What is a Brain Aneurysm?
When Brandon’s was diagnosed with a raptured brain aneurysm, he had never even heard of the term, and it was all so unexpected.
He was a generally healthy and active person and he’d never had any serious health issues.
On that particular evening, he had come from a particularly vigorous gym session when he developed a sudden headache.
Within a few minutes, the headache became so painful, unlike any headache he had ever experienced before. He was also experiencing double vision.
He called his wife and was rushed to hospital. After running some tests and a CT scan, the doctor informed Brandon that he had a raptured brain aneurysm.
Like Brandon, perhaps you have also never heard of the term brain aneurysm before, until you or someone close to you was diagnosed with the condition.
A brain aneurysm is a very serious condition that can even result in death if not treated promptly.
But what exactly is an aneurysm, and what should you do in case you get one?
WHAT IS A BRAIN ANEURYSM?
A brain aneurysm refers to a situation where an artery within the brain bulges at a certain spot, mainly due to weakness in the walls of the artery.
The bulge then fills with blood. You can think of an aneurysm as a blood-filled balloon attached to an artery inside your brain.
Once this blood-filled balloon forms, there is always the possibility that it might start leaking or burst.
In many cases, it is possible to have an aneurysm for a long time and never know about it until it bursts, like in Brandon’s case.
Most aneurysms do not show any symptoms and are not dangerous.
However, when an aneurysm is at its most severe stage, it can rupture, causing internal bleeding.
This bleeding can turn out to be fatal.
Doctors classify aneurysms according to the part of the body in which they occur.
The two most common types of aneurysms are those that occur in the arteries of the brain and of the heart.
According to the Center for Disease Control and Prevention (CDC), aortic aneurysms kill up to 25,000 people in the US each year.
At the same time, over 30,000 people in the US suffer from raptured brain aneurysms every year, with about a quarter of them dying within 24 hours. In this article, we will focus solely on cerebral/brain aneurysms.
Brain aneurysms are common in the 35 – 60 age bracket, though they are not limited to this age bracket. Even children suffer from brain aneurysms.
Women are also more likely to suffer from brain aneurysms that men. In most cases, there are no warning signs of a brain aneurysm.
Many people only learn of the aneurysm after it raptures.
Early diagnosis is key for surviving a brain aneurysm rupture.
The initial hemorrhage may lead to devastating neurologic outcomes, or in the worst case scenario, kill you.
For those who survive, a large number experience permanent neurological deficit or experience disabilities.
CAUSES AND RISK FACTORS OF BRAIN ANEURYSM
Brain aneurysms form when the walls of arteries in the brain grow thin and weaken.
They typically form at the arteries’ branch points since these are the weakest sections.
Sometimes brain aneurysms are present right from a person’s birth, which is usually caused by an abnormality in an artery wall.
Some aneurysms develop over the course of your life, some develop right from birth due to genetic reasons, and some develop due to brain injuries.
Some of the factors that can put you at risk of developing cerebral aneurysms include:
Genetic Risk Factors
Brain aneurysms may occur as a result of genetic connective tissue disorders that cause weakening of the artery walls.
You also have a higher chance of developing a brain aneurysm if there is a history of aneurysms occurring in a first-degree family member such as a parent, sibling, or child.
Arteriovenous malformations occur when the veins and arteries inside your bran become entangled, disrupting the flow of blood.
Risk Factors That Develop Over Time
Brain aneurysms may also occur due to risk factors that gradually develop over time.
These include high blood pressure that remains untreated, cigarette smoking, and drug abuse, particularly of cocaine or amphetamines which cause blood pressure to rise to dangerous levels.
Intravenous drug abuse causes infectious mycotic aneurysms.
Being over 40 years of age is also a risk factor for brain aneurysms.
Other Risk Factors
Other risk factors for brain aneurysms include head trauma, brain tumors, and infection of the arterial walls.
In addition, cigarette smoking, diabetes, cholesterol, and high blood pressure also increase your chances of developing brain aneurysms because they put you at risk of getting atherosclerosis.
