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| Brain aneurysm by Pharmacytimess |
Overview
A brain aneurysm (AN-yoo-riz-um) — also known
as a cerebral aneurysm or intracranial aneurysm — is a bulge or ballooning in a
blood vessel in the brain. An aneurysm often looks like a berry hanging on a
stem.
Experts think brain aneurysms form and grow
because blood flowing through the blood vessel puts pressure on a weak area of
the vessel wall. This can increase the size of the brain aneurysm. If the brain
aneurysm leaks or ruptures, it causes bleeding in the brain, known as a
hemorrhagic stroke.
Most often, a ruptured brain aneurysm occurs
in the space between the brain and the thin tissues covering the brain. This
type of hemorrhagic stroke is called a subarachnoid hemorrhage.
Brain aneurysms are common. But most brain
aneurysms aren't serious, especially if they're small. Most brain aneurysms
don't rupture. They usually don't cause symptoms or cause health problems. In
many cases, brain aneurysms are found during tests for other conditions.
However, a ruptured aneurysm quickly becomes
life-threatening and requires medical treatment right away.
If a brain aneurysm hasn't ruptured, treatment
may be appropriate in some cases. Treatment of an unruptured brain aneurysm may
prevent a rupture in the future. Talk with your health care provider to make
sure you understand the best options for your specific needs.
Types
·
Saccular
aneurysm, also known as a berry aneurysm. This type of aneurysm looks like a berry hanging from a
vine. It's a round, blood-filled sac that protrudes from the main artery or one
of its branches. It usually forms on arteries at the base of the brain. A berry
aneurysm is the most common type of aneurysm.
·
Fusiform
aneurysm. This type of
aneurysm causes bulging on all sides of the artery.
·
Mycotic
aneurysm. This type of
aneurysm is caused by an infection. When an infection affects the arteries in
the brain, it can weaken the artery wall. This can cause an aneurysm to form.
Symptoms
Most brain aneurysms that haven't ruptured
don't cause symptoms. This is especially true if they're small. Brain aneurysms
may be found during imaging tests that are done for other conditions.
However, a ruptured aneurysm is a very serious
condition, typically causing a severe headache. And if an unruptured aneurysm
presses against brain tissue or nerves, it may cause pain and other symptoms.
Ruptured aneurysm
A sudden, severe headache is the key symptom
of a ruptured aneurysm. This headache is often described by people as the worst
headache they've ever experienced.
In addition to a severe headache, symptoms of
a ruptured aneurysm can include:
·
Nausea and vomiting
·
Stiff neck
·
Blurred or double
vision
·
Sensitivity to light
·
Seizure
·
A drooping eyelid
·
Loss of consciousness
·
Confusion
'Leaking' aneurysm
In some cases, an aneurysm may leak a slight
amount of blood. When this happens, a more severe rupture often follows. Leaks
may happen days or weeks before a rupture.
Leaking brain aneurysm symptoms may include:
·
A sudden, extremely
severe headache that may last several days and up to two weeks.
Unruptured aneurysm
An unruptured brain aneurysm may not have any
symptoms, especially if it's small. However, a larger unruptured aneurysm may
press on brain tissues and nerves.
Symptoms of an unruptured brain aneurysm may
include:
·
Pain above and behind
one eye.
·
A dilated pupil.
·
A change in vision or
double vision.
·
Numbness of one side
of the face.
When to see a doctor
Seek immediate medical attention if you develop a:
·
Sudden, extremely
severe headache
If you're with someone who complains of a
sudden, severe headache or who loses consciousness or has a seizure, call 911
or your local emergency number.
Causes
Brain aneurysms are caused by thinning artery
walls. Aneurysms often form at forks or branches in arteries because those
areas of the vessels are weaker. Although aneurysms can appear anywhere in the
brain, they're most common in arteries at the base of the brain.
Risk factors
Several factors can contribute to weakness in
an artery wall. These factors may increase the risk of a brain aneurysm or aneurysm
rupture.
Some of these risk factors develop over time.
But some conditions present at birth can increase the risk of developing a
brain aneurysm.
Risk factors include:
·
Older
age. Brain aneurysms
can occur at any age. However, they're more common in adults between ages 30
and 60.
·
Being
female. Brain aneurysms
are more common in women than in men.
·
Cigarette
smoking. Smoking is a
risk factor for brain aneurysms to form and for brain aneurysms to rupture.
·
High
blood pressure. This condition can
weaken arteries. Aneurysms are more likely to form and to rupture in weakened
arteries.
·
Drug
use, particularly using cocaine. Drug use raises blood pressure. If illicit drugs are used
intravenously, it can lead to an infection. An infection can cause a mycotic
aneurysm.
