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What is Brain Aneurysm?

A brain aneurysm, also known as a cerebral aneurysm, occurs when a bulge forms in a weak part of an artery in or near your brain. The persistent pressure of blood flow pushes the weakened section outward, which creates a blister-like bump. When blood rushes into this bulge, the aneurysm begins stretching even farther. It is the same as how a balloon becomes thinner and there is more chance of it popping up as it fills with air. Brain aneurysms can happen in any area of your brain, but they mostly form in the major arteries at the base of your skull. Around 10% to 30% of people with a brain aneurysm have multiple aneurysms. A large number of brain aneurysms are tiny and don’t lead to symptoms. An aneurysm will cause symptoms when it puts pressure on adjacent brain tissue or nerves. If the aneurysm ruptures (bursts open) or leaks, it results in bleeding in your brain. A ruptured brain aneurysm can be fatal and needs emergency medical treatment.

What are the Types of Brain Aneurysms?

The types of brain aneurysms include:

– Saccular aneurysm

This type of aneurysm seems like a berry hanging from a vine. It’s a round, blood-filled sac protruding from the main artery or one of its branches. It normally develops in arteries at the base of the brain. It’s the most common type of aneurysm.

– Fusiform aneurysm

This type of aneurysm leads to bulging on all sides of the artery.

– Mycotic aneurysm

This type of aneurysm occurs because of an infection. When an infection affects the arteries in the brain, it makes the artery wall weak and results in an aneurysm to form.

What are the Symptoms of Brain Aneurysm?

The symptoms of a brain aneurysm are based on whether it’s unruptured or ruptured.

Symptoms of a ruptured aneurysm include:

– Sudden onset and severe headache

– Nausea

– Vomiting

– Stiff neck

– Double or blurred vision

– Sensitive to light

– Seizures

– A dilated pupil and drooping eyelid

– Pain in eyes

– Confusion

– Weakness

– Numbness

– Loss of consciousness

Symptoms of an unruptured brain aneurysm

Unruptured (intact) brain aneurysms usually don’t cause symptoms but if they become big enough, there might be pressure on nearby nerves or brain tissue because of the bulge, giving rise to the following symptoms:

– Headaches.

– Changes in vision

– Enlarged (dilated) pupil.

– Tingling or numbness on your face or head

– Pain above and behind your eye.

– Seizures

What are the Causes of Brain Aneurysm?

Brain aneurysms occur when the artery walls get thin. Aneurysms usually develop at forks or branches in arteries because these areas of the vessels are weak. Aneurysms mostly form in arteries at the base of the brain but it can occur in any part of the brain.

What are the Risk Factors for Brain Aneurysm?

Many factors contribute to weakness in an artery wall which increases the risk of a brain aneurysm, some of which develop over time. There are some conditions present at birth that can raise the risk of developing a brain aneurysm.

Risk factors of a brain aneurysm include:

– Older age

One can develop brain aneurysms at any age but they’re more common in adults between ages 30 and 60.

– Sex

Brain aneurysms are more common in females than in males.

– Smoking

Smoking increases the risk of brain aneurysms to form and for it to rupture.

High blood pressure

High blood pressure makes the arteries fragile. Aneurysms are more likely to occur and rupture in weakened arteries.

– Drug abuse

Using drugs increases blood pressure. If illicit drugs are taken intravenously, it can cause an infection which can result in a mycotic aneurysm.

– Heavy alcohol use

Drinking alcohol in large amounts increases blood pressure, a risk factor for brain aneurysms.

– Inherited connective tissue disorders

Some diseases such as Ehlers-Danlos syndrome, polycystic kidney disease, a narrow aorta, known as coarctation of the aorta, and brain arteriovenous malformation increase the risk of brain aneurysms.

– A family history of brain aneurysm

Your risk of getting this disease increases if you have family members who already have a brain aneurysm.

Risk factors for a ruptured aneurysm

There are some factors that increase the chance of an aneurysm getting ruptured including:

–  Large aneurysm.

– Developing aneurysms in certain locations.

– Smoking cigarettes.

– Untreated high blood pressure.

What are the Complications of Brain Aneurysms?

Complications that might occur after an aneurysm is ruptured include:

– Re-bleeding

An aneurysm that has previously ruptured or leaked might bleed again. Re-bleeding can lead to further damage to brain cells.

– Narrowed blood vessels in the brain

When a brain aneurysm ruptures, blood vessels in the brain might narrow down or contract, a condition known as vasospasm which can lead to an ischemic stroke, where there’s limited blood flow to brain cells causing additional cell loss and damage.

– Buildup of fluid within the brain

Quite sometimes, a ruptured brain aneurysm forms in the area between the brain and the thin tissues that cover the brain. The blood might block the movement of fluid surrounding the brain and spinal cord. Because of it, an excess of fluid puts pressure on the brain and the tissues might get damaged.

