What is an Aneurysm?
A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. It often looks like a berry hanging on a stem.
A brain aneurysm can leak or rupture, causing bleeding into the brain (hemorrhagic stroke). Most often a ruptured brain aneurysm occurs in the space between the brain and the thin tissues covering the brain. This type of hemorrhagic stroke is called a subarachnoid hemorrhage.
A ruptured aneurysm quickly becomes life-threatening and requires prompt medical treatment.
Most brain aneurysms, however, don’t rupture, create health problems or cause symptoms. Such aneurysms are often detected during tests for other conditions.
Treatment for an unruptured brain aneurysm may be appropriate in some cases and may prevent a rupture in the future.
Symptoms of Aneurysm
A sudden, severe headache is the key symptom of a ruptured aneurysm. This headache is often described as the “worst headache” ever experienced.
Common signs and symptoms of a ruptured aneurysm include:
- Sudden, extremely severe headache
- Nausea and vomiting
- Stiff neck
- Blurred or double vision
- Sensitivity to light
- A drooping eyelid
- Loss of consciousness
In some cases, an aneurysm may leak a slight amount of blood. This leaking (sentinel bleed) may cause a sudden, extremely severe headache
A more severe rupture often follows leaking.
An unruptured brain aneurysm may produce no symptoms, particularly if it’s small. However, a larger unruptured aneurysm may press on brain tissues and nerves, possibly causing:
- Pain above and behind one eye
- A dilated pupil
- Change in vision or double vision
- Numbness of one side of the face
Learn more about your specific Aneurysm symptoms, and how they can be treated at The Morrison Clinic™. Schedule an e-consult.
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Ways to Avoid Aneurysm Surgery
Other treatments for ruptured brain aneurysms are aimed at relieving symptoms and managing complications.
- Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.
- Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These medications may lessen the erratic narrowing of blood vessels (vasospasm) that may be a complication of a ruptured aneurysm.
One of these medications, nimodipine (Nymalize, Nimotop), has been shown to reduce the risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage from a ruptured aneurysm.
- Interventions to prevent stroke from insufficient blood flow include intravenous injections of a drug called a vasopressor, which elevates blood pressure to overcome the resistance of narrowed blood vessels.
An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain. A drug known as a vasodilator also may be used to expand blood vessels in the affected area.
- Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid (Depakene) and others. Their use has been debated by several experts, and is generally subject to caregiver discretion, based on the medical needs of each patient.
- Ventricular or lumbar draining catheters and shunt surgery can lessen pressure on the brain from excess cerebrospinal fluid (hydrocephalus) associated with a ruptured aneurysm. A catheter may be placed in the spaces filled with fluid inside of the brain (ventricles) or surrounding your brain and spinal cord to drain the excess fluid into an external bag.
Sometimes it may then be necessary to introduce a shunt system — which consists of a flexible silicone rubber tube (shunt) and a valve — that creates a drainage channel starting in your brain and ending in your abdominal cavity.
- Rehabilitative therapy. Damage to the brain from a subarachnoid hemorrhage may result in the need for physical, speech and occupational therapy to relearn skills
Treating unruptured brain aneurysms
Surgical clipping or endovascular coiling or a flow diverter can be used to seal off an unruptured brain aneurysm and help prevent a future rupture. However, in some unruptured aneurysms, the known risks of the procedures may outweigh the potential benefit.
A neurologist, in collaboration with Dr. Morrison, or an interventional neuroradiologist, can help you determine if this treatment is appropriate for you.
Factors to consider in making treatment recommendations include:
- The size, location and overall appearance of the aneurysm
- Your age and general health
- Family history of ruptured aneurysm
- Congenital conditions that increase the risk of a ruptured aneurysm
If you have high blood pressure, Dr. Morrison can advise you on how to manage the condition through aneurysm treatment. If you have a brain aneurysm, proper control of blood pressure may lower the risk of rupture.
In addition, cigarette smoking increases risk for formation, growth and rupture of the aneurysm.
Aneurysm Treatment Procedures
There are two common treatment options for a ruptured brain aneurysm.
- Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then he or she places a tiny metal clip on the neck of the aneurysm to stop blood flow to it.
- Endovascular coiling is a less invasive procedure than surgical clipping. The surgeon inserts a hollow plastic tube (catheter) into an artery, usually in your groin, and threads it through your body to the aneurysm.
He or she then uses a guide wire to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and essentially seals off the aneurysm from the artery.
Both procedures pose potential risks, particularly bleeding in the brain or loss of blood flow to the brain. The endovascular coil is less invasive and may be initially safer, but it may have a slightly higher risk of need for a repeat procedure in the future due to reopening of the aneurysm.
Schedule an e-consult with Dr. Morrison to discuss your Aneurysm treatment options today.
In most cases, aortic aneurysms tend to grow throughout the patient’s lifetime and, if left untreated, usually progress towards rupture. Therefore, as soon as significant dilatation of the aorta is detected, an assessment by a specialist becomes essential to determine if preventive action is necessary to avoid complications or, alternatively, whether to continue with appropriate monitoring.
Once the aneurysm has been repaired, patients tend to remain stable for the rest of their lives and rarely require another operation on the same section of aorta. But the aorta may still become dilated in other sections, which would also need an intervention.
Although less and less common, patients who undergo endovascular surgery (using a catheter) sometimes require additional procedures throughout the follow-up period, mainly due to stent graft migration or a loss of seal at the aneurysm. Nevertheless, it is important to note that such procedures are normally carried out via a catheter technique and are therefore less aggressive.
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