blood to leak in between them. This process is called a dissection.
• The aneurysm can burst completely, causing bleeding inside the body. This is called a rupture.
• Dissections and ruptures are the cause of most deaths from aortic aneurysms.

Facts About Aortic Aneurysm in the United States

• Aortic aneurysms or aortic dissections were the cause of 9,904 deaths in 2019.¹
• In 2019, about 59% of deaths due to aortic aneurysm or aortic dissection happen among men.¹
• A history of smoking accounts for about 75% of all abdominal aortic aneurysms.²
• The U.S. Preventive Services Task Force recommends that men 65 to 75 years old who have ever smoked should get an ultrasound screening for abdominal aortic aneurysms, even if they have no symptoms.³

What are the types of aortic aneurysm?

A thoracic aortic aneurysm happens in the chest. Men and women are equally likely to get thoracic aortic aneurysms, which become more common with increasing age.⁴

Thoracic aortic aneurysms are usually caused by high blood pressure or sudden injury. Sometimes people with inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms.

Signs and symptoms of thoracic aortic aneurysm can include the following:

• Sharp, sudden pain in the chest or upper back
• Shortness of breath
• Trouble breathing or swallowing

An abdominal aortic aneurysm happens below the chest. Abdominal aortic aneurysms happen more often than thoracic aortic aneurysms.

Abdominal aortic aneurysms are more common in men and among people age 65 and older. Abdominal aortic aneurysms are more common among white people than among black people.⁵

Abdominal aortic aneurysms are usually caused by atherosclerosis (hardened arteries), but infection or injury can also cause them.⁶

Abdominal aortic aneurysms often don’t have any symptoms. If an individual does have symptoms, they can include the following:

• Throbbing or deep pain in the back or side
• Pain in the buttocks, groin, or legs

Aneurysms can happen in other parts of your body. A ruptured aneurysm in the brain can cause a stroke. Peripheral aneurysms—those found in arteries other than the aorta—can happen in the neck, in the groin, or behind the knees. These aneurysms are less likely to rupture or dissect than aortic aneurysms, but they can form blood clots. These clots can break away and block blood flow through the artery.

What are the risk factors for aortic aneurysm?

Diseases and unhealthy behaviors that damage your heart and blood vessels also increase your risk for aortic aneurysm. Smoking is the most important behavior related to aortic aneurysm.

Other factors include

• High blood pressure
• High blood cholesterol
• Atherosclerosis (hardened arteries)

Some inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, can also increase your risk for aortic aneurysm. Your family may also have a history of aortic aneurysms that can increase your risk.

How are aortic aneurysms treated?

The two main treatments for aortic aneurysms are medicines and surgery. Medicines can lower blood pressure and reduce risk for an aortic aneurysm. Surgery can repair or replace the affected section of the aorta.

More Information

• State and Local Public Health Actions
• Million Hearts^®
• MedlinePlus
• National Heart, Lung, and Blood Institute
• American Heart Association

References

1. Centers for Disease Control and Prevention, National Center for Health Statistics. About Multiple Cause of Death, 1999–2019. CDC WONDER Online Database website. Atlanta, GA: Centers for Disease Control and Prevention; 2019. Accessed February 1, 2021.
2. Norman PE, Curci JA. Understanding the effects of tobacco smoke on the pathogenesis of aortic aneurysm. Arterioscler Thromb Vasc Biol. 2013;33(7):1473–7.
3. U.S. Preventive Services Task Force. Rockville, MD: U.S. Preventive Services Task Force; 2014. Accessed February 16, 2018.
4. Clouse WD, Hallett JW Jr., Schaff HV, Gayari MM, Ilstrup DM, Melton LJ 3rd. Improved prognosis of thoracic aortic aneurysms: a population-based study.JAMA. 1998;280(22):1926–9.
5. Guirguis-Blake J, Wolff TA. Screening for abdominal aortic aneurism. Am Fam Physician. 2005;71(11):2154–5.
6. Creager MA, Loscalzo J. Diseases of the aorta. In: Fauci AS, Longo DL, Kasper D, Braunwald E, Jameson JL, Loscalzo J, Hauser SL, eds. Harrison’s Principles of Internal Medicine. 17th ed. Columbus, OH: McGraw-Hill; 2008:1563–7.

