- A brain aneurysm is a condition that leads to the bulging of a blood vessel in the brain.
- There are no known symptoms of this medical condition, and hence it often goes unnoticed.
- A leak in the brain aneurysm can further lead to rupture of the aneurysm, which would be life-threatening to the individual.
What is Brain Aneurysm?
The term “brain aneurysm” means that there is a bulging weak area in the wall of an artery that basically supplies blood to the brain. This area can also have a ballooned look, and in some cases, it looks like a small berry. Most of the time, there are no known symptoms for a person suffering with this medical condition. In some cases, the symptoms go unnoticed.
There have been rare cases wherein the brain aneurysm ruptures, which then leads to a release of blood in the skull, leading to stroke. The rupturing of the aneurysm is also medically termed as subarachnoid hemorrhage, and this rupture is known to occur in the space that lies in between the brain and the thin tissues. Depending on the severity of the hemorrhage, the result could be life-threatening.
The network of the blood vessels that is located at the base of the brain is the most common location where one can have a brain aneurysm. This network of blood vessels is also known as the circle of Willis.
What causes a Brain Aneurysm?
An individual could inherit the tendency to form brain aneurysms due to the hardening of the arteries and the aging factor. Certain factors that could lead to brain aneurysms can be controlled, whereas a few others cannot be controlled. The ones mentioned below are known to cause an increase in the risk of an individual to develop brain aneurysms. In some other cases, if the person has already had brain aneurysm, then it can lead to an increase in the risk of an aneurysm rupturing.
- Gender: Studies reveal that women are more likely to develop a brain aneurysm or to have an aneurysm rupture, known as subarachnoid hemorrhage.
- Smoking: An increase in the intake of cigarettes can also lead to the development of a brain aneurysm or a rupture.
- Family medical history: Those patients who have a family medical background of brain aneurysms can also be at a higher risk of similar incidence compared to those who do not have such a family medical background.
- High blood pressure: It is also a cause for concern in those individuals who have high blood pressure or have a previous medical history of high blood pressure.
- Race/ethnicity: In a few cases, it has been observed that those individuals who belong to the African American race are at a higher risk of developing this medical condition.
- Previous history of aneurysm: If an individual had this medical condition in the past, it is also likely to have another case of brain aneurysm in the future.
What are the Symptoms of Brain Aneurysm?
As mentioned previously, an individual suffering from a brain aneurysm would not show any symptoms of the same, or the symptoms may go unnoticed. The same can only be discovered with the help of medical tests for another unrelated condition. If there is a ruptured aneurysm, then the same can be identified by pressing on the areas in the brain. In such cases, people would complain of severe headaches, sudden changes in speech, vision issues or blurry vision, and/or pain in the neck. The symptoms are ideally based on which part of the brain has been affected and the severity of the condition. When an individual has a ruptured brain aneurysm, it would come on all of a sudden. One should inform the doctor immediately if they have the below-mentioned symptoms or notice the same in someone else:
- A headache that is severe and is quite different than the usual
- Fainting or dizziness
- Seizure attacks
- Loss of consciousness
- Stiffness or pain in the neck
- Light sensitivity
- Eyelid drooping
In a few individuals, there can be an instance of a leaking brain aneurysm. This would lead to leakage of a slight amount of blood. This is also called a sentinel bleed and can often cause only one symptom, which is a sudden and severe headache. Post the sentinel bleed or leaking, there are chances of a severe rupture.
As previously said, un-ruptured aneurysms do not show any symptoms; however, a large number of them may press against the brain tissues and nerves, thus leading to a few signs, such as:
- Drooping of the eyelid
- Double vision or blurry vision
- Sudden changes in the vision that seemed quite normal before
- Dilated pupil
- Weakness or numbness, and in some cases paralysis of the face, which ultimately results in difficulty speaking
- Pain that arises behind and above the eye
What is the diagnosis of Brain Aneurysm?
Since a brain aneurysm does not show any symptoms until people go for diagnosis for a different medical condition, if the doctor believes that there is a brain aneurysm, then they may suggest the following tests:
Computed tomography scan (CT scan): With the help of a CT scan, the doctor would be able to identify the existence of any bleeding in the brain. If the doctor suspects a ruptured aneurysm, then he can use a lumbar puncture.
Computed tomography angiogram scan (CTA scan): The CTA scan is one of the most precise methods for evaluating the blood vessels, rather than using the standard CT scan. In the CTA scan, CT scanning is used along with contrast material (dye) that is injected into the blood. This then produces the images of the blood vessels.
Magnetic resonance angiography (MRA): With the similar process of CTA, the MRA also uses a magnetic field, along with the pulses of the radio wave energy so as to provide the pictures of the blood vessels that are inside the body. A dye is often used while carrying out an MRA so that the blood vessels can be seen more clearly for a better diagnosis.
Cerebral angiogram: While carrying out a cerebral angiogram, the doctor would insert a catheter through the blood vessel in the groin or arm. This is then moved upwards through the vessel in the brain. After this process, a dye is injected into the cerebral artery. In case there are any problems in the artery, which would also include the aneurysm, then it would clearly show up on the X-ray with the help of the dye. This test is known to carry a lot of risks compared to the other tests, but it is a much better way to locate even the smallest aneurysm in the brain, which may be smaller than five mm in size.
