How To Diagnose Brain Aneurysm

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What Should I Do If I Have An Unruptured Cerebral Aneurysm

2-Minute Neuroscience: Brain Aneurysms

If you have an unruptured brain aneurysm, its important to talk to your healthcare provider about your treatment and management options. You and your provider may decide its best to closely monitor it and manage medical conditions that can further weaken the blood vessel, or you may decide early treatment makes the most sense. Your healthcare provider will take into account several factors including the aneurysms:

  • Risk of rupture.

What Are The Complications Of A Ruptured Cerebral Aneurysm

Aneurysms may rupture and bleed into the space between the skull and the brain and sometimes into the brain tissue . These are forms of stroke called hemorrhagic stroke. The bleeding into the brain can cause a wide spectrum of symptoms, from a mild headache to permanent damage to the brain, or even death.

After an aneurysm has ruptured it may cause serious complications such as:

  • Rebleeding. Once it has ruptured, an aneurysm may rupture again before it is treated, leading to further bleeding into the brain, and causing more damage or death.
  • Change in sodium level. Bleeding in the brain can disrupt the balance of sodium in the blood supply and cause swelling in brain cells. This can result in permanent brain damage.
  • Hydrocephalus. Subarachnoid hemorrhage can cause hydrocephalus. Hydrocephalus is a buildup of too much cerebrospinal fluid in the brain, which causes pressure that can lead to permanent brain damage or death. Hydrocephalus occurs frequently after subarachnoid hemorrhage because the blood blocks the normal flow of cerebrospinal fluid. If left untreated, increased pressure inside the head can cause coma or death.
  • Vasospasm. This occurs frequently after subarachnoid hemorrhage when the bleeding causes the arteries in the brain to contract and limit blood flow to vital areas of the brain. This can cause strokes from lack of adequate blood flow to parts of the brain.

What Does A Brain Aneurysm Look Like

Brain aneurysms can take several forms. About 90 percent are saccular, or berry, aneurysms. This type forms a sac outside the artery that looks like a berry attached to a vine.

A fusiform aneurysm is a rarer type of aneurysm that affects a longer section of the artery wall, causing the artery to bulge all the way around. Its estimated that

Brain aneurysms can affect anyone. However, some factors can increase your risk.

There are different risk factors for aneurysm development and rupture.

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What Is A Brain Aneurysm And How Do You Diagnose It

Aman*, a business development executive, was recently diagnosed with a brain aneurysm. The afternoon before the diagnosis, Aman was at work, when he was struck by a sudden, severe pain in his head, accompanied by nausea, dizziness and vomiting. His co-workers rushed him to the hospital, where a CT scan revealed the diagnosis. So what exactly is a brain aneurysm and could Aman have prevented it in any way? Read on to find out.

Definition:

A brain aneurysm indicates a bulge or ballooning of a blood vessel in the brain. It occurs when a weak spot in the brains arterial walls bulges and fills with blood. This is a life-threatening condition because if an aneurysm breaks, it can lead to strokes, brain damage and even death, if not treated in time.

However, most brain aneurysms do not rupture in fact, 50% to 80% of aneurysms never rupture during a persons lifetime, according to the Brain Aneurysm Foundation.

Symptoms:

Aneurysms generally have no symptoms. Sometimes, symptoms may manifest as seizures, double vision, dizziness, mild/severe headaches or pain above or behind the eye. However, if an aneurysm ruptures, it almost always produces distinct symptoms including:

  • Sudden, severe headache- the worst headache of my life
  • Blurry/double vision
  • Trouble speaking/walking
  • Unconsciousness
Who is at risk? Precautions to take:
Diagnosis and screening tests:

Read our article to know more about MRI and CT scans.

Other diagnostic tests include an angiogram or arteriogram.

Treatment:

What Are The Symptoms

Brain Aneurysm: Overview, Causes, Symptoms, Treatment

Unruptured aneurysm Most cerebral aneurysms do not show symptoms until they either become very large or rupture. Small unchanging aneurysms generally will not produce symptoms.

