Brain Aneurysm 101: Symptoms, Causes, Stages & Treatment - MalaysiaChronic Conditions

Brain Aneurysm 101: Symptoms, Causes, Stages & Treatment

A brain aneurysm, also known as intracranial or cerebral aneurysm, is the bulging of a blood vessel in the brain. Find out more about brain aneurysms, their symptoms, causes, stages, and treatment options.

What is a Brain Aneurysm?

A brain aneurysm, commonly referred to as a cerebral or intracranial aneurysm, is a bulge or ballooning of an artery in the brain caused by a thin inner layer of a blood vessel. A weak, thin blood vessel will eventually become worn out from a constant flow of blood, causing a small area to bulge outwards as it fills with blood.

There are a few forms that the aneurysm may take on:

• Saccular aneurysm, the most common type, bulges out into a cherry or dome shape, with a neck that connects it to the main artery
• Fusiform aneurysm, a rarer form, where the artery widens on both sides
• Mycotic aneurysm, an infection that weakens a blood artery’s wall, causing it to bulge
• Dissecting aneurysm, where there is a tear in the artery’s lining that can leak blood

Brain aneurysms are small in size, but they still run the risk of rupturing, which can lead to various life-threatening complications if not treated immediately. While it is estimated that between50 to 80 per cent of aneurysms do not rupture, unruptured aneurysms can present other health conditions, or may not even present any symptoms. There are occasions when doctors discover an aneurysm by accident while diagnosing someone for other health issues.

Brain aneurysms can affect anyone, though it is quite rare among children under 18 (with a higher prevalence among men than women). It is common among adults between the age of 30 to 60 years but is more common among women. It generally occurs anywhere in the brain, but usually along the base of the brain (the circle of Willis), at branching points of the arteries.

Symptoms of Brain Aneurysm

There are two stages to a brain aneurysm: unruptured and ruptured aneurysms.

Unruptured aneurysms may not present any symptoms at all because of their small size. In some cases, unruptured aneurysms that slowly grow in size may press on nerve cords or other blood vessels. This may result in any of the following symptoms:

• Drooping eyelid
• Dilated pupil
• Blurry/double vision
• Weakness/numbness
• Paralysis on one side of the face
• Splitting headache
• Nausea
• Pain above or behind the eye

If the aneurysm ruptures, the above-mentioned symptoms may become more intense, or others may present themselves.

• Sudden and intense headache (often described as “the worst headache of my life”)
• Vomiting
• Stiff neck
• Sensitivity to light
• Impaired vision
• Difficulty speaking/walking
• Loss of consciousness
• Seizure/convulsions (may occur at the time of rupture, or after)

Though bleeding caused by the rupture may not last very long, it will leak blood into the area surrounding the brain. This may cause brain cells to be damaged and lead to a subarachnoid haemorrhage, which may also lead to lasting brain damage. If not treated quickly, there is a chance of another bleed to happen from the ruptured aneurysm.

There is also the possibility of narrowing arteries, or vasospasm/constriction, which can also affect the blood flow to the brain. If the arteries narrow so much that not enough blood can be supplied to the brain, this may cause anischaemic stroke. If blood accumulates in the spinal fluid, it may build up fluid in the brain cavities, thus causing pressure and swelling directly to the brain tissue. All of these will eventually cause permanent brain damage.

It is very important to observe the signs of a ruptured aneurysm, as immediate medical attention can reduce the likelihood of lasting brain damage or even prevent death.

Causes and Risk Factors of Brain Aneurysms

Brain aneurysms occur when the walls of the arteries in the brain become thin and weaken; it commonly occurs at branching points of the arteries as they are the weakest sections. Wear and tear caused by age are a common cause of brain aneurysms, though particular risk factors increase the chances of having an aneurysm. Some risk factors may develop over time or maybe present since birth (congenital disorders).

Some of the risk factors for brain aneurysms include the following:

• Age (those between 30 to 60 years of age; more prevalent among women)
• Family history (among first-degree family members, e.g. children, siblings, parents)
• High blood pressure
• Damage to blood vessels
• Rare blood vessel disorders
• Genetic disorders
• Frequent smoking
• Drug abuse
• Birth defect
• Head injury or trauma
• Previously having an aneurysm
• Complications from blood-related illnesses
• Atherosclerosis (blockage in the arteries)

You must remember that having a risk factor does not mean you will have a brain aneurysm.

If there is an unruptured brain aneurysm, there are factors that may cause it to rupture. Some studies have also noted that any activities that can raise blood pressure can rupture an aneurysm. This is because blood is pushed harder against the artery walls, which will further weaken the blood vessel. Some of these activities include vigorous exercise, lifting heavy objects, emotional outbursts, or even drinking coffee.

Blood-thinning medication, or medicines that prevent blood clots from forming, may also be a potential cause for aneurysm ruptures.

There is also the risk that a ruptured aneurysm may bleed again within 48 to 72 hours after the first bleed.

Medical professionals will advise you or your loved one to reduce risk factors that can be controlled, such as smoking and alcohol consumption.

Diagnosing Brain Aneurysm

Medical practitioners will need to identify the symptoms before deciding on the treatment plan. If the symptoms are severe, such as having a very sudden and severe headache or convulsions, it may be likely that the aneurysm has ruptured. However, there are still medical conditions that may present similar symptoms, such as meningitis or tumour growth.

A thorough diagnosis can be done via brain imaging methods, such as CT or MRI scans. These exams will create images of your brain using either x-rays (CT scan); or magnetic fields and radio waves (MRI scan). Both exams may require a contrast dye to be injected into your body to clearly define the blood vessels in the images generated. These images will show the location of the aneurysm, its shape, and whether it has ruptured or not.