How to Treat a Brain Aneurysm
Before deciding the best course of treatment, there are several things that a doctor would go through with the patient. The multiple things that would decide the type of treatment to be received are the age of the individual, the size of the brain aneurysm, the current overall health of the individual, any past major medical history, family history, and any other additional risk factors.
When it comes to the risk of a small aneurysm (which can be less than 10mm), the chances of the aneurysm rupturing are often very low, and surgery in such cases is also very risky. In such instances, the doctor would rather suggest to not go for the surgery immediately and would wait and observe the condition. There are certain ways to ensure the blood vessels are kept as healthy as possible to avoid extra stress on the vessels.
In such cases, one would need to manage the blood pressure and keep it normal. Also, the patient should not smoke. Surgery would only be suggested by the doctor if the brain aneurysm is large or causing extensive pain, or if there are any other symptoms. Surgery can also be suggested if the patient had a previous instance of a ruptured brain aneurysm.
The doctors can take in either of the below routes for treating the ruptured, as well as the un-ruptured, brain aneurysms:
Surgical clipping - This procedure usually involves placing of a small metal clip around the base of the brain aneurysm. The purpose of doing so is to isolate it from the normal blood circulation. This would then decrease the pressure that would fall on the aneurysm and also prevent the instance of rupturing. Whether to perform this surgery or not would clearly depend on the various factors concerning the aneurysm and patient, such as overall health of the patient, the size, and the location of the aneurysm.
Endovascular embolization - In case the embolization has to be performed, then a small tube is inserted into the artery that has been affected due to aneurysm. When coil embolization is concerned, there would be soft metal coils that are moved through the tube into the aneurysm. It fills up the aneurysm, making it less likely to rupture. For mesh embolization, a mesh is placed in the aneurysm. This leads to a reduction in the flow of blood to the aneurysm, making it less likely to rupture. All of these various types of embolization are less intrusive than surgery, but they also involve their own risks, which also includes rupturing of the aneurysm.
These procedures should be carried out only in the hospital, similar to other procedures which are also taken care in the hospitals.
In some of the instances, there is bulging of the aneurysm in such a way that they would need to be cut off, and those ends of the blood vessels have to be stitched together. However, this occurrence is quite rare. To carry out this procedure, sometimes the artery is not long enough for both the ends to be stitched together, and in such cases, a piece of the other artery is taken for stitching the ends.
If the aneurysm bleeds, then it is a serious matter, and it often leads to death or a lifetime disability. In such instances, the main aim of the healthcare provider and its staff would be to relieve the pressure on the brain, as well as maintain normal breathing and other vital functions, such as maintaining the blood pressure to normal and also to avoid bleeding instances.
Risk factors of brain aneurysm
There are a number of risk factors that are known to contribute to the weakening of the artery wall, thus leading to an increase in the risk of brain aneurysm. Such a medical condition is mostly found in adults rather than in children and more so in women than in men. Below are few of the risk factors that could develop over time and lead to an instance of brain aneurysm.
- Injury in the head
- Certain types of blood infections
- Hypertension or high blood pressure
- Dip in the estrogen levels due to menopause or any other hormonal changes
- Alcohol consumption
- Use of cocaine or any other drug abuse
- Arteriosclerosis (hardening of the arteries)
Below are the risk factors that can be present at birth:
Abnormally narrow aorta – This means that there is a conarctation of the aorta. This is the large blood vessel that delivers blood rich in oxygen from the heart to the body.
Inherited connective tissue disorders – One such syndrome of inherited connective tissue disorder is called Ehlers Danlos Syndrome, which often tends to weaken the blood vessels.
Family medical history concerning brain aneurysm – This is a common concern when someone is affected with this medical condition. It is often related to either the parents or siblings.
Polycystic kidney disease – This is an inherited disorder that often results in sacs filled with fluid. These sacs are present in the kidneys and tend to increase blood pressure.
Cerebral arteriovenous malfunction – Due to an abnormal connection between the veins and arteries that is present in the brain, it tends to interrupt the normal flow of blood between them.
Complications of Brain Aneurysm
Brain aneurysm can create severe complications if it is not detected in a timely fashion. When there is a rupture in the aneurysm, the bleeding caused by this rupture would only last for few seconds; however, it would cause direct damage to the surrounding cells and tends to kill those cells. Apart from this damage, the blood enters the skull and can put pressure inside the skull. If the pressure becomes too elevated, then it can lead to disruption in the supply of blood and oxygen to the brain. It can lead to such a point that the person may face loss of consciousness or, in severe cases, it can lead to death of the person instantly.
Below are few complications that could develop due to the rupture:
Hydrocephalus – When there is a rupture in the brain that results in bleeding in the space between the brain and its surrounding tissues, which is the most common case, this blood can then lead to blockage of circulation of the fluid that is surrounding the spinal cord and the brain. This condition can further lead to damage in the tissues, since there is an excess of cerebrospinal fluid that can increase the pressure on the brain, leading to further damage.
Re-bleeding – If there is an aneurysm that has leaked or ruptured, then it can also cause re-bleeding. This can further lead to damage of brain cells.
Vasospasm – The blood vessels that are present in the brain can tend to narrow erratically after the rupture. This medical condition can lead to limited flow of blood to the brain cells and lead to additional cell loss and damage.