Atherosclerosis is a disease that affects blood vessels by causing a buildup of fat inside the artery walls. This can increase the risk of one developing a fusiform aneurysm.
Factors that Put You at Risk of an Aneurysm Rupture
Not all aneurysms result in a rupture.
Factors such as the size of the aneurysm and where it is located may affect the risk of the aneurysm rupturing.
Some medical conditions may also play a role in influencing a rupture.
The risk factors that cause aneurysm rupture include:
- Smoking: This is one dangerous habit, considering it is linked to the development as well as the rupture of cerebral aneurysms. Smoking could even lead to the formation of multiple cerebral aneurysms.
- Size of the aneurysm: If a person has not been showing any symptoms of having an aneurysm, the ones that are most likely to rupture are the largest aneurysms.
- High blood pressure: HBP damages and weakens arteries, which increases the likelihood of the arteries forming aneurysms which will rupture.
- Location of the aneurysm: Aneurysms which are located on the posterior communicating arteries and possibly those located on the anterior communicating artery are more likely to rupture than those located elsewhere in the brain. The posterior communicating arteries are a pair of arteries located in the back area of the brain. The anterior communicating artery is a single artery which is located in the front of the brain.
- Growth: Aneurysms that are continuously growing have a higher risk of rupturing than those which do not grow.
- Family history: If someone in your family history has had an aneurysm rupture, this puts you at a higher risk of suffering an aneurysm rupture.
- Multiple aneurysms: The greatest risk occurs in a person who has multiple aneurysms and who has already suffered a previous rupture or sentinel bleed.
WHAT ARE THE SYMPTOMS OF BRAIN ANEURYSMS?
As I mentioned before, cerebral aneurysms do not show symptoms or warning signs, and that is why they are such a high-risk disease.
However, when they grow too large, or when they rupture, some symptoms will start to show. It is only the small, unchanging aneurysms that remain undetected.
Symptoms of a Large, Unruptured Aneurysm
As the aneurysm enlarges, it presses on tissues and nerves within the brain and that causes the following symptoms:
- Paralysis on one side of your face
- Pain above and behind your eye
- Dilated pupil in your eye
- Changes in vision or double vision
Symptoms of a Ruptured Aneurysm
Once the aneurysm bursts, you will experience an abrupt and extremely severe headache – it will feel like the worst headache you have ever experienced in your life.
Other symptoms of a ruptured brain aneurysm include:
- Stiff neck
- Double vision
- Light sensitivity
- Brief or prolonged loss of consciousness
- Cardiac arrest
Symptoms of a Leaking Aneurysm
Sometimes, instead of bursting outright, the aneurysm will start leaking a small amount of blood in your brain.
This is known as a sentinel bleed.
This leaking aneurysm will cause sentinel/warning headaches. This may happen days or even weeks in advance of the coming rupture.
However, many people do not experience a sentinel headache before a rupture.
If you experience a sudden, severe headache, especially one combined with any other symptoms, do not hesitate to seek medical attention at once.
CLASSIFICATION OF BRAIN ANEURYSMS
Cerebral aneurysms are classified according to type.
There are three types of brain aneurysms:
- Saccular Aneurysm: This is a round sac filled with blood, which is found on a main artery or on one of the branches of a main artery. It is also called a berry aneurysm, because it looks like a berry hanging from a vine. It is the most common type of brain aneurysm. Saccular aneurysms are typically found on arteries located at the base of the brain. They occur most often in adult individuals, and about 2% to 3% of the population has them.
- Fusiform Aneurysm: This is an aneurysm that bulges or balloons out on all sides of an artery. Fusiform aneurysms are less common and rarely get ruptured.
- Mycotic Aneurysm: This type of aneurysm is caused by an infection. The infection makes the artery wall weak, leading to the formation of a bulging aneurysm.
COMPLICATIONS CAUSED BY A RUPTURED BRAIN ANEURYSM
When an aneurysm ruptures and bleeds into the space between your skull and brain, this is referred to as subarachnoid hemorrhage.