A larger aneurysm that is steadily growing may press on tissues and nerves causing:

  • pain above and behind the eye
  • paralysis on one side of the face
  • a dilated pupil in the eye
  • vision changes or double vision.

Ruptured aneurysmWhen an aneurysm ruptures , one always experiences a sudden and extremely severe headache and may also develop:

TypeThere are three types of cerebral aneurysms:

  • Saccular aneurysm. A saccular aneurysm is a rounded sac containing blood, that is attached to a main artery or one of its branches. Also known as a berry aneurysm , this is the most common form of cerebral aneurysm. It is typically found on arteries at the base of the brain. Saccular aneurysms occur most often in adults.
  • Fusiform aneurysm. A fusiform aneurysm balloons or bulges out on all sides of the artery.
  • Mycotic aneurysm. A mycotic aneurysm occurs as the result of an infection that can sometimes affect the arteries in the brain. The infection weakens the artery wall, causing a bulging aneurysm to form.

SizeAneurysms are also classified by size: small, large, and giant.

  • Small aneurysms are less than 11 millimeters in diameter .
  • Large aneurysms are 11 to 25 millimeters .
  • Giant aneurysms are greater than 25 millimeters in diameter .

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Who Should Get Treatment For A Brain Aneurysm

A leaking or ruptured brain aneurysm requires emergency surgery. But you might only find out about a brain aneurysm when you have an imaging test for an unrelated condition.

If you have a small brain aneurysm that isnt causing symptoms, and you do not have other relevant risk factors, your healthcare provider may recommend not treating it. Instead, your provider will order regular imaging tests to rule out any change or growth over time. They will also recommend you quit smoking and require that your blood pressure control is under control. Youll need to get help right away if you develop symptoms, or aneurysm change/growth occurs on follow-up imaging.

If you have symptoms, positive risk factors, and/or the aneurysm is large, you and your healthcare provider will discuss the benefits, risks and alternatives of surgical and/or endovascular treatment. The decision depends on several factors, including but not limited to your:

  • Risk of a brain bleed

What Causes A Brain Aneurysm To Rupture

Risk of rupture increases when the blood pressure in the vessel rises. Rupture risks also depend on the size and shape of the aneurysm, among many other variables. Expert and prompt evaluation, and treatment if needed, can decrease the risk of rupture.

In this video, Rose Du, MD, PhD, Director of Cerebrovascular Surgery discusses brain aneurysm risk factors, the decision of whether to treat an aneurysm, and what types of treatments are available.

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What Can I Do To Reduce My Risk Of Having Another Brain Aneurysm

Taking care of your overall health is the best thing you can do to prevent future aneurysms. Steps you can take include:

  • Eat a healthy diet, limit caffeine and avoid stimulant drugs.
  • Manage conditions that contribute to high blood pressure.
  • Talk to your healthcare provider about lifestyle changes you can make and medications that may help.

Summary

A sudden, severe headache with or without stroke symptoms could be a sign of a brain aneurysm. A ruptured brain aneurysm is a serious, life-threatening condition that needs immediate medical attention and emergency treatment. If you have an unruptured brain aneurysm, talk with your healthcare provider about the risks and benefits of different treatment and management options.

Last reviewed by a Cleveland Clinic medical professional on 04/26/2020.

References

Treatment For Your Type Of Aneurysm

What are the Symptoms of an Aneurysm?

Brain aneurysm diagnoses fall into two broad categories unruptured and ruptured. Regardless of the category within which you or your loved one fall, and whether youre waiting to hear about initial or next treatment steps from a healthcare provider, or treatment is already underway, youll likely benefit from understanding how your particular brain aneurysm may be treated.

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Can An Aneurysm Be Cured

The only way to get rid of an aneurysm is to have it repaired with surgery or an endovascular procedure. Sometimes surgery isn’t possible, or it may pose more danger than the aneurysm. Careful monitoring and medication may be best in that case. Your doctor will figure out the size, type, and location of the aneurysm.

