1 case of vertebral aneurysm with stubborn headache and high blood pressure as the first manifestation

1Case informationmale, 42 years old, due to repeated headache for 3 years, aggravated by 4 d in my hospital cardiology3 years before admission, more than fatigue or mental stress headache, a burst of pulsating bulging pain, the degree of light moderate, each time lasts a few minutes to several hours, after rest can be improvedHas been visited in the local hospital, high blood pressure measurement, after many times blood pressure at least 3 times non-same-day blood pressure greater than 140 /90 mmHg, up to 180/120 mmHg, diagnosed as "
high blood pressuredisease 3", to antihypertensive treatment (the name of the drug is unknown), symptom relief, after which no system diagnosis and treatment, medication, blood pressure test is still high, headache symptoms are still high4 d before admission to hospital, increased headache, persistent head swelling headache discomfort, moderate to severe, unconscious disorder, faintingI was admitted to the hospital in the cardiology department, the hospital blood pressure test 156/113 mmHgPreoperative CTA checked for a right vertebral artery V5 aneurysm (Figure 1A)In-whole hemp-down intracranial aneurysm embolismFirst full brainvascularangiography examination see the right vertebral aneurysm (Figure 1B), for the tumor neck wide aneurysm, size 10.5 mm x 10 mm, placed in the LviS3.5 x 20 self-puffing stent system, electro-release spring ring filling aneurystic cavity, review the imaging to see spring ring stability, the first partial release of the spring to stabilize the spring ring, the first partial release of the spring to stabilize the ring6 spring ring embolism aneurysm cavity, review the contrast, determine stent position stability and spring ring stability, aneurysm completely filled, tumor neck covered by spring ring, angiography review aneurysm disappear, full release of the stent when the spring ring, review the contrast vertebral artery and its branches develop well, carrier aneurysticsmooth, aneurystic disappearance, spring ring stability (Figure 1C)Figure 1 With stubborn headache, hypertension as the first manifestation of vertebral aneurysm embolism before and after the video A preoperative CTA shows the right vertebral artery V5 section aneurysm; B Preoperative DSA show right vertebral artery V5 aneurysm; C Postoperative DSA osteuriated vertebral aneurystanous aneurysm patients with uncomplaining headache, dizziness, nausea and other discomforts, and no dysfunction, After 3 months of follow-up, oral antihypertensive blood pressure control at normal levels, no headache, dizziness, sleep disorders and other discomfort, work and life are normal 2 Discussion vertebral aneurysms accounted for 0.3% to 0.9% of intracranial aneurysms Post-circulating aneurysms are currently treated with embolism The application of the stent can protect the tumor-carrying artery and prevent the release of the spring ring, and can also change the hemodynamics of aneurysm into and out of the channel, and promote the formation of blood clots in the tumor Even the simple use of stent technology to treat the vertebrae-base artery unbroken shuttle aneurysm is a safe and effective measure the cases in this paper were stent-assisted electro-relief spring-ring embolism aneurysms, in which no aneurysm rupture and thrombosis occurred The application of stent reduces the recurrence rate of aneurysm after surgery to some extent, but the long-term effect needs further confirmation The case of this paper to headache, blood pressure rise as the main performance, before surgery did not confirm that the above clinical symptoms are closely related to vertebral aneurysm, postoperative headache symptoms basically disappeared, blood pressure returned to normal (oral blood pressure medication), 3 d blood pressure after surgery is basically normal, 3 months after surgery return visit, normal blood pressure, headache symptoms disappear, so it can be clear that aneurysand is closely related to the above symptoms myelin is the basic center of cardiovascular activity , and the lateral structure of the entil you in the heart is maintained the main part of cardiovascular intercardial tension activity, which plays an important role in maintaining the relative stability period of arterial blood pressure Neurons on the outer side of the laterside of the upper abdomen of the end of the myelin, whose axial intrusions directly dominate the pre-intercom neurons of the outer column in the middle of the spinal cord In this case, aneurysms are larger in volume, about 1.1 cm in diameter, round, located in front of the elongated pulp (abdominal side), due to the larger volume, has produced a occupancy effect, resulting in the compression of the elongated myelin, enhance the sympathetic nerve activity of the elongation of the myelin, resulting in higher blood pressure, oral antihypertensive drug effect is not significant At the same time, the patient's headache is throbbing, consider the increased aneurysm with the fluctuation of blood vessels and stimulate the epidural or peripheral blood vessels and nerves, resulting in pulsating headache, postoperative aneurysm dense filling after although the occupaposition effect exists, but it can no longer stimulate surrounding tissue with vascular throbbing, the above symptoms immediately disappear in general, it is necessary to recommend patients with severe blood pressure and persistent headache sourcing in the clinical to clarify vertebral-base aneurysms In this case, long-term headache, elevated blood pressure, comprehensive treatment effect is not obvious, the aneurysm after surgery disease significantly improved, the above symptoms are basically controlled, so further clear the cause of treatment for the disease
diagnosis and treatment is very critical