Sometimes it may bleed into the brain tissue – this is known as intracerebral hemorrhage.
Both subarachnoid and intracerebral hemorrhage may lead to hemorrhagic stroke, brain damage, and even death.
Some of the other complications that may result from a ruptured brain aneurysm include:
- Rebleeding: A ruptured aneurysm may rupture again before it has been treated, leading to further leakage of blood into the brain and causing more damage or even death.
- Change in sodium levels: The bleeding can cause a disruption of sodium balance in the blood supply. This leads to swelling in the brain cells and can cause permanent brain damage.
- Hydrocephalus: This occurs when too much cerebrospinal fluid builds up in your brain, causing pressure that could lead to permanent brain damage or death. This condition frequently occurs after subarachnoid hemorrhage because all the leaking blood blocks the cerebrospinal fluid’s normal flow. When left untreated, the pressure built up in the head can lead to coma or even death.
- Vasospasm: This is a frequent occurrence after subarachnoid hemorrhage – the bleeding makes the arteries contract, which limits the flow of blood to vital areas in your brain. This may cause strokes.
- Seizures: Seizures and convulsions may occur during the bleeding or immediately after. Untreated seizures and seizures that fail to respond to treatment can cause brain damage.
DIAGNOSING A BRAIN ANEURYSM
In most cases, you won’t know about the presence of a brain aneurysm until a rupture happens, and even then, if the doctor fails to perform the necessary tests, you may be misdiagnosed.
The main symptom of a ruptured aneurysm is the extremely severe headache.
The doctor will put you through medical imaging tests so as to determine if any blood has leaked into the space between the skull bone and brain.
There are a variety of tests that the doctor can perform to diagnose brain aneurysms and determine appropriate treatment. These include:
A CT scan enables doctors to see inside your body, using a combination of X-rays and a computer to develop pictures of your organs, bones, and other tissues.
CT scans show much more detail than a regular X-ray. Doctors can do a CT scan on any part of your body. It’s a painless procedure that does not take long.
When it comes to brain aneurysms, a CT scan is typically the first test a doctor will order to see if there is leakage of blood into the brain.
The CT scan uses X-rays to make two-dimensional images (“slices”) of the brain and the skull.
A contrast dye could be injected into the bloodstream before the scanning commences.
This is known as CT angiography (CTA), and the intention is to provide sharper, more detailed images of the blood flow in your arteries. CTA helps doctors see the location, shape, and size of an unruptured or ruptured aneurysm.
MRI (Magnetic Resonance Imaging)
An MRI is a test that uses strong magnet and radio waves, and a computer to create detailed cross-sectional pictures of the internal organs and structures of your body.
The scanner typically looks like a large tube with a table in the middle which enables the patient to slide in. MRI scans (unlike CT scans and X-rays) do not use potentially harmful ionizing radiation.
Like the CT scan, the MRI will help the doctor determine if there is leakage of blood into the brain.
Magnetic resonance angiography (MRA) provides detailed images of the brain arteries which help the doctor to see the location, size, and shape of an aneurysm.
Cerebral angiography is a test that uses an X-ray to create an image which a doctor can use to determine whether there are any blockages and other abnormalities in the blood vessels located in your head or neck.
Such blockages or abnormalities may lead to bleeding in the brain and even stroke.
The cerebral angiography can also help doctors identify weak spots in an artery.
With an angiography, the doctor can determine what caused bleeding to occur in the brain, and the precise location, shape, and size of an aneurysm.
The doctor passes a catheter (a long, flexible tube) to inject a small amount of contrast dye into the neck and brain arteries.
The contrast dye enables the X-ray to provide a detailed picture of the aneurysm or any blockage in the arteries.
Cerebrospinal Fluid (CSF) Analysis
Cerebrospinal fluid is a clear, colorless fluid found in your brain and spinal cord – these two make up your central nervous system.
The central nervous system controls and coordinates everything you do, from muscle movement to organ function, as well as complex thinking and planning.
The cerebrospinal fluid protects your central nervous system by acting like a buffer or cushion against any sudden impact or injury to your brain or spinal cord.