Types Of Diagnostic Tests

Computerized tomography A CT scan, a specialized X-ray exam, is usually the first test used to determine if you have bleeding in the brain. The test produces images that are two-dimensional slices of the brain. With this test, you may also receive an injection of a dye that makes it easier to observe blood flow in the brain and may indicate the site of a ruptured aneurysm. This variation of the test is called CT angiography.

Cerebrospinal fluid test If youve had a subarachnoid hemorrhage, there will mostly likely be red blood cells in the fluid surrounding your brain and spine . Your doctor will order a test of the cerebrospinal fluid if you have symptoms of a ruptured aneurysm but a CT scan hasnt shown evidence of bleeding. The procedure to draw cerebrospinal fluid from your spine with a needle is called a lumbar puncture or spinal tap.

Magnetic resonance imaging An MRI uses a magnetic field and radio waves to create detailed images of the brain, either two-dimensional slices or three-dimensional images. The use of a dye, MRI angiography, can enhance images of blood vessels and the site of a ruptured aneurysm. This imaging test may provide a clearer picture than a CT scan.

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What Are The Symptoms Of Brain Aneurysm

Many people have a brain aneurysm without realising it. It may only be found when the person has a brain scan for another reason. Usually there are no symptoms. Sometimes, if the aneurysm becomes very large, it can cause pain behind the eyes, numbness, weakness, vision changes or paralysis on the side of the face.

When an aneurysm bursts, it causes a sudden and extremely bad headache.

Other symptoms of a burst aneurysm include:

  • double vision or sensitivity to light
  • loss of consciousness

Are There Any Warning Signs Before A Brain Aneurysm

Cerebral Aneurysm

The ballooning of a blood vessel located in the brain is called a brain aneurysm. It leads to a bulge developing in the blood vessel, and this can rupture or leak in the brain, causing a type of hemorrhagic stroke known as a subarachnoid hemorrhage.

A ruptured brain aneurysm is a life-threatening condition that requires immediate medical care. Brain aneurysms are typically the result of thinning artery walls. They usually form at branches or forks in arteries since these are the weakest parts. They can develop on any part of the brain but typically at the base.

Most people develop brain aneurysms that do not rupture, so they do not lead to any health issues. These types of aneurysms are typically detected while the patient is being tested for some other condition.

Treating a brain aneurysm that has not ruptured might prevent a life-threatening condition from occurring in the future. Each patient’s circumstances are unique, so the doctor will advise them on the best way to proceed if an unruptured aneurysm is detected.

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When Do You Need Screening Tests For Brain Aneurysms

Screening tests can be a good idea if:

  • You had a brain aneurysm in the past.
  • You had a type of stroke called a subarachnoid hemorrhage. Its caused when an aneurysm bursts and theres bleeding between the brain and the tissue around it.
  • You have two or more close relatives who have had aneurysms.
  • You have other risks for aneurysms, such as these genetic conditions: Marfan Syndrome, Ehlers-Danlos syndrome IV, or Polycystic kidney disease.

How Is An Aneurysm Diagnosed

Special imaging tests can detect a brain aneurysm. In the CTA , patients are placed on a table that slides into a CT scanner. A special contrast material is injected into a vein, and images are taken of the blood vessels to look for abnormalities such as an aneurysm. In the second test, called MRA , patients are placed on a table that slides into a magnetic resonance scanner, and the blood vessels are imaged to detect a cerebral aneurysm.

The most reliable test is called a diagnostic cerebral angiogram. In this test, the patient lies on an X-ray table. A small tube is inserted through a blood vessel in the leg and guided into each of the blood vessels in the neck that go to the brain. Contrast is then injected, and pictures are taken of all the blood vessels in the brain. This test is slightly more invasive and less comfortable.

Beforeanytreatment is considered, a diagnostic cerebral angiogram is usually performed to fully map a plan for therapy.

If one aneurysm forms, will others form? Having one aneurysm means theres about a 20 % chance of having one or more other aneurysms.

