Definition

An Intracranial Aneurysm is a dilation of the walls of a cerebral artery that develops as a result

of weakness in the arterial wall.

Contents

Causes

Clinical Manifestations

Assessment and Diagnostic Methods

Medical Management

Nursing Assessment

Nursing Diagnoses

Potential Complications

Planning and Goals

Nursing Care Plans

Nursing Interventions

o Improving Cerebral Tissue Perfusion

o Relieving Sensory Deprivation

o Monitoring and Managing Potential Complications

o Teaching Patients Self Care

o Continuing Care

Evaluation

o Expected Patient Outcomes

See Also

Causes

Its cause is unknown, but it may be due to atherosclerosis, a congenital defect of the vessel walls,

hypertensive vascular disease, head trauma, or advancing age. Most commonly affected are the

internal carotid, anterior or posterior cerebral, anterior or posterior communicating, and

middle cerebral arteries.

Symptoms are produced when the aneurysm presses on nearby cranial nerves or brain tissue or

ruptures, causing subarachnoid hemorrhage.

Prognosis depends on the age and neurologic condition of the patient, associated diseases, and

the extent and location of the aneurysm.

Clinical Manifestations

Neurologic deficits (similar to those of ischemic stroke)

Rupture of the aneurysm causes sudden, unusually severe headache; often, loss of

consciousness for a variable period; pain and rigidity of the back of the neck and spine;

and visual disturbances (visual loss, diplopia, ptosis). Tinnitus, dizziness, and

hemiparesis may also occur.

If the aneurysm leaks blood and forms a clot, patient may show little neurologic deficit or

may have severe bleeding, resulting in cerebral damage followed rapidly by coma and

death.

The four types of aneurysms (A) saccular, (B) dissecting, (C) mycotic, and (D) pseudoaneurysm.

Assessment and Diagnostic Methods

CT scan or MRI, cerebral angiography, and lumbar puncture are diagnostic procedures

used to confirm an aneurysm.

Medical Management

Allow the brain to recover from the initial insult (bleeding).

Prevent or minimize the risk of rebleeding.

Prevent or treat other complications: rebleeding, cerebral vasospasm, acute

hydrocephalus, and seizures.

Provide bed rest with sedation to prevent agitation and stress.

Manage vasospasm with calcium channel blockers, such as nimodipine (Nimotop).

Endovascular techniques may also be used.

Administer supplemental oxygen and maintain the hemoglobin and hematocrit at

acceptable levels to assist in maintaining tissue oxygenation.

Institute surgical treatment (arterial bypass) or medical treatment to prevent rebleeding.

Manage increased intracranial pressure (ICP) by draining the CSF via ventricular catheter

drainage.

Administer mannitol to reduce ICP, and monitor for signs of dehydration and rebound

elevation of ICP.

Administer antifibrinolytic agents to delay or prevent dissolution of the clot if surgery is

delayed or contraindicated.

Manage systemic hypertension with antihypertensive therapy, arterial hemodynamic

monitoring, and stool softeners to prevent straining and elevation of blood pressure.

Nursing Assessment

Perform a complete neurologic assessment: level of consciousness, pupillary reaction

(sluggishness), motor and sensory function, cranial nerve deficits (extraocular

eye movements, facial droop, ptosis), speech difficulties, visual disturbance or headache,

and nuchal rigidity or other neurologic deficits.

Document and report neurologic assessment findings, and reassess and report any

changes in patient’s condition.

Detect subtle changes, especially altered levels of consciousness (earliest signs of

deterioration include mild drowsiness and slight slurring of speech).

Diagnosis

Nursing Diagnoses

Ineffective tissue perfusion (cerebral) related to bleeding or vasospasm

Disturbed sensory perception due to the restrictions of aneurysm precautions

Anxiety due to illness or restrictions of aneurysm precautions

Potential Complications

Vasospasm

Seizures

Hydrocephalus

Aneurysm rebleeding

Hyponatremia

Planning and Goals

Patient goals include improved cerebral tissue perfusion, relief of sensory and perceptual

deprivation, relief of anxiety, and absence of complications.

Nursing Care Plans

Main Article: 8 Cerebrovascular Accident (Stroke) Nursing Care Plans

Nursing Interventions

Improving Cerebral Tissue Perfusion

Monitor closely for neurologic deterioration, and maintain a neurologic flow record.

Check blood pressure, pulse, level of consciousness, pupillary responses, and motor

function hourly; monitor respiratory status and report changes immediately.

Implement aneurysm precautions (immediate and absolute bed rest in a quiet,

nonstressful setting; restrict visitors, except for family).

Elevate the head of bed 15 to 30 degrees or as ordered.

Avoid any activity that suddenly increases blood pressure or obstructs venous return (eg,

Valsalva maneuver, straining), instruct patient to exhale during voiding or defecation to

decrease strain, eliminate caffeine, administer all personal care, and minimize

external stimuli.

Apply antiembolism stockings or sequential compression devices. Observe legs for signs

and symptoms of deep vein thrombosis tenderness, redness, swelling, warmth,

and edema.

Relieving Sensory Deprivation

Keep sensory stimulation to a minimum.

Explain restrictions to help reduce patient’s sense of isolation.

Relieving Anxiety

Inform patient of plan of care.

Provide support and appropriate reassurance to patient and family.

Monitoring and Managing Potential Complications

Assess for and immediately report signs of possible vasospasm, which may occur several

days after surgery or on the initiation of treatment (intensified headaches, decreased level

of responsiveness, or evidence of aphasia or partial paralysis). Also administer calcium

channel blockers or fluid volume expanders as prescribed.

Maintain seizure precautions. Also maintain airway and prevent injury if a seizure occurs.

Administer antiseizure medications as prescribed (phenytoin [Dilantin] is medication of

choice).

Monitor for onset of symptoms of hydrocephalus, which may be acute (first 24 hours

after hemorrhage), subacute (days later), or delayed (several weeks later).

Report symptoms immediately: acute hydrocephalus is characterized by sudden stupor or

coma; subacute or delayed is characterized by gradual onset of drowsiness,

behavioral changes, and ataxic gait.

Monitor for and report symptoms of aneurysm rebleeding. Rebleeding occurs most often

in the first 2 weeks.

Symptoms include sudden severe headache, nausea, vomiting, decreased level of

consciousness, and neurologic deficit.

Administer medications as ordered.

Hyponatremia: monitor laboratory data often because hyponatremia (serum sodium

level under 135 mEq/L) affects up to 30% of patients. Report low levels persisting for 24

hours, as syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral

salt wasting syndrome (kidneys cannot conserve sodium) may develop.

Teaching Patients Self Care

Provide patient and family with information to promote cooperation with the care and

required activity restrictions and prepare them for patient’s return home.

Identify the causes of intracranial hemorrhage, its possible consequences, and the medical

or surgical treatments that are implemented. Discuss the importance of

interventions taken to prevent and detect complications (eg, aneurysm precautions, close

monitoring of patient). As indicated, facilitate transfer to a rehabilitation unit or center.

Continuing Care

Urge patient and family to follow recommendations to prevent further complications and

to schedule and keep followup appointments. Refer for home care if warranted,

and encourage health promotion and screening practices.