An aneurysm is an abnormal swelling or bulge in the wall of a blood vessel, such as an artery. It begins as a weak spot in the blood vessel wall, which balloons out of shape over time by the force of the pumping blood. Usually, aneurysms develop at the point where a blood vessel branches, because the ‘fork’ is structurally more vulnerable.
Aneurysms can occur anywhere throughout the circulatory system, but most commonly develop along the aorta (the body’s main artery that runs the length of the trunk from the heart) and in blood vessels of the brain. Aneurysms are potentially fatal if they rupture. Death can occur within minutes.
Types of aneurysms include:
– Saccular – (most common, also called “berry”) the aneurysm bulges from one side of the artery and has a distinct neck at its base.
– Fusiform – the aneurysm bulges in all directions and has no distinct neck.
– Giant – may be saccular or fusiform and measures more than 2.5 cm in diameter; the neck is often wide and may involve more than one artery.
– Traumatic – caused by a closed head injury or penetrating trauma to the brain.
Symptoms of an aneurysm
An aneurysm may have no symptoms (asymptomatic) until it is either very large or it ruptures. Symptoms depend on which blood vessel is affected.
If you experience the symptoms of a SAH, call 911 immediately!
– stiff neck
– sensitivity to light (photophobia)
– blurred or double vision
– loss of consciousness
– sudden onset of a severe headache (often described as “the worst headache of my life”)
– nausea and vomiting
What are the causes?
Some events encourage the development or rupture of an aneurysm in the brain. A study in the American Heart Association’s journal Stroke concluded that the following factors may trigger the rupture of an existing aneurysm:
– excessive exercise
– coffee or soda consumption
– straining during bowel movements
– intense anger
– sexual intercourse
Some aneurysms develop over the course of a person’s lifetime, some are inherited, and some result from brain injuries.
Who’s at risk for a brain aneurysm?
Brain aneurysms can affect anyone, but people with atherosclerosis (hardening of the arteries) are at high risk of forming brain aneurysms.
The Brain Aneurysm Foundation also states that brain aneurysms are most common in people between 35 and 60 years old. Women are more likely to get aneurysms than men due to low estrogen levels after menopause. If aneurysms run in your immediate family, your risk of having one is higher.
How is a brain aneurysm diagnosed?
Unless an aneurysm ruptures, it may be difficult to diagnose the condition. Doctors can use certain tests to locate aneurysms in people who have family histories of the condition, risk factors, and inherited, aneurysm-related health issues.
CT and MRI scans take pictures of the brain tissues and arteries. CT scans take several X-rays and then provide a 3-D image of your brain on a computer. MRI scans work by scanning your brain with radio waves and magnetic fields and creating images.
CT scans are better at revealing bleeding that may already be present. A spinal tap, where a doctor draws fluid from the spine, can check for signs of bleeding in the brain. Cerebral angiograms can also check for bleeding and any abnormalities in the brain arteries.
Treatment for an aneurysm
Treatment for an aneurysm depends on its location and severity, but may include:
– Cerebral aneurysm – is repaired either by coils or stent insertion, or by surgery where the aneurysm has been clipped. If the aneurysm has ruptured, then you will need to stay in hospital for up to 21 days because of potential complications, including vasospasm and hydrocephalus. Around one third of all people who experience a ruptured cerebral aneurysm die, and less than 30 per cent get back to a pre-rupture state.
– Thoracic aortic aneurysm – requires drugs to control high blood pressure and surgery to repair the aneurysm if necessary. Sometimes, the nearby heart valve may also need fixing during the operation. Most people with a ruptured thoracic aortic aneurysm die within minutes.
– Abdominal aortic aneurysm – requires drugs to control high blood pressure and surgery to repair the aneurysm if necessary. The mortality rate is more than 50 per cent if the aneurysm ruptures.
Surgical repair of aneurysms
If the aortic aneurysm is less than five cm wide, it is usually left untreated, but closely monitored (in case it gets bigger). If it is larger than five cm, the aneurysm is surgically repaired. In most cases, the aneurysm is cut out and the hole is plugged with an artificial graft.
Depending on the location of the cerebral aneurysm, it will be treated either surgically with clipping, or by using fine platinum coils inserted in the aneurysm via an angiogram, which is a radiological procedure used, in this case, to close the aneurysm and preserve the normal flow of blood in the brain.
Treatment of a ruptured cerebral aneurysm is an urgent procedure, but treatment of an unruptured aneurysm can be performed semi-electively.
Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care.
Recovery and prevention
The possibility of having a second bleed is 35% within the first 14 days after the first bleed. This is why neurosurgeons prefer to do direct surgical or endovascular treatment as soon as the aneurysm is diagnosed, so that the risk of a rebleed is lessened.
A common complication of SAH is vasospasm, which is a narrowing (spasm) of an artery that may occur 5 to 10 days following a SAH.
In the ICU you will be monitored every hour or so for signs of vasospasm which include arm or leg weakness, confusion, sleepiness, or restlessness.
Aneurysm patients may suffer short-term and/or long-term deficits as a result of a rupture or treatment. Some of these deficits may disappear over time with healing and therapy.
The recovery process is long and may take months or years to understand the deficits you incurred and regain function.