Intervertebral hernia of the cervical region. What is an intervertebral hernia of the cervical spine?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Intervertebral hernia of the cervical region – degeneration and prolapse beyond the boundaries of the intervertebral space of the cervical intervertebral disc. Clinically manifests pain in the shoulder girdle and arm, radiating to the fingers, weakness and hypesthesia of the arm, vertebral artery syndrome. It is diagnosed mainly by the results of MRI of the cervical spine. Conservative therapy consists of anti-inflammatory and muscle relaxant drugs, corticosteroid blockades, kinesiotherapy, physiotherapy, massage, therapeutic traction. Surgical treatment usually consists of removing the affected disc and stabilizing the spine.

• Causes of cervical hernia
• Cervical hernia symptoms
• Hernia diagnostics
• Cervical hernia treatment
• Prices for treatment

General

Intervertebral hernia of the cervical region is quite common. In terms of prevalence, it ranks second after the intervertebral hernia of the lumbar region. Most often, hernias form in the discs between the fifth and sixth, between the sixth and seventh cervical vertebrae. More rarely – between the fourth and fifth, extremely rarely between the seventh cervical and first thoracic vertebrae. Considering the prevalence of cervical hernias, the relatively young age of the patients (on average 30-50 years), the risk of severe vascular complications, this pathology remains an urgent problem in clinical neurology, vertebrology and orthopedics.

The discs of the cervical spine are smaller in diameter than the thoracic and lumbar discs, and therefore the hernias in this section are smaller. However, a narrower spinal canal and a reduced space for the roots to exit the spinal cord cause clinical symptoms even with a slight disc protrusion. A feature of the cervical region is the passage from both sides along the bodies of the vertebrae of the vertebral arteries. In this regard, the intervertebral hernia is manifested not only by neurological, but also by vascular disorders.

Intervertebral hernia of the cervical region

Causes of cervical hernia

The formation of an intervertebral hernia is associated with degenerative processes occurring in the disc, due to which it loses its elasticity. Chronic injury with increased load on the cervical region or acute injury of the spine (contusion of the spine, subluxation of the cervical vertebrae) lead to the formation of cracks in the fibrous ring of the disc, the exit of part of the disc beyond the intervertebral space, and in the future – to the prolapse of the nucleus pulposus.

Degenerative changes in the intervertebral discs are usually associated with osteochondrosis, but can be caused by cervical spondylosis, spondyloarthrosis, tuberculosis of the spine, inadequate load on the cervical region in case of anomalies in the development of the spine (Klippel-Feil syndrome, wedge-shaped vertebra, atlas assimilation), impaired posture, cervical – thoracic scoliosis, obesity. Factors contributing to disc degeneration are various dysmetabolic processes in the body that occur with diabetes mellitus, alcoholism, smoking, and genetically determined metabolic diseases.

Clinical symptoms of intervertebral hernia are caused by its compression of the spinal root, substance of the spinal cord, vertebral artery. In the first two cases, neurological symptoms occur (pain, motor deficits and sensory disorders), in the third – vertebral artery syndrome. The latter can cause repeated transient ischemic attacks (TIA), chronic cerebral ischemia in the vertebrobasilar basin with the formation of discirculatory encephalopathy.

MRI SHOP. Herniated disc protrusions in s. C5-C6, C6-C7 posteriorly, with pronounced narrowing of the spinal canal and compression of the spinal cord

Cervical hernia symptoms

In the initial stages of a cervical hernia, its main manifestations are pain and vertebral syndromes associated with irritation of the spinal root at the level of hernia formation. Initially, the pain syndrome can be periodic in nature, provoked by turns and tilts of the head. Then the pain is transformed into a permanent one, aggravated by head movements. It is localized in the neck, shoulder and arm from the side of the formed hernia, accompanied by paresthesia and numbness of the arm. When moving in the cervical region, so-called. “lumbago” – a sharp pain going from the neck to the fingers of the hand.

Pain impulses cause reflex development of muscular-tonic changes that make up the spinal syndrome. The resulting increase in the tone of the paravertebral muscles of the cervical region and other muscles of the neck leads to limited mobility and exacerbates the course of the pain syndrome. Tonic contraction of the muscles on the side of the lesion causes the occurrence of reflex torticollis.

