Disease patterns

An aneurysm is an abnormally enlarged blood vessel in the cerebral artery. An aneurysm is usually found at the bifurcations and branches of the cerebral arteries, two to four millimetres in diameter, at the base of the brain. Due to strong blood flow (the brain is one of the best supplied organs) and the resulting continuous pressure on the cerebral arteries, an aneurysm presents itself as a kind of fatigue. It can continue to grow after its emergence and its wall can become inflamed, particularly in places where blood clots (thrombi) form and soften. Aneurysms occur in about 2,000-3,000 per 100,000 people. As a result of high blood pressure, the wall can balloon or even rupture (tear), which occurs in about 10 per 100,000 people a year. This results in a brain haemorrhage, after which only about a third of patients are able to resume a normal life following such a painful and difficult ordeal, despite the most complex and modern hospital care. A further third will remain permanently disabled and the remaining third will die.

Aneurysms are detected increasingly by chance, and it is important that patients with such incidental aneurysms receive the proper counselling and treatment where necessary. To estimate the risk of rupture, one has to take into account the size, precise location and regularity of the shape of the aneurysm. These factors characterise to a large extent the condition of the arterial wall and the typical course of the disease. The risk factors in the development and rupture of an aneurysm are mainly high blood pressure and smoking, both of which the patient can influence.

In the following video, we present neuroradiology at Klinik Hirslanden. The experienced medical team uses the latest methods to evaluate the risk of rupture and treatment of an aneurysm. If the risk of bleeding is estimated to be greater than the risk of treatment, treatment of the aneurysm through a small incision in the groin is usually recommended. This requires only a short hospital stay of three to four days. In very rare cases, surgery may be required – the decision is made by an interdisciplinary team together with the neurosurgeon.

A vascular malformation of the central nervous system is associated with an abnormal collection of blood vessels. These are found either in the head or spinal canal, are very fragile and do not take part in tissue supply. This can lead to a vascular rupture (tear) with bleeding in various parts of the central nervous system and the surrounding cavities, or it may disrupt (stroke, paralysis) or irritate the brain tissue (epilepsy).

The type of vascular anomaly and its risks can be analysed precisely through modern imaging and treated according to the diagnosis. With cerebral vascular malformations, experienced doctors can use modern technological means, such as imaging, access instruments and implants, to selectively switch off a vascular anomaly in order to close it completely or to prepare it for closure through other methods. The aim of treatment is to eliminate the risk of bleeding. As an alternative to endovascular therapy, another treatment method is neurosurgical removal of the vascular anomaly or the use of radiation to destroy the vessels (radiotherapy) with a special device called a CyberKnife. Each of these methods can be used alone or in combination – our neuroradiology department organises and offers excellent treatment in this field and consults in a multidisciplinary approach with other specialists to evaluate possible treatment plans.

In spinal vascular anomalies, it is a matter of making way due to the delicacy of the narrow, adjacent normal vessels to avoid the risk of a spinal cord injury. This requires not only technical competence, but also specialist experience in this very rare pathology – our centre is experienced in this and has treated many international patients with these diseases. In the following film, we present neuroradiology at Klinik Hirslanden, which has at its disposal an experienced and well-established medical team and state-of-the-art facilities. This allows us to provide expert consultation and treatment to patients with vascular malformations.

In 80% of all cases, mini-strokes and acute strokes are due to a blood clot and occur frequently in Europe. Stroke is the leading cause of permanent disability and inability to work, and the third leading cause of death. The damage caused by a stroke caused by insufficient blood supply due to acute occlusion of a cranial artery in the neck or head is characterised by a blood clot. This leads to closure of a critical level of cerebral blood flow, and depending on the affected area acute neurological malfunction.

In recent years, methods of reopening arteries with high-grade stenosis and vascular occlusion have improved significantly. Tiny stents, called micro-stents, and extremely flexible suction systems have made it possible to remove arterial blood clots in a very short period of time.

In the following video, we present neuroradiology at the Klinik Hirslanden. It draws on our extensive experience in the treatment of strokes. The most important factor is time because cerebral blood flow must be restored as quickly as possible. This improves the prognosis among stroke patients in which the rule of thumb is ‘time is brain’: The quicker a stroke is treated, the more likely the patient is to recover.

Who hasn’t experienced an annoying whistle or whooshing in the ears after going to a loud concert, for example. Fortunately, these noises usually disappear of their own accord, but for many patients they do not go away. They suffer from debilitating noise that disrupts their sleep and which only they can hear. In the majority of cases, it is experienced as a persistent whistling sound; in rare cases, the noise is not smooth, but is rhythmic and in sync with the pulse. Unlike the classic persistent whistling sound in the ear, pulse-synchronous tinnitus often demonstrates pathological changes in the vessels, so an ear, noise and throat doctor should be consulted immediately.

Computer tomography (CT) and magnetic resonance imaging (MRI) determine whether the pulse-synchronous tinnitus is caused by congenital or acquired changes to the vessels. Congenital changes usually have little clinical significance, whereas acquired changes can have potentially dangerous causes. This could be, for example, an abnormal short circuit between the arterial and venous vascular system, where it may interfere or block the normal venous drainage of the brain tissue and would involve a risk of bleeding. This is what is called an arteriovenous fistula. Treatment with a microcatheter, into which a liquid adhesive is injected, is possible in the majority of cases.

This film shows which – potentially dangerous – causes may be responsible for pulse-synchronous tinnitus, how they can present and their treatment. As this particular form of tinnitus can have many causes, only very selective use of various radiological methods will reach a clear diagnosis. In addition to examinations and counselling, neuroradiology at Klinik Hirslanden offers various therapeutic treatment options. The team of interventional neuroradiologists at our clinic is well versed and experienced in treating various cerebral vascular diseases and is available 24 hours a day.