For many individuals, having an aneurysm is not noticeable. A brain (cerebral) aneurysm is a bulging, weak area in the wall of an artery that supplies blood to the brain. In most cases, a brain aneurysm causes no symptoms and goes unnoticed. In rare cases, the brain aneurysm ruptures, releasing blood into the skull and causing a stroke.
When a brain aneurysm ruptures, the result is called a subarachnoid hemorrhage. Depending on the severity of the hemorrhage, brain damage or death might result.
A person might inherit the tendency to form aneurysms, or aneurysms may develop because of hardening of the arteries (called atherosclerosis) and aging. Some risk factors that can lead to brain aneurysms can be controlled, and others can't.
These risk factors might increase your risk of developing an aneurysm, or if you've already had an aneurysm, they might increase your risk of it rupturing:
- Family history. People who have a family history of brain aneurysms are twice as likely to have one as those who don't.
- Previous aneurysm. About 20 percent of patients with brain aneurysms have more than one.
- Sex. Women are twice as likely to develop a brain aneurysm or to suffer a subarachnoid hemorrhage as men.
- Race. Blacks have twice as many subarachnoid hemorrhages as whites.
- Hypertension. The risk of subarachnoid hemorrhage is greater in people with a history of high blood pressure (hypertension).
- Smoking. In addition to being a cause of hypertension, smoking can greatly increase the chances of a brain aneurysm rupturing.
Most brain aneurysms are discovered during tests for another, usually unrelated, condition. In other cases, an unruptured aneurysm will cause problems by pressing on areas within the brain. When this happens, depending on the areas of the brain that are affected and the severity of the aneurysm, you might suffer from:
- Severe headaches.
- Blurred vision.
- Changes in speech.
- Neck pain.
An eye exam can show increased pressure within the brain, including swelling of the optic nerve or bleeding into the retina of the eye. The following tests might be used to diagnose cerebral aneurysm and determine the cause of bleeding within the brain:
- CT scan of the head.
- CSF exam (spinal tap).
- MRI of the head.
- Cerebral angiography or spiral CT scan angiography of the head to reveal the location and size of the aneurysm.
- Electroencephalogram (EEG) if seizures occur.
If you have any of the following symptoms or notice them in someone you know, please see a health professional immediately:
- Sudden, severe headache.
- Neck pain.
- Nausea and vomiting.
- Sensitivity to light.
- Fainting or loss of consciousness.
Aneurysm Treatment Options
Treatment will depend on your age, size of the aneurysm, any additional risk factors and your overall health. HonorHealth's experts will discuss your options with you to help determine your plan.
Because the risk of a small aneurysm rupturing is low, and surgery for a brain aneurysm is often risky, your doctor might want to continue to observe your condition rather than perform surgery. However, if your aneurysm is large or causing pain or other symptoms, or if you've had a previous ruptured aneurysm, your doctor might recommend surgery.
The following surgeries are used to treat both ruptured and unruptured brain aneurysms:
- Coil embolization. During this procedure, a specialist inserts a small tube into the affected artery and positions it near the aneurysm. Tiny metal coils are moved through the tube into the aneurysm, relieving pressure on the aneurysm and making it less likely to rupture. This procedure is less invasive and is believed to be safer than surgical clipping although it might not be as effective at reducing the risk of a later rupture.
- Surgical clipping. This surgery involves placing a small metal clip around the base of the aneurysm to isolate it from normal blood circulation. This decreases the pressure on the aneurysm and prevents it from rupturing. Whether this surgery can be done depends on the location of the aneurysm, its size, and your general health.
Some aneurysms bulge in such a way that the aneurysm has to be cut out and the ends of the blood vessel stitched together, but this is rare. Occasionally, the artery is not long enough to stitch together, and a piece of another artery has to be used.
Aneurysms that have bled are very serious and in many cases lead to death or disability. Management includes hospitalization and intensive care to relieve pressure in the brain and maintain breathing and vital functions, such as blood pressure, and treatment to prevent re-bleeding.