Over time, compression of the nerve fibers of the spinal root by a hernia leads to a violation of the conduction of nerve impulses along them – a radicular syndrome appears. There is weakness in the arm, accompanied by a decrease in muscle tone (flaccid monoparesis). Paresthesias are replaced by a significant decrease or complete loss of pain and other types of sensitivity in the zone of innervation of the compressed root.

A further increase in the size of the cervical hernia entails compression of not only the root, but also the spinal cord with the development of discogenic myelopathy. Compression of the vertebral artery is manifested by dizziness, headache, vestibular ataxia, transient visual disturbances (photopsias, scotomas, decreased visual acuity), tinnitus and mild hearing loss, autonomic disorders, the occurrence of fainting with a sharp turn of the head, drop attacks, TIA.

Intervertebral hernia of the cervical region, depending on the level of location, may have a variable clinical picture. With a herniated disc C4-C5, pain in the shoulder and weakness of the muscles of the shoulder girdle predominate. With a hernia of the C5-C6 level, weakness is noted in the biceps and extensors, numbness and paresthesia in the thumb are characteristic. Hernia C6-C7 is accompanied by a decrease in muscle strength in the triceps and extensors of the fingers, pain running along the back of the hand to the tip of the middle finger. Hernia C7-T1 is manifested by weakness when the hand is clenched into a fist, pain and paresthesia radiate to the little finger.

Hernia diagnostics

In the initial stages (disc protrusion), in the presence of only pain and spinal syndromes in the clinic, it is difficult for a doctor to suspect the formation of a cervical hernia. In such cases, an x-ray of the spine is usually performed, which can reveal signs of osteochondrosis, spondylarthrosis, and other pathological changes in the bone structures of the spinal column. A cervical hernia can be visualized using an MRI or CT scan of the spine. The indication for their implementation is the presence of muscle weakness in the arm or the clinic of the vertebral artery syndrome. Previously, contrast myelography was used in such cases. Currently, MRI of the spine is a safer and more informative diagnostic method. MRI better than CT allows visualization of the soft tissue structures of the spine, provides more complete information about the size of the hernia and the degree of narrowing of the spinal canal.

MRI of the cervical spine. Intervertebral hernia in the C5-C6 segment, exfoliating the posterior longitudinal ligament

Electrophysiological studies (EMG, ENG, ENMG) make it possible to identify the neural nature of the lesion and determine its level. To assess the state of the vertebral artery, an REG with functional tests, duplex scanning or ultrasound of the vertebral arteries is performed. Differential diagnosis is carried out with brachial plexitis, humeroscapular periarthrosis, cervical plexitis, cervical myositis, infectious myelopathy at the cervical level.

Cervical hernia treatment

Conservative therapy of a cervical hernia and recovery after its surgical treatment can be carried out by the joint efforts of a neurologist, orthopedist, vertebrologist, chiropractor, masseur, kinesiotherapist. In the acute pain period, anti-inflammatory drugs are prescribed (ibuprofen, ketorolac, nimesulide, meloxicam, etc.), local administration of corticosteroids (hydrocortisone, diprospan), muscle relaxants (tolperisone hydrochloride). From the first days, neurometabolic pharmaceuticals have been used, primarily vitamins of group B. The use of electrophoresis, UHF, magnetic therapy and phonophoresis contributes to the relief of pain and the reduction of inflammation.

In order to reduce pressure on the affected intervertebral disc, gentle manual therapy or traction therapy may be used. Traction of the cervical spine is performed using the Glisson loop in the sitting position. The use of myofascial massage techniques and reflexotherapy contributes to a decrease in the intensity of the muscular-tonic syndrome. In vertebral artery syndrome, vascular (pentoxifylline, vinpocetine) and nootropic (piracetam, pyritinol) agents are additionally prescribed.

At the beginning of the disease, it is necessary to ensure the rest of the cervical spine. For this purpose, the wearing of the Shants collar is widely used. However, it is fraught with the rapid development of atrophy of the muscles of the neck, while the main guarantee of recovery and prevention of further progression of the disease is the creation of a powerful muscle corset that holds the anatomical structures of the cervical spine in a normal position. This problem is solved with the help of kinesiotherapy, which includes the performance, under the supervision of a physical therapy doctor or a kinesiologist, of individually selected exercise therapy exercises and classes on special simulators.