– Change in sodium level

The balance of sodium in the blood might be disrupted because of bleeding in the brain.  A drop in blood sodium levels can cause swelling of brain cells and permanent damage.

How Brain Aneurysms Are Diagnosed?

A large number of people with an unruptured brain aneurysm are not aware that they have this condition which a doctor might detect during an imaging test of the brain, like an MRI or CT scan that people might take for a different medical reason.

If you have symptoms of a brain aneurysm, like a severe headache, you will prescribe tests to examine if a brain aneurysm has ruptured. These tests usually include:

– CT (computed tomography) scan

It’s usually the first imaging test a doctor will recommend to check if there is a leaking of blood into your brain. X-rays and computers are used to create images of a cross-section of your body. A CT angiogram (CTA), might also be used to produce more detailed images of blood flow in your brain’s arteries which shows the location, size, and shape of an unruptured or ruptured aneurysm.

– MRI (magnetic resonance imaging) scan

In this test, a big magnet, computer, and radio waves are used to create detailed images of the brain. Magnetic resonance angiography (MRA) creates detailed images of your brain’s arteries and shows the location, size, and shape of an aneurysm.

– Cerebral angiography

In this procedure, a catheter is inserted into a blood vessel in your wrist or groin which is attached to your brain and it produces accurate images of the arteries in your brain and neck. This imaging test detects the blockages in arteries in your neck or brain along with identifying the weak spots in an artery, such as an aneurysm. This test is used to find out the reason for bleeding in your brain and the exact location, shape, and size of an aneurysm.

– Cerebrospinal fluid (CSF) analysis

This test is used to measure the substances in the fluid surrounding and protecting your spinal cord and brain. Your doctor will collect a CSF sample by carrying out a spinal tap (lumbar puncture). This test helps to detect bleeding near your brain.

What are the Treatment Options Available for Brain Aneurysms?

The main aim of brain aneurysm treatment is to decrease or stop the flow of blood into the aneurysm. A ruptured or leaking brain aneurysm needs emergency surgery. You might or might not require treatment for an unruptured aneurysm based on your situation.

Your doctor will recommend the best surgery option for you depending on your vascular anatomy, location, and aneurysm size along with various other factors.

The treatment options usually include:

– Microvascular clipping for brain aneurysms

In this surgical procedure, a neurosurgeon or a neuroradiologist will cut a small opening in your skull to find the aneurysm and a tiny microscope and instruments are used to attach a tiny metal clip there. It blocks the blood flow into the aneurysm. The surgery helps to stop a brain bleed or for keeping an intact aneurysm to enlarge or break open.

– Endovascular coiling for brain aneurysm

In this procedure, a catheter (a flexible tube) will be inserted into a blood vessel, normally in your groin or wrist, and attached it to your brain. Through the catheter, a neurosurgeon or a neuroradiologist attaches a small coil of soft wire to the aneurysm. It stops blood from entering the aneurysm, using a seal in a similar way to a clip.

– Flow diversion stents for brain aneurysm

Here, a catheter into a blood vessel will be inserted in your wrist or groin and attached to your brain. Via the catheter, a neurosurgeon or a neuroradiologist will place a mesh tube in the area of the blood vessel containing the aneurysm. Your blood flow is diverted away from the aneurysm by the mesh.

– WEB device for brain aneurysm

In this procedure, a catheter into a blood vessel is inserted in your wrist or groin and attached to your brain. Through the catheter, a metal mesh-like cube or sphere is placed into the aneurysm. It does not allow the blood into the aneurysm anymore to stop it from rupturing or enlarging.

Additional treatments for a ruptured brain aneurysm

If you have a ruptured aneurysm, your healthcare team will use additional treatments to manage your symptoms and try to prevent complications. These treatments may include:

– Anti Seizure medications

Medicines are given sometimes to prevent seizures linked to a ruptured aneurysm.

– Calcium channel blockers

These medicines help to decrease your risk of stroke because of vasospasm.

– Shunt

It’s a tube helping drain cerebrospinal fluid (CSF) to flow from your brain to somewhere else in your body and helps to prevent hydrocephalus.

If you have a small unruptured brain aneurysm without any symptoms and risk factors, then no treatment is needed but you need to go for regular imaging tests to monitor it to check any changes or growth over time.

Living with Brain Aneurysms

If you have an unruptured brain aneurysm, then you need to regularly monitor the size of the aneurysm and manage risk factors such as smoking and high blood pressure. If you have a ruptured brain aneurysm, then your doctor will check its severity, place, etc, and start treatment accordingly.

Whom to Consult?

If you develop a sudden, extremely severe headache along with other symptoms of brain aneurysm such as losing consciousness, seizure or know someone with these symptoms, then you shall immediately contact your doctor as a ruptured brain aneurysm might have life-threatening consequences.

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