Being diagnosed with a brain aneurysm is frightening. Although ruptured aneurysms are relatively uncommon, they represent a very serious illness that is associated with a high rate of mortality and disability. Having survived a ruptured aneurysm is a very difficult experience to have gone through and can be extremely unsettling. Gathering information about your condition can help ease this fear, help begin the healing process, and help bring a sense of comfort and support during a trying time.
A brain aneurysm, also referred to as a cerebral aneurysm or intracranial aneurysm (IA), is a weak bulging spot on the wall of a brain artery very much like a thin balloon or weak spot on an inner tube. Over time, the blood flow within the artery pounds against the thinned portion of the wall and aneurysms form silently from wear and tear on the arteries. As the artery wall becomes gradually thinner from the dilation, the blood flow causes the weakened wall to swell outward. This pressure may cause the aneurysm to rupture and allow blood to escape into the space around the brain. A ruptured brain aneurysm commonly requires advanced surgical treatment.
Unruptured brain aneurysms are typically completely asymptomatic. These aneurysms are typically small in size, usually less than 5mm in diameter. However, large unruptured aneurysms can occasionally press on the brain or the nerves stemming out of the brain and may result in various neurological symptoms. Any individual experiencing some or all of the following symptoms, regardless of age, should undergo immediate and careful evaluation by a physician.
Certain people have a higher risk for brain aneurysms than the general population. These include individuals with a strong family history (more than one first degree relative with brain aneurysm), or a history of certain conditions such as polycystic kidney disease or collagen vascular diseases.
Brain aneurysms are discovered more and more frequently in people undergoing brain imaging, such as MRI, for other reasons, such as evaluation of headaches, after head trauma or in work-up of other neurological symptoms. Often in these situations, the aneurysm itself is an incidental finding, unrelated to the symptoms that prompted the imaging. However, once diagnosed, it is important to consult with a neurosurgeon to review the findings, determine if further imaging is needed, and discuss management options.
Risk factors that doctors and researchers believe contribute to the formation of brain aneurysms:
High blood pressure or hypertension
Congenital resulting from inborn abnormality in artery wall
Familial intracranial aneurysms are generally defined as the presence of two or more family members among first- and second-degree relatives with proven aneurysmal SAH (subarachnoid hemorrhage) or incidental aneurysms.
The incidence of familial aneurysms among SAH patients is 6% to 20%.
Brain aneurysms can be similar to heart attacks. Just like a person may have no warning of an impending heart attack, there almost is never a warning that a brain aneurysm is about to rupture. Fortunately, through imaging screening techniques,
Screening in the setting of a family history of fusiform aneurysm:
In the case of a first degree relative with a known intracranial fusiform aneurysm, it is unclear if screening is recommended, but there are several reports of fusiform aneurysms occurring in a family. Some doctors would recommend screening.
Screening in the setting of a family history of saccular aneurysm:
If one member of the family is known to be affected with saccular aneurysm, then screening of other family members is not clearly recommended since the occurrence of an aneurysm with screening is approximately the same or only slightly higher
When a brain aneurysm ruptures, it causes bleeding into the compartment surrounding the brain, the subarachnoid space and is therefore also known as a subarachnoid hemorrhage (SAH).
With important medical advances throughout the neurosurgical/neurological and endovascular fields, treatment for brain aneurysms is more promising than it was several years ago. There are more effective and less invasive treatment options for patients, who in years past, would have been told they had inoperable aneurysms. Decisions regarding management of an unruptured brain aneurysm are based on the careful comparison of the short- and long-term risks of aneurysmal rupture, compared to the risk of intervention whether that is surgical clipping or endovascular management.
If an aneurysm is detected but has not ruptured, there are more options: either treatment or observation. Once an aneurysm has already ruptured, the options are either open surgery or an endovascular approach. Either is recommended to be performed as early as possible after hemorrhage, to prevent rebleed of the aneurysm. The goal of either treatment is to prevent rebleeding by sealing off the aneurysm so that the aneurysm is totally obliterated with either a clip or coil.