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How Should An Aneurysm Be Treated

The best treatment depends on many things, including whether the aneurysm has ruptured or not. A ruptured aneurysm usually requires treatment right away. However, the treatment time and options depend on the size, location and shape of the aneurysm, as well as the patients overall medical condition. If an aneurysm hasnt ruptured, the treatment decision depends on its size, location and shape, and the patients symptoms

Safety And Common Complications

What Are Brain Aneurysms?

Although the frequencies of certain complications vary according to the intervention, both clipping and coiling share the same complications. Rupture of the aneurysm is one of the most serious complications seen in either procedure. Exact frequencies of ruptures are not well documented, but reported rupture rates range from 2 percent to 3 percent for both coiling and clipping. Rupture can cause massive intracerebral hemorrhage and subsequent coma or death. Although rupture can have catastrophic consequences during either procedure, surgery probably provides a better opportunity to control hemorrhage because of direct access to the ruptured aneurysm and the supplying vessels.

Ischemic stroke is another serious complication frequently encountered in both clipping and coiling. The pattern and distribution of strokes varies according to the aneurysm location and procedure type.

The actual length of the procedure, the associated risks, the projected recovery time and the expected prognosis depend on both the location of the aneurysm, the presence/severity of hemorrhage and the patient’s underlying medical condition. Therefore, each individual case should be discussed with the treating neurosurgeon/physician.

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What Are The Chances Of Surviving A Brain Aneurysm

People can go their entire lives not knowing they have an unruptured brain aneurysm. As long as its intact, your odds are good. But there is a risk that the brain aneurysm will rupture, which depends on many factors, including aneurysm size, location and several others. If an aneurysm does rupture, it leaks blood into the space surrounding your brain and sometimes into the brain tissue itself, causing a hemorrhagic stroke.

A ruptured brain aneurysm requires emergency medical treatment. As more time passes with a ruptured aneurysm, the likelihood of death or disability increases. About 75% of people with a ruptured brain aneurysm survive longer than 24 hours. A quarter of the survivors, though, may have life-ending complications within six months.

Your Recovery And Managing Side Effects

As you or your loved one may already be learning, recovery from a brain aneurysm requires great grit and determination and can be very slow moving. You and your loved one may regularly find yourselves feeling frustrated by the pace of recovery, and the fact that recovery may not be linear, i.e., that there are days when you feel like youre taking steps backward vs. moving forward. Know that we and others who visit this site feel your physical and emotional pain.

Get answers to common questions asked by patients and caregivers about recovery and dealing with the mental and physical side effects of brain aneurysms and/or learn more about what to expect during recovery.

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The Warning Signs Of A Brain Aneurysm

The symptoms and signs of a ruptured aneurysm include:

  • A severe headache that comes out of nowhere
  • Drooping eyelids

An unruptured aneurysm might not initially have any symptoms, but that usually changes as it grows larger. The warning signs that indicate a person has developed an unruptured brain aneurysm include:

  • Pain behind or above an eye
  • Numbness on one side of the patient’s face

Patients are advised to seek immediate medical attention if:

  • They have a severe headache that is incomparable in pain to past headaches suddenly occurs
  • They have a seizure
  • They lose consciousness

How Do Aneurysms Form Are People Born With An Aneurysm

Brain Aneurysm

People usually arent born with aneurysms. Most develop after age 40. Aneurysms usually develop at branching points of arteries and are caused by constant pressure from blood flow. They often enlarge slowly and become weaker as they grow, just as a balloon becomes weaker as it stretches. Aneurysms may be associated with other types of blood vessel disorders, such as fibromuscular dysplasia, cerebral arteritis or arterial dissection, but these are very unusual. Some aneurysms are due to infections, drugs such as amphetamines andcocaine or direct brain trauma from an accident.

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Can You Fully Recover From A Brain Aneurysm

It will take 3 to 6 weeks to fully recover. If you had bleeding from your aneurysm this may take longer. You may feel tired for up to 12 or more weeks. If you had a stroke or brain injury from the bleeding, you may have permanent problems such as trouble with speech or thinking, muscle weakness, or numbness.

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