Brain Aneurysm

A brain aneurysm is an abnormal outward balloon-like widening of a section of an artery or a vein in the brain. This bulging structure with a neck is also known as intracerebral aneurysm and intracranial aneurysm.

Aneurysms commonly occur in the weak areas in an artery or vein wall in the anterior region of the Circle of Willis; this is the important network loop of arteries at the base of the brain that connects with all parts of the brain and provides them with blood and nutrition. The areas most likely to develop weak spots are at the junctions of arteries and veins.

• Head injury
• High blood pressure
• High cholesterol
• Atherosclerosis
• Artery wall damage due to abnormal blood flow

• Infection of the arterial wall - mycotic aneurysms
• Congenital malformation of blood vessels
• Diseases of the vascular system
• Tumors of the head and neck
• Medical conditions like Polycystic kidney disease, Ehlers-Danlos syndrome, and Marfan syndrome
• Cigarette smoking
• Drug abuse
• Binge drinking
• Using oral contraceptives

• Small aneurysms - less than 11mm to 15mm in diameter
• Large aneurysms - 15 to 25 mm in diameter
• Giant aneurysms - 25 to 50 mm in diameter
• Super Giant aneurysms - over 50 mm in diameter

• Berry aneurysm or saccular aneurysm - aneurysm having a round saccular or berry-like pouch or a blood sac attached to an artery or vein with a narrow stem or neck. This is the most common type of aneurysm, found on Circle of Willis at the base of the brain. It can occur at any age, but is common in adults than children, and more frequently seen in women.

• Lateral aneurysm - Grows as a bulge on one wall of the artery or vein.
• Fusiform aneurysm - Formed by the widening along all walls of the vessel.

• A berry aneurysm is particularly dangerous, because it is found on one of the main arteries that supply blood to the brain. It is easily susceptible to rupture, and rupturing can lead to fatal bleeding within the brain.

• The bulging pouch-like structure puts pressure on a nerve or surrounding brain tissue.
• The artery or vein wall can weaken further, and cause the aneurysm to rupture or leak, and cause blood hemorrhage in the brain or in the subarachnoid space surrounding the brain. This is known as subarachnoid hemorrhage.

• Subarachnoid hemorrhage, depending on the severity, can cause hemorrhagic stroke, brain damage, or death.
• The larger the aneurysm, the greater the risk of rupturing.
• Some aneurysms, if very small, do not rupture or cause other problems, or produce any symptoms.
• Risks associated with this condition depend on size and location, and on your age and health.

Small aneurysm - generally will have no symptoms.
Large aneurysm - no symptoms until very large. Pressure on surrounding brain tissue can produce headaches.

Before rupturing, the person will experience -

• Unbearably severe headaches
• Change in mental state
• Nausea
• Increased sensitivity to light
• Pain above and behind the eye
• Drooping of an eyelid
• Dilated pupils

• Double vision
• Numbness
• Weakness
• Paralysis on one side of the face
• Vomiting
• Stiff neck
• Dizziness
• Seizures
• Loss of consciousness

If you experience these symptoms or notice them in anyone, contact a health professional immediately.

• Computed tomography (CT)
• Computed tomography angiogram (CTA)
• Lumbar puncture (LP, or spinal tap)
• Angiography
• Magnetic resonance imaging (MRI)

• Extent and location of aneurysm
• Neurological condition
• Person's age
• General health

• Restoring deteriorating respiration
• Reducing Intracranial Pressure
• Stopping the bleeding
• Preventing any permanent brain damage
• Reducing risk of recurrence

• Person can die from initial bleeding.
• Person can die of later complications.
• Person can recover with little or no neurological deficit.

If very small, likelihood of rupturing of the aneurysm is low, and hence, surgery is not recommended. Condition is observed and treated with medications.
If large, possibility of rupturing is high, and doctors may suggest a surgery.

• Microvascular Clipping - Blood supply to the aneurysm is cut off with a metal clip to the base

• Endovascular Coiling - A catheter is inserted into the groin through the femoral artery, and passed into the aneurysm by way of the aorta and brain arteries. Through the catheter, platinum coils are released into the aneurysm to cause clotting, and thereby eliminating the aneurysm

• Shunt Surgery - This is done in case of development of hydrocephalus to drain away the excess cerebrospinal fluid from the brain.

• Give up smoking
• Don't use stimulant drugs
• Don't drink too much alcohol
• Reduce caffeine intake
• Don't over-strain your body
• Don't take aspirin, medicines for cold and cough, or any other medications unless prescribed by your doctor
• Control your blood pressure
• Check with your doctor about oral contraceptives
• Go for a regular physical examination