Brain Aneurysm

A brain aneurysm is an abnormal, outward bulging of an artery in the brain caused by weakness in the arterial wall. Aneurysms can occur at any age; however aneurysms are most often detected in patients between the ages of 40 and 60 years. In addition, aneurysms are more prevalent among women (60 percent), and approximately 20 percent of patients have two or more aneurysms.

Cerebral aneurysms can rupture and cause a serious stroke or death, and cause bleeding into the brain or the space closely surrounding the brain called the subarachnoid space.

Although some aneurysms can go unnoticed for a lifetime, some aneurysm patients will experience the following symptoms:

• Limited eye movement
• Fatigue
• Dilated pupils
• Speech problems
• Double vision
• Change in balance
• Pain above and behind eye or coordination
• Localized headache

There are various causes for brain aneurysms. Some people may be genetically prone to aneurysms. Smoking, high blood pressure, alcohol, and underlying diseases can increase the risk for developing a brain aneurysm.

Many individuals do not experience any symptoms from an aneurysm and only realize that they have one once it ruptures. The rupture of a cerebral aneurysm is considered a medical emergency. Up to 25 percent of patients suffering a ruptured aneurysm will die before reaching a hospital. When an aneurysm ruptures, blood will spill from the artery into the subarachnoid space surrounding the brain. The rupture can lead to stroke, vasospasm (constriction of the brain arteries) and increased pressure on the brain. Over half will die within the first 30 days after the hemorrhage.

Sometimes patients describing “the worst headache in my life” are actually experiencing one of the symptoms related to a ruptured brain aneurysm. Other symptoms include:

• Intense headache
• Dilated pupils
• Nausea and vomiting
• Sensitivity to light
• Stiff neck or neck pain
• Loss of sensation
• Blurred or double vision
• Pain above and behind the eye

With the increase in imaging technology, more unruptured aneurysms are being detected more often. Although the aneurysm is unruptured, there is cause for concern and a treatment will most likely be warranted. Your physician will evaluate a number of factors when suggesting a course of treatment. These factors include:

• Risk of hemorrhage — what is the probability of the aneurysm rupturing?
• Size and location
• Age and health of patient
• Family history
• Surgical risks

Surgical clipping has been the traditional method for treatment of brain aneurysms. This method requires a neurosurgeon to perform a craniotomy (removal of part of the skull) to access the brain and blood vessels. The surgeon blocks blood flow to the aneurysm by applying a metal clip to its base, redirecting the blood flow away from the aneurysm. Then the wound is sealed again and closed.

Depending on your aneurysm, the physician may recommend surgical clipping, endovascular coiling or observation and medical management.

Endovascular coil therapy is a minimally invasive procedure that accesses the treatment area from within the blood vessel. A catheter (small tube) is inserted into the patient’s femoral artery and advanced through the body until the aneurysm is accessed from the inside. Small, soft platinum coils are inserted through the catheter into the aneurysm. The coils are packed into the aneurysm to block the flow of blood into the aneurysm. By blocking the flow, the pressure on the aneurysm is reduced. Over time, new tissue will grow at the opening of the aneurysm and blood flow will be diverted away from the aneurysm. There are different types of coils available. Some coils have a coating that hydrates and packs the aneurysm while others have a bioactive coating to accelerate a stable platform for tissue growth. The procedure is performed under the guidance of fluoroscopic X-rays. The fluoroscopy allows the physician to visualize the vasculature and properly place the coils.