·
Heavy
alcohol use. This also can
increase blood pressure.
·
Inherited
connective tissue disorders, such as Ehlers-Danlos syndrome. These disorders weaken
blood vessels.
·
Polycystic
kidney disease. This inherited
disorder results in fluid-filled sacs in the kidneys. It also may increase
blood pressure.
·
A
narrow aorta, known as coarctation of the aorta. The aorta is the large blood vessel that
delivers oxygen-rich blood from the heart to the body.
·
Brain
arteriovenous malformation, known as AVM. In this condition, arteries and veins in the brain are
tangled. This affects blood flow.
·
A
family history of brain aneurysm. Your risk is higher if you have family members who have
had a brain aneurysm. This is particularly true if two or more first-degree
relatives — such as a parent, brother, sister or child — has had a brain
aneurysm. If you have a family history, you can ask your health care provider
about getting screened for a brain aneurysm.
Some types of aneurysms may occur after a head
injury or from certain blood infections.
Risk factors for a
ruptured aneurysm
There are some factors that make it more
likely an aneurysm will rupture. They include:
·
Having a large
aneurysm.
·
Having aneurysms in
certain locations.
·
Smoking cigarettes.
·
Having untreated high
blood pressure.
Complications
When a brain aneurysm ruptures, the bleeding
usually lasts only a few seconds. However, the blood can cause direct damage to
surrounding cells and can kill brain cells. It also increases pressure inside
the skull.
If the pressure becomes too high, it may
disrupt the blood and oxygen supply to the brain. Loss of consciousness or even
death may occur.
Complications that can develop after the
rupture of an aneurysm include:
·
Re-bleeding. An aneurysm that has ruptured or has
leaked is at risk of bleeding again. Re-bleeding can cause further damage to
brain cells.
·
Narrowed
blood vessels in the brain. After
a brain aneurysm ruptures, blood vessels in the brain may contract and narrow.
This is known as vasospasm. Vasospasm can cause an ischemic stroke, in which
there's limited blood flow to brain cells. This may cause additional cell
damage and loss.
·
A
buildup of fluid within the brain, known as hydrocephalus. Most often, a ruptured brain aneurysm
occurs in the space between the brain and the thin tissues covering the brain.
The blood can block the movement of fluid that surrounds the brain and spinal
cord. As a result, an excess of fluid puts pressure on the brain and can damage
tissues.
·
Change
in sodium level. Bleeding in the
brain can disrupt the balance of sodium in the blood. This may occur from
damage to the hypothalamus, an area near the base of the brain. A drop in blood
sodium levels can lead to swelling of brain cells and permanent damage.
Prevention
In many cases, brain aneurysms can't be
prevented. But there are some changes you can make to lower your risk. They
include quitting smoking if you smoke. Also work with your health care provider
to lower your blood pressure if it's high. Don't drink large amounts of alcohol
or use drugs such as cocaine.
Diagnosis
A sudden, severe
headache or other symptoms that could be related to a ruptured aneurysm require
testing. Tests can determine whether you've had bleeding into the space between
your brain and surrounding tissues. This type of bleeding is known as
subarachnoid hemorrhage. The tests also can determine if you've had another
type of stroke.
You also may be
given tests if you show symptoms of an unruptured brain aneurysm. These
symptoms may include pain behind the eye, changes in vision or double vision.
Screening tests and
procedures used to diagnose and detect brain aneurysms include:
·
CT scan. This specialized X-ray is usually the first test used to
detect bleeding in the brain or another type of stroke. The test produces
images that are 2D slices of the brain.
A CT angiogram
can create more-detailed images of the arteries providing blood flow in the
brain. The test involves injecting dye that makes it easier to observe blood
flow. It also can detect the presence of an aneurysm.
·
Lumbar puncture, known as a spinal tap. If you've had
a subarachnoid hemorrhage, there will most likely be red blood cells in the
fluid surrounding your brain and spine. This fluid is called cerebrospinal
fluid. If you have symptoms of a ruptured aneurysm but a CT scan
doesn't show evidence of bleeding, a test of your cerebrospinal fluid can help
make a diagnosis.
The procedure to
draw cerebrospinal fluid from your back with a needle is called a lumbar
puncture.
·
MRI. This imaging test uses a magnetic field and radio waves to
create detailed images of the brain, either 2D images or 3D images. The images
can show if there's bleeding in the brain.
A type
of MRI that captures images of the arteries in detail is called MR
angiography. This type of MRI can detect the size, shape and location
of an unruptured aneurysm.
·
Cerebral angiogram. During this procedure, a thin,
flexible tube called a catheter is used. The catheter is inserted into a large
artery, usually in the groin or the wrist. The catheter threads past your heart
to the arteries in your brain. A special dye injected into the catheter travels
to arteries throughout your brain.