CSF also facilitates the removal of waste products from the brain. It helps the central nervous system work properly.
The CSF analysis involves a group of tests that examine your cerebrospinal fluid to help the doctor diagnose diseases and conditions that affect the brain or spinal cord.
CSF analysis measures the chemicals in the cerebrospinal fluid.
The doctor collects this fluid by doing a spinal tap procedure (lumbar puncture), which involves inserting a thin needle into the lower back (lumbar spine).
This way, the doctor collects a small amount of fluid which he/she removes for testing.
The results of the CSF analysis will enable the doctor to determine if there is any bleeding going on in the brain.
If the analysis shows that bleeding is happening, the doctor will have to do additional tests to identify the exact cause of this bleeding.
TREATMENT OF BRAIN ANEURYSMS
It’s worth mentioning that not all brain aneurysms need treatment.
The very small, unruptured aneurysms that are not linked with any factors that cause a high risk of rupture can be safely left alone.
So long as these are monitored for growth with MRA or CTA, you have nothing to worry about.
Before treating an unruptured brain aneurysm, the doctor will consider a number of factors in order to determine the best treatment option. These factors include:
- Risk of rupture
- Risk of treatment
- Size, type, and location of aneurysm
- Patient’s age and health
- Patient’s personal and family medical history
If you have an unruptured brain aneurysm and want to reduce the risk of rupturing, there are some steps you can take to keep yourself safe. These include
- Carefully monitor and control your blood pressure.
- Quit smoking.
- Steer clear of cocaine and other stimulant drugs which raise your blood pressure.
The main goal when treating a ruptured aneurysm is to prevent further bleeding and the potential permanent brain damage that could occur.
Some of the available options for treating ruptured brain aneurysms include:
Endovascular treatments include the use of endovascular coils, stents, or Onyx, which is a liquid glue.
Endovascular treatment is a minimally invasive treatment option which involves inserting a catheter into the body through a small hole in the leg, and then navigating it using real-time X-ray guidance through the vascular system to the head and the aneurysm’s location.
Coiling and Stenting
In this treatment method, endovascular coils are used to block the flow of blood into the aneurysm. Typically, a patient will need 4 to 6 coils for blood flow to be successfully blocked. Coiling is much safer than surgical clipping, though there is a risk that the aneurysm might bleed again in future.
This is yet another endovascular treatment. It involves the use of a liquid material known as Onyx which is injected into the patient’s bloodstream via tiny tube fed into the brain. This liquid solidifies quickly and cuts off the flow of blood to the damaged vessel, and thus stemming the bleeding.
Open Surgery Treatment
The traditional treatment for brain aneurysms is open brain surgery.
An example of this is surgical clipping, a procedure during which a surgeon removes a section of skull.
The surgeon then places a metal clip across the aneurysm’s base, and then puts back the section of skull in its original place.
The function of the metal clip is to stop the aneurysm’s blood supply.
Generally, aneurysms which are completely clipped do not recur. In the three weeks immediately following the hemorrhage, treatment and monitoring is very important.
Complications are most likely to occur during this three-week period.
The doctor may prescribe medication and sedatives. Total bed rest is necessary.
If the aneurysm has not yet ruptured, the doctor will focus on preventing an initial rupture using either open surgery or endovascular techniques.
Protecting Yourself from Brain Aneurysm
If you want to reduce the risk of getting or rupturing an aneurysm, you should avoid activities and a lifestyle that can potentially raise your blood pressure or damage your blood vessels.
These activities include:
- Eating a high-fat diet
- Drug abuse
- Ignoring high blood pressure
Brain aneurysms are potentially life threatening, yet at the same time they are not easy to detect unless they rapture.
The best way to keep yourself safe is to seek immediate medical attention whenever you experience any sudden and severe headache.
If you are diagnosed with an unruptured aneurysm, you should take active steps to control your blood pressure.
You can do this by eating a balanced diet, avoiding harmful habits like smoking and drug abuse and generally living a healthy lifestyle.
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