What is a Brain Aneurysm?

A brain aneurysm is a focal bulging of the wall of an artery that supplies blood to the brain. While most brain aneurysms remain silent, a few burst leading to bleed within the brain. The bleed may be so devastating that almost half of the people die and do not reach the hospital. Since most of the aneurysms rupture in the fourth through sixth decades of life, significant part of productive life is lost due to long term disability and death. Hence it is important for the people to know about the symptoms of brain aneurysms and possible treatment options. It is also important for general practitioners to be aware so that they can refer their patients to treatment centers that are capable of managing brain aneurysms.

What causes Brain aneurysms?

In most of the people, aneurysms are acquired. This means, that most people with brain aneurysms are not born with these and during their life time, the aneurysms form. High blood pressure, smoking, excessive alcohol intake are some of the risk factors that predispose an individual to aneurysm formation. Women are more likely to develop aneurysms than men and African-Americans and Finnish are more likely to have an aneurysmal rupture than people belonging to other races. An individual with a strong family history (at least 2 close relatives with brain aneurysms) also is a risk factor. Rare hereditary conditions such as polycystic kidney disease are associated with brain aneurysms.

What are the symptoms?

Most aneurysms do not cause any symptoms. They are discovered incidentally during MRI or CT imaging for an unrelated cause. However, aneurysms can cause symptoms when they burst or occasionally, when they become big in size and press upon the surrounding brain structures. The most common symptoms of aneurysm rupture are

• Sudden Severe Headache
• Neck Pain
• Nausea & Vomiting
• Loss of Consciousness
• Intolerance to Light
• Seizures (fits)

Tother symptoms may include blurred vision, double vision and changes in speech

How are aneurysms diagnosed?

There are several tests that the doctor may do to diagnose brain aneurysm rupture. CT scan, MRI, lumbar puncture (in which a needle is inserted in the spinal canal in the back and spinal fluid is drawn to look for blood products) and cerebral angiography. A cerebral angiogram is a test where a catheter is inserted through an artery in the groin and advanced all the way up to the neck. Dye is injected through the catheter and X-ray pictures taken.

How are aneurysms treated?

There are two ways in which aneurysms are treated. First, "Clipping", in which the aneurysm is closed from outside with a metal clip through open surgery. Second, "Coiling" in which thin metal threads called 'coils' are inserted in the aneurysm using a catheter in the same way as an angiogram is done. Both these treatment options are complimentary to one another and, depending upon the characteristics, the aneurysm may be suitable for clipping or coiling. If the aneurysm is very small and not ruptured, your neurosurgeon may also recommend observation depending upon the risk of rupture