The basics of brain aneurysms

The brain is the most complex organ in the body.  Every thought, memory, emotion, movement, and senses are controlled by this master in charge of who we are. That’s why the thought of having a brain aneurysm can be very unsettling. Brain aneurysm – just the name of it sounds ominous. And they certainly can be. Anyone told they have a brain aneurysm can be one of the most frightening diagnoses to receive.

Even though ruptured aneurysms are relatively rare, this scary diagnosis is a serious condition and is associated with a high rate of mortality and disability. Anyone who has survived the experience of a brain aneurysm will tell you it is extremely upsetting and difficult to deal with.

What is a brain aneurysm?

A brain aneurysm is a weak bulging spot on the wall of a brain artery. To understand a brain aneurysm, use the analogy of a thin balloon or weak spot on an inner tire ready to pop. As blood flows within the artery, it pounds against the thinned portion of the wall and aneurysms silently form from wear and tear on the arteries. Over time, the artery wall gradually becomes thinner from the pressure, causing the wall to swell outward. Eventually, the pressure may result in the aneurysm rupturing, allowing blood to escape into the space around the brain.

Who is at risk?

There are many contributing factors believed to contribute to the formation of brain aneurysms which include: 

·      Smoking

·      High blood pressure or hypertension

·      Congenital abnormality in artery wall

·      Family history of aneurysms

·      Age over 40

·      Women have an increased risk of incidence of aneurysms over men at a ratio of 3:2

·      Anyone with Ehlers-Danlos Syndrome, Polycystic kidney disease, Marfan Syndrome, and Fibromuscular Dysplasia

·      Drug use, especially cocaine

·      Infection

·      Tumors

·      Traumatic head injury

Are there warning signs or symptoms?

Unfortunately, a brain aneurysm that has not ruptured can remain silent as they are typically completely asymptomatic. Asymptomatic aneurysms are usually small in size of less than half an inch in diameter. Large unruptured aneurysms can sometimes press on the brain or the nerves stemming out of the brain, resulting in various neurological symptoms.  Anyone, regardless of age, experiencing any of the following symptoms, should be evaluated by a physician immediately:

·      Localized headache

·      Dilated pupils

·      Blurred or double vision

·      Pain above and behind the eye

·      Weakness and numbness

·      Difficulty speaking

Anyone experiencing some or all of the following symptoms should seek medical attention immediately:

·      Sudden severe headache or having the worst headache of your life

·      Loss of consciousness

·      Nausea/vomiting

·      Stiff neck

·      Sudden blurred or double vision

·      Sudden pain above/behind the eye or difficulty seeing

·      Sudden change in mental status or awareness

·      Sudden trouble walking or dizziness

·      Sudden weakness and numbness

·      Sensitivity to light

·      Seizure

·      Drooping eyelid

How is a brain aneurysm diagnosed?

With widespread use of MRI and CT technology, most aneurysms are now discovered “incidentally.”  Often they are found when an MRI/MRA is done for evaluation of chronic headaches, dizziness, etc., which has nothing to do with the original complaint. Occasionally, aneurysms grow to be large enough to press on an adjacent brain or nerves which might produce a “mass effect” such as a pupil of the eye getting larger than the other, double vision, etc. Another way they may be discovered is the “sentinel bleed” which is either a small hemorrhage or bleed, or a period of aneurysm growth which produces a new, bad headache. These sentinel bleeds are important as they may be a warning sign of an aneurysm rupture.

Brain aneurysms can be easily identified with non-invasive imaging tests. These tests could include a variety of imaging equipment such as CT scan, CTA, MRI, and MRA.

Are there treatments available?

Fortunately, important medical advances have made it more promising than in the past on treating a brain aneurysm. If an aneurysm is detected but has not ruptured, the two options are either treatment or observation. If an aneurysm has already ruptured, the options are either open surgery or an endovascular approach.  It is best to perform these options as early as possible after hemorrhage, to prevent a rebleed of the aneurysm. The goal of treatment is to prevent rebleeding by sealing off the aneurysm so it is totally obliterated with either a clip or coil.

Whatever treatment is chosen, it is critical for the patient and family to have trust in the skill and ability of their physician. Ask questions, do your research, and have a say in how you want to be treated for this condition that suits your best needs.

David B. Samadi, MD, Urologic Oncology Expert and Robotic Surgeon located at 485 Madison Avenue on the 21st floor, New York, NY – 212-365-5000.  Follow Dr. Samadi at www.samadimd.com,  www.prostatecancer911.com, and www.roboticoncology.com.