A series of X-rays
can then reveal details about the conditions of your arteries and detect an
aneurysm. A cerebral angiogram — also called a cerebral arteriogram — is
usually used when other diagnostic tests don't provide enough information.
Screening for brain aneurysms
The use of imaging
tests to screen for unruptured brain aneurysms is generally not recommended
unless you're at high risk. Talk to your health care provider about the
potential benefit of a screening test if you have:
·
A family history of brain aneurysms. Particularly if two
first-degree relatives — your parents, siblings or children — have had brain
aneurysms.
·
A disorder that increases your risk of developing a brain
aneurysm. These disorders include polycystic kidney disease, coarctation of the
aorta or Ehlers-Danlos syndrome, among others.
Most aneurysms don't
rupture. And for many people, an unruptured aneurysm never causes symptoms. But
if the aneurysm ruptures, several factors may affect the outcome, which is
known as the prognosis. They include:
·
The person's age and health.
·
Whether the person has other conditions.
·
The size and location of the aneurysm.
·
How much bleeding occurred.
·
How much time passed before receiving medical care.
About 25% of people
who experience a ruptured aneurysm die within 24 hours. Another 25% have
complications that lead to death within six months.
Treatment
Repairing a ruptured
aneurysm requires surgery or endovascular treatment. Endovascular treatment
means an aneurysm is treated from inside the artery. You also may be given
treatments to relieve symptoms. If you have an unruptured aneurysm, talk with
your health care provider about possible treatments. Discuss whether the risk
of leaving the aneurysm alone is greater than the risk of treating the
aneurysm.
Surgery
There are two common
treatment options for repairing a ruptured brain aneurysm. In some cases, these
procedures may be considered to treat an unruptured aneurysm. However, the
known risks may outweigh the potential benefits for people with some unruptured
aneurysms.
Surgical
clipping
Surgical clipping is
a procedure to close off an aneurysm. The neurosurgeon removes a section of
your skull to access the aneurysm. The neurosurgeon then locates the blood
vessel that feeds the aneurysm. The surgeon places a tiny metal clip on the
neck of the aneurysm to stop blood flow into it.
Surgical clipping
can be very effective. Typically, aneurysms that are clipped don't return. The
risks of surgical clipping include bleeding in the brain or loss of blood flow
to the brain. These risks are low.
Recovery from
surgical clipping usually takes about 4 to 6 weeks. When surgical clipping is
done for an unruptured aneurysm, many people can leave the hospital a day or
two after surgery. For those who undergo surgical clipping because of a
ruptured aneurysm, the hospital stay is typically much longer as they recover
from the aneurysm rupture.
Endovascular
treatment
This is a less
invasive procedure than surgical clipping, and it may be safer. Endovascular
treatment involves accessing the aneurysm by threading a small plastic tube
called a catheter through the artery. The catheter is advanced into the brain
arteries. Then coils or stents may be placed.
·
Endovascular coils. During this procedure, a
neurosurgeon inserts the catheter into an artery, usually in the wrist or
groin. Then the surgeon threads it through the body to the aneurysm. A coil shaped
like a spiral is placed inside the aneurysm. This prevents blood from flowing
into the aneurysm. The coil also causes the blood that's in the aneurysm to
clot. This destroys the aneurysm.
·
Endovascular stents. A stent is a small tube that may
be used with an endovascular coil for some types of brain aneurysms. A stent
can hold the coil in place.
Other endovascular
methods may be used depending on the location and size of the aneurysm.
Like surgical
clipping, endovascular treatment carries the risk of bleeding in the brain or
loss of blood flow to the brain. Also there's a risk that the aneurysm may
again appear over time. If that happens, the procedure needs to be repeated.
You'll likely need follow-up imaging tests to be sure the aneurysm hasn't
returned.
Flow diversion
Flow diversion is a
newer endovascular treatment option for treatment of a brain aneurysm. The
procedure involves placing a stent in the blood vessel to divert blood flow
away from the aneurysm. The stent that's placed is called a flow diverter.
With less blood flow
going to the aneurysm, there's less risk of rupture. It also allows the body to
heal. The stent prompts the body to grow new cells that seal the aneurysm.
Flow diversion may
be particularly useful in larger aneurysms that can't be treated with other
options.
A neurosurgeon or
interventional neuroradiologist will likely work with your neurologist to
recommend treatment. Treatment is based on the size, location and overall
appearance of the brain aneurysm. They also may consider factors such as your
ability to undergo a procedure.
Other treatments for ruptured aneurysms
Other methods for
treating ruptured brain aneurysms are aimed at relieving symptoms and managing
complications.