Surgical treatment of a cervical hernia should be carried out according to strict indications and with extreme caution. The reason for the operation may be the development of a significant neurological deficit that does not decrease on the background of conservative therapy, a pronounced narrowing of the spinal canal, compression of the vertebral artery, leading to ischemia of the brain tissues. Surgical treatment, as a rule, involves radical removal of the hernia (discectomy or microdiscectomy), supplemented by spinal fixation operations (intervertebral fixation with cages, interbody fusion, etc.). Minimally invasive interventions (puncture laser vaporization, endoscopic microdiscectomy, intradiscal electrothermal therapy) can be used only for small hernias, when conservative methods of treatment are also effective in most cases.

Sources

1. treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

   Femoral hernias – surgery-first.ru

   Femoral hernia is the protrusion of preperitoneal fat or peritoneal abdominal organs through the femoral canal medially from the femoral vein into the area of ​​the femoral triangle.

   This type of hernia is dangerous with a high chance of strangulation, therefore, if symptoms are detected, it is necessary to consult a surgeon for treatment.

   Femoral hernias are more common in women than in men. As a rule, the problem occurs in women after 40 years, due to a decrease in the elasticity of the connective tissue.

   Femoral triangle and hernia

   There is a space between the inguinal ligament and the pelvic bones, which is divided by the iliopectineal fascia into two gaps – muscular and vascular. The muscular lacuna contains the iliopsoas muscle and the femoral nerve, and the vascular lacuna contains the femoral artery and femoral vein. Between the femoral vein and the lacunar ligament there is a gap filled with fibrous connective tissue and the Pirogov-Rosenmuller lymph node. And this gap is called the femoral ring, through which the femoral hernia comes out.

   Femoral hernias may occur:

   • inside the femoral canal (C),
   • medial (M),
   • laterally (L) from him,
   • prevascular (R),
   • retrovascular (R).

   Diagnosis of femoral hernia

   Femoral hernia very often clinically manifests itself in the same way as inguinal hernia: discomfort and / or pain in the groin area with the appearance of a hernial protrusion. Femoral hernias are more common in women, especially thin women.

   Causes of a hernia

   Among the main anatomical and physiological factors that can cause the appearance and development of a femoral hernia can be:

   • rapid and drastic weight loss;
   • hip dislocations;
   • constant physical activity;
   • prolonged constipation;
   • childbirth;
   • chronic cough.

   Main symptoms of femoral hernia

   • soft to the touch inguinal fold, disappears when lying down;
   • pain in the lower abdomen;
   • flatulence, nausea, vomiting, constipation;
   • problems with urination: pain, difficult or vice versa rapid.

   It is not uncommon for a surgeon to make an incision over the inguinal fold to treat an inguinal hernia but not find it in the inguinal canal because the patient (or patient) has a femoral hernia. In addition, very often a femoral hernia is mistaken for an inguinal lymph node.

   Femoral hernia can also cause acute intestinal obstruction due to infringement of the intestine in the hernial orifice.

   In general, there is a rule: an irreducible protrusion in the area of ​​the femoral triangle should be considered as a strangulated hernia, unless proven otherwise! At the same time, if a patient develops a clinical picture of acute intestinal obstruction, examination and palpation of the femoral triangle are mandatory!

   Diagnosis

   The diagnosis of femoral hernia is clinical; is based on complaints, medical history and physical examination data of the patient.

   As additional examination methods can be used:

   1. Ultrasound examination of the groin and femoral triangle. The sensitivity of ultrasound is 80%, the specificity is 88%, and the negative predictive value reaches 92%.

   Ultrasound examination of a 24-year-old man with a left-sided femoral hernia: A – femoral artery, V – femoral vein, P – m.pectineus (comb muscle), H – hernial sac.

   2. X-ray examination of the abdominal organs with and without barium (to assess the passage), especially if the patient develops signs of intestinal obstruction.

   Treatment of femoral hernia

   The only treatment is surgery .

   Operations for femoral hernias ⇒

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   Treatment of femoral hernias in the department of thoracoabdominal surgery and oncology of the Republican Scientific Center of Surgery

   Surgical treatment of hernias in our department is highly qualified doctors , the best modern equipment and attentive staff.