If the imaging tests do not detect anything, care professionals may decide to perform either a cerebral angiography or a lumbar puncture.

Cerebralangiographyis an invasive diagnostic method that helps find blockages or abnormalities in the blood vessels, including aneurysms. A small tube, called a catheter, will be inserted into you or your loved one’s body via a blood vessel in your leg, and lead into the blood vessels to the neck and brain arteries. A dye will be inserted through the catheter to help with clearly defining the x-ray images that will be taken of the blood vessels.

A lumbar puncture, commonly referred to as a spinal tap or cerebrospinal fluid test, examines a sample of spinal fluid extracted via a needle through the lower back. The results will help to check for bleeding around the brain, and what caused this bleeding.

Besides these tests, your care professional may also request additional information related to your health (or that of your loved one), including any family history of aneurysms or neurological conditions. They will inform the medical team on the right treatment plan that has the highest chance of successfully treating the aneurysm.

Treatment of Brain Aneurysm

The results of the diagnosis and medical history will guide medical professionals on the right treatment plan. A ruptured brain aneurysm requires immediate treatment to prevent lasting brain damage. The main purpose of treatment is to reduce any more bleeding into the brain, or in the case of unruptured aneurysms, to reduce the probability of it rupturing.

Surgical Clipping

Open surgery is normally conducted when the aneurysm is unruptured. The surgeon will remove a small section of your skull, then uses a microscope to locate the aneurysm and any arteries that lead to it. Treating the aneurysm is called clipping, where a tiny, metallic clip is placed (pinched) at the neck of the aneurysm, cutting it off from the artery. Larger aneurysms may require more than one clip or other methods to treat it.

By closing off the neck of the aneurysm, blood will no longer flow into the aneurysm, thus preventing it from swelling in size or rupturing. Clipping has been used to treat unruptured aneurysms for a long time and is a highly effective method in preventing new bleeds or recurring aneurysms.

Endovascular Treatments

The term ‘endovascular’ means within the blood vessels. Endovascular treatments are less invasive methods which are similar to surgical clipping, in that it prevents blood from flowing into the aneurysm. This is done by inserting a catheter (led by a guidewire) through an artery in your leg and then is threaded to where the aneurysm is.

There are a variety of endovascular treatment methods. The most common one is coiling, where a soft platinum wire is guided through the catheter and inserted into the aneurysm. As this soft wire exits the catheter, it “coils” up and spirals inside the aneurysm; multiple coils may be used, depending on the nature of the aneurysm. Once the coils have conformed to the shape of the aneurysm, it will stop all blood flow into the aneurysm.

Other endovascular treatments include the use of stents. Stents are a type of flow diverter, which essentially divert blood away from the aneurysm. Stents are usually cylindrical wire mesh that is placed in the artery where the aneurysm is found, covering the neck of the aneurysm. This may optionally be done in conjunction with coiling, to ensure that the aneurysm is effectively cut off. The diversion of blood can help stimulate the gradual repair of the parent artery.

Cerebrospinal Treatment

This treatment method is to alleviate pressure build upon the brain, caused by excess spinal fluid that accumulates after a ruptured aneurysm. Because bleeding into the area surrounding the brain can cause significant complications, it may be necessary todraw out excess spinal fluidvia a catheter, diverting the excess fluid into an external bag.

In some cases, a shunt system, comprising a flexible silicone rubber tube, or shunt, and a valve, may be needed. The shunt drains the excess spinal fluid, starting in your brain and ending in your abdominal cavity, where the fluid is absorbed by the body. The valve may even be set to automatically remove excess fluid when it reaches a certain volume.

Medical Therapy

This method relies on the use of medication to treat complicated cases of brain aneurysms. You may be prescribed a few types of medicines.

• Pain relieversto help with managing headaches
• Calcium channel blockers, which prevent calcium from entering cells of the blood vessel walls (reducing the risk of vasospasm/stroke)
• Anti-seizure medications, or anticonvulsants, to prevent seizures from occurring owing to a ruptured aneurysm
• Rehabilitationfor cases where damage to the brain requires physiotherapy, speech therapy and/or occupational therapy to restore impaired/lost functions

Brain Aneurysm Prevention

In most cases, small unruptured brain aneurysms may not present any complications at all. There are even occasions where a brain aneurysm will not be found until a routine medical check-up for other medical complications.

Nevertheless, you or your loved one should see a medical professional immediately if any of the symptoms occur. Early treatment is a crucial step in preventing further complications from developing in the future.

A change of lifestyle will greatly help reduce the risks of rupturing. Some things you or your loved one can do include:

• Quit smoking
• Regular exercise
• Having a balanced diet
• Limit caffeine intake
• Control high blood pressure

A lifestyle change is also recommended for those who have already undergone treatment for brain aneurysms, as it will help reduce the risk of getting another aneurysm. You may also refer to a medical professional for additional advice.

Post-Treatment for Brain Aneurysm

Depending on the nature of the treatment (for an unruptured or ruptured aneurysm), the recovery process may take a few days or last for weeks. You or your loved one will be closely monitored while warded to ensure that everything is well. Ensure that you communicate with the medical team if you may be experiencing any side effects or other signs of abnormalities.

The after-effects of a ruptured brain aneurysm may have long-term side effects stemming from bleeding into the brain. While some of these effects can be treated throughtherapy, other challenges may arise with memory, attention, or cognition. You or your loved one may also experience infrequent bouts of headaches, fatigue, weakness or even changes to your behaviour and speech. If the aneurysm has led to a stroke, these effects may be magnified. In these instances, gettingcare supportfor stroke can be crucial to avoid a secondary stroke.Close communication with loved ones or medical experts will help with coping with these deficits. Seek help from care professionals ortherapy groupsif needed.

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