Brain (Cerebral) Aneurysm
An aneurysm is an outpouching of a blood vessel wall. This can occur anywhere there are blood vessels, including in the brain. The bulging, blood-filled pocket can put pressure on parts of the brain. In addition, the blood vessel can rupture, causing bleeding in the brain. Early detection and diagnosis may help prevent severe or fatal complications in some people. Many aneurysms go unnoticed for a lifetime and cause no symptoms.
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Aneurysms form in areas where the artery wall becomes thin or weak. Thinning artery walls and resulting aneurysms can be caused by a number of factors. Common causes include:
- Weakness in artery wall that is present at birth
- High blood pressure
- Trauma or injury to the brain
- Plaque build-up on artery walls
These factors increase your chance of developing a brain aneurysm. These risk factors also increase your chance of a rupture. Older adults are more likely to develop an aneurysm than children. Females are at slightly higher risk. Tell your doctor if you have any of these risk factors:
- Genetic diseases—circulatory, connective tissue, or polycystic kidney disease
- Family history of aneurysms
- Heavy alcohol use
- Drug abuse
- High blood pressure
- Traumatic head injury
- Arteriovenous malformations
Symptoms may include:
- Pain behind the eye
- Numbness, sometimes on one side of the face or body
- Weakness on one side of the body or face
- Vision changes
- Drooping eyelid
- Differences between the size of the pupils
- Speech impairment
Most aneurysms do not cause symptoms until they leak or rupture. A leaking or ruptured aneurysm may cause:
- Stiff neck
- Confusion or sleepiness
- Loss of consciousness
You will be asked about your symptoms and medical history. A physical exam will be done. Tests may include the following:
- Brain imaging such as CT scan or MRI scan
- Catheter , or MR or CT angiography using dye contrast test to view the arteries and veins
- Lumbar puncture to test the cerebrospinal fluid that surrounds the brain and spinal cord
Talk with your doctor about the best treatment plan for you. Other medical conditions, lifestyle factors, as well as the type, size, and location of the aneurysm will direct treatment. For a known aneurysm that is not leaking or ruptured, treatment options include the following:
The aneurysm will be monitored for changes in size or to see if it is leaking. You will be monitored for the appearance of symptoms.
Medications are not used to fix an aneurysm. They may be used to help lower blood pressure, treat pain, or stop side effects of the aneurysm such as seizures.
During this procedure, a catheter is threaded up to the aneurysm. Coils, a special liquid, or balloons are used to fill the aneurysm and stop circulation, causing it to clot. This may need to be done more than once.
Surgical options include:
- Microvascular clipping—A neurosurgeon cuts off blood flow to the aneurysm.
- Microvascular occlusion—A neurosurgeon clamps off the entire artery leading to the aneurysm. Sometimes a bypass procedure (rerouting a new blood vessel) is done too.
In many cases, there is no known way to prevent an aneurysm from forming. To help reduce your chances of a brain aneurysm or having it burst:
- Control high blood pressure.
- If you smoke , talk to your doctor about ways to quit.
- Do not use illegal drugs.
Discuss with your doctor:
- Benefits and risks of oral contraceptives
- Whether it is safe to use daily aspirin or other pain medications that may thin the blood
- Cerebral aneurysm. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Cerebral-Aneurysm. Updated . Accessed March 1, 2018.
- Cerebral aneurysms fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Cerebral-Aneurysms-Fact-Sheet. Updated May 10, 2017. Accessed March 1, 2018.
- Subarachnoid hemorrhage. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T116453/Subarachnoid-hemorrhage . Updated December 20, 2017. Accessed March 1, 2018.
- Vlak MH, Rinkel GJ, Greebe P, van der Bom JG, Algra A. Trigger factors and their attributable risk for rupture of intracranial aneurysms: a case-crossover study. Stroke. 2011;42(7):1878-1882.