·
Pain relievers, such as acetaminophen (Tylenol, others), may be used to
treat headache pain.
·
Calcium channel blockers prevent calcium from entering
cells of the blood vessel walls. These medicines may lessen the risk of having
symptoms from the narrowing of blood vessels, known as vasospasm. Vasospasm may
be a complication of a ruptured aneurysm.
One of these
medicines, nimodipine (Nymalize), has been shown to reduce the risk of delayed
brain injury caused by insufficient blood flow. This can happen after
subarachnoid hemorrhage from a ruptured aneurysm.
·
Medicines to open blood vessels. A drug can be
given to dilate the blood vessels. This can be given through an IV in the arm
or with a catheter directly into the arteries supplying the brain. This can
help prevent a stroke by allowing the blood to flow freely. Blood vessels also
can be expanded using medicines known as a vasodilators.
·
Angioplasty. This is a procedure to expand a narrowed blood vessel in
the brain caused by vasospasm. The procedure also can help prevent a stroke.
·
Anti-seizure medicines may
be used to treat seizures related to a ruptured aneurysm. The medicines
typically aren't given if a seizure hasn't occurred.
·
Ventricular or lumbar draining catheters and shunt surgery can lessen
pressure on the brain from excess cerebrospinal fluid. Fluid can build up after
a ruptured aneurysm. A catheter may be placed in the spaces that are filled
with fluid inside the brain. Or it can be placed in the area surrounding the
brain and spinal cord. The catheter drains the excess fluid into an external
bag.
Sometimes a shunt
system is placed. A shunt system is a flexible silicone rubber tube and a valve
that creates a drainage channel. The drainage channels starts in the brain and
ends in the abdominal cavity.
·
Rehabilitative therapy. Damage to the brain from a subarachnoid
hemorrhage may result in the need for physical, speech and occupational therapy
to relearn skills.
Treating unruptured brain aneurysms
A surgical clip, an
endovascular coil or a flow diverter can be used to seal off an unruptured
brain aneurysm. This can help prevent a future rupture. However, the risk of
rupture is extremely low in some unruptured aneurysms. In these cases, the
known risks of the procedures may outweigh the potential benefits.
A neurologist
working with a neurosurgeon or interventional neuroradiologist can help you
determine whether surgical or endovascular treatment is appropriate for you.
Factors to consider
in making treatment recommendations include:
·
The aneurysm size, location and overall appearance of the
aneurysm.
·
Your age and general health.
·
Family history of ruptured aneurysm.
·
Conditions you were born with that increase the risk of a
ruptured aneurysm.
If you have high
blood pressure, talk to your health care provider about medicine to manage the
condition. If you have a brain aneurysm, proper control of blood pressure may
lower the risk of rupture.
In addition, if you
smoke cigarettes, talk with your care provider about strategies to stop
smoking. Cigarette smoking is a risk factor for formation, growth and rupture
of the aneurysm.
Lifestyle and home remedies
Lifestyle changes to lower your risk
If you have an
unruptured brain aneurysm, you may lower the risk of rupture by making these
lifestyle changes:
·
Don't smoke cigarettes. If you smoke, talk to your health
care provider. Your provider can suggest strategies or a treatment program to
help you quit.
·
Control your blood pressure if you have high blood pressure.
·
Eat a healthy diet and exercise. Changes in
diet and exercise can help lower blood pressure. Talk to your health care
provider about changes that are appropriate for you.
·
Don't use drugs such as cocaine, methamphetamine or others. If you do use
these drugs and would like to quit, talk to your provider.
Preparing for your appointment
Brain aneurysms are
often detected after they've ruptured and become medical emergencies. However,
a brain aneurysm may be detected when you've undergone head-imaging tests for
another condition.
If such test results
indicate you have a brain aneurysm, you'll need to discuss the results with a
specialist in brain and nervous system disorders. These specialists include
neurologists, neurosurgeons and neuroradiologists.
What you can do
To make the best use
of your time with your health care provider, you may want to prepare a list of
questions, such as:
·
What do you know about the size, location and overall appearance
of the aneurysm?
·
Do the imaging test results provide evidence of how likely it is
to rupture?
·
What treatment do you recommend at this time? What are the risks
of treatment?
·
If I wait, how often will I need to have follow-up tests?
·
What steps can I take to lower the risk of an aneurysm
rupturing?
What to expect from your doctor
Your neurologist,
neurosurgeon or neuroradiologist may ask you the following questions to help
determine the best course of action:
·
Do you smoke?
·
How much alcohol do you drink?
·
Do you use recreational drugs?
·
Are you being treated for high blood pressure?
·
Do you take your medicines as prescribed by your health care
provider?
·
Is there a history of brain aneurysm or brain aneurysm rupture
in your family?
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