A cerebral aneurysm or a brain aneurysm is a balloon-like swelling in your brain’s blood vessels. It typically forms at a weak spot where the arterial wall bulges and fills with blood. As the aneurysm grows, it exerts pressure on the surrounding structures and may gradually rupture. It can be a life-threatening condition and may affect anyone irrespective of their age. A ruptured aneurysm may result in brain damage, stroke, or even death if not managed immediately.
The good news is that 50%-80% of the aneurysms do not rupture. Unruptured aneurysms are detected by chance during a scan for other health issues. The risk of rupture depends on the aneurysm size and location.
Cerebral aneurysm treatment & management options include observation and minimally invasive procedures. In some cases, cerebral aneurysm open surgery may be required.
Cerebral Aneurysm Symptoms
Aneurysms are unpredictable and may be silent unless they rupture. Ruptured or large aneurysms usually show symptoms and may need emergency medical care. Cerebral aneurysm warning signs and symptoms depend on whether they are ruptured or not.
An unruptured aneurysm may have the following symptoms:
- Severe, sudden headache, which could be described as the worst headache of your life
- Double or blurry vision
- Neck stiffness
- Drooping eyelid
- Sensitivity to light
- Loss of consciousness
- Difficulty in walking
- Nausea or vomiting
- Loss of consciousness
A leaking aneurysm with minimal bleed may just cause a severe, sudden headache. If you have any of these symptoms, seek emergency medical attention immediately.
Cerebral Aneurysm Causes
Some common causes include:
- Brain injury
- Genetic conditions
- Severe infection
- Long-standing high blood pressure
- Autosomal dominant polycystic kidney disease, a condition that increases blood pressure and weakens blood vessels in the brain
- Marfan’s syndrome, a genetic disorder that alters the formation of connective tissue. It also creates a weakness in the blood vessel wall that can result in a brain aneurysm
The following causes may cause an existing aneurysm to rupture:
- Excessive Soda or coffee consumption
- Excessive exercise
- Intense anger
- Straining while passing stools
- Sexual intercourse
Cerebral Aneurysm Risk Factors
While a cerebral aneurysm can affect anyone, certain factors increase your risk of getting it. Some common risk factors include:
- Older age
- Menopausal women
- Drug and alcohol abuse
- Head injury
- Coarctation of the aorta, a condition of congenital narrowing of the aorta
- Cerebral arteriovenous malformation
- Congenital problems affecting blood vessel walls, such as Ehlers-Danlos syndrome
Cerebral Aneurysm Treatment
Management of cerebral aneurysm include:
In some cases, the ideal treatment is to wait and watch. The doctor will ask you to control high blood pressure and quit smoking. Small(generally less than 3mm), asymptomatic, and unruptured aneurysms can be monitored with scans every year. If the aneurysms show a change in size or shape then they need to be treated.
This procedure involves a cut in the skull under general anesthesia. The brain is retracted, and a small clip is placed on the neck of the aneurysm to prevent blood from entering it. The clip is made up of titanium and stays permanently in the brain.
Recovery time is usually between four to six weeks but may take longer.
It is a minimally invasive option and is performed during an angiogram. During this procedure, a catheter is introduced in the leg artery through a small cut in the groin, which is then passed to the aneurysm in the brain.
The doctor packs the aneurysm with platinum coils introduced through the catheter. These coils promote clotting, sealing the aneurysm, and preventing blood from entering it. Sometimes in addition to the coils balloon or stent assistance is required.
It may take up to two to four days for complete recovery. Coiling requires periodical monitoring through imaging for five years.
Endovascular flow diversion
When coiling and clipping are difficult due to the size or shape of the aneurysm, flow diversion can come in handy. A flow-diverter stent is a tightly woven mesh tube and is inserted in the main artery across the aneurysm.
The tight mesh stent prevents easy blood flow into the aneurysm, and blood flows through the artery predominantly with minimal flow inside the aneurysm. Lack of blood supply will cause the aneurysm to form thrombus/clot and it gradually disappears.
The recovery time is usually two to four days in an unruptured aneurysm.
Artery occlusion and bypass
This procedure is done very infrequently these days. This procedure is recommended when the aneurysm is inaccessible or large, or the blood vessel is damaged. It involves opening the skull and introducing clips to block the aneurysm and artery.
Now the surgeon bypasses the blood flow around the blocked artery by placing a graft. This graft is a small artery, usually taken from your leg, connected both above and below the occluded artery to allow blood flow through the graft.
Usually, it takes four to six weeks to recover, but it may even take longer.
Cerebral Aneurysm Prevention
Though the occurrence of aneurysms cannot be totally prevented certain lifestyle modifications aid in managing or preventing rupture of the aneurysm, such as:
- Eating a healthy diet of vegetables, fruits, whole-grain, low-fat dairy products, and lean meat.
- Quitting smoking
- Managing high cholesterol or high blood pressure
- Regular, but not excessive, exercise