What is a Brain Aneurysm?
A brain aneurysm is an abnormal bulge in the wall of an artery in the brain. They occur at areas of thinning and weakness in the artery wall. They most frequently occur at forks in arteries at the base of the brain. They can also be called berry aneurysms because they frequently appear as the shape and size of a small berry. Most brain aneurysms produce no symptoms until they enlarge, start to leak blood, or burst. Should they burst they are a medical emergency and you should call 911 for transportation to the hospital. Fortunately, most brain aneurysms do not rupture and are detected from other tests for other conditions.
Unruptured brain aneurysms tend to have few or no symptoms. If they expand and press on nerves then they may have symptoms related to those nerves. These can include droopy eyelids, headaches, a dilated pupil, blurred vision or weakness.
Ruptured brain aneurysms are a life threatening medical emergency and you should call 911 for immediate medical care and transportation to the hospital. These will cause a subarachnoid hemorrhage which is bleeding into the space around the brain. Since the brain is in an enclosed space, the pressure inside of the head increases. Patients often describe this as “the worst headache of my life.” It can also cause confusion, loss of consciousness, a stiff neck, weakness, numbness, seizures, light sensitivity, nausea and vomiting.
A leaking brain aneurysm may allow a small amount of blood to escape called a “sentinel bleed”. This can also cause “the worst headache of my life” and symptoms in common with a rupture. In addition, rupture of the aneurysm can also follow this sentinel leak.
The causes of brain aneurysm are unknown. Risk factors may be present at birth or develop over time. Progressive risk factors include aging, tobacco use, high blood pressure, heavy alcohol or drug abuse. Head trauma or certain infections can also lead to aneurysms.
Conditions present at birth include connective tissue disorders, polycystic kidney disease, and cerebral arteriovenous malformations. In addition, having a family history of a brain aneurysm with a first degree relative can increase your risk.
Most brain aneurysms are detected with testing for other conditions like headaches. Diagnosis may be suggested by a combination of a patient’s history and symptoms. MRI (Magnetic Resonance Imaging) and MRI (Magnetic Resonance Angiogram) are usually the test of choice to detect unruptured brain aneurysms. These scans use strong magnetic fields and produce detailed soft tissue images of the brain.
Emergency surgery is required for a leaking or ruptured brain aneurysm. For unruptured aneurysms the size, location and symptoms will help determine the likelihood of future rupture. In addition, the potential of injury from repair of a brain aneurysm needs to be considered in relation to the symptoms and chance of rupture.
Should a brain aneurysm be discovered on an unrelated imaging test, and you do not have related symptoms or risk factor, your doctor may recommend watchful waiting with regular imaging tests to ensure that the aneurysm does not grow over time. It is also important to stop smoking and to have blood pressure well controlled. Should you develop symptoms it is important to get help immediately.
Surgery and/or endovascular treatment are the procedures to treat ruptured or unruptured brain aneurysms.
Open surgical (microvascular) clipping
A small opening in your skull or skull base to provide access to the brain aneurysm. Microinstruments are used attach metal clips to seal of the base of the aneurysm. This stops blood from flowing into the aneurysm and will stop brain bleed or prevent future aneurysm rupture. Recovery time may be a few weeks for unruptured aneurysms with longer times of up to a few months for ruptured aneurysms. Aneurysm surgery is considered curative although aneurysms may recur.
Endovascular therapy which includes coil embolization, stenting, balloon remodeling, flow diversion, or an intraluminal “Web” device.
Sometimes it is possible to treat a brain aneurysm through a catheter in the arm or groin. The catheter is threaded through the vessel to the area of the aneurysm. Using balloons or stents, wires are used to coil inside of the aneurysm. An intraluminal Web device is a mesh ball that can also be placed in the aneurysm. Both techniques form blood clot formation to block blood flow into the aneurysm.
Flow diversion uses a similar catheter to place a mesh tube in the part of the blood vessel that contains the aneurysm. The tube acts as a stent to bypasses the aneurysm.
The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of brain aneurysms. Our neurosurgeons can provide the optimal treatment. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number). Should you have sudden onset of symptoms, like the ones listed above, call 911 and seek immediate medical care.