Have you ever heard the word ' brain aneurysm'? Maybe you've even heard of a friend of yours having one. It's normal to feel a little scared and shocked when we hear this name. Who wouldn't be scared when they say a blood vessel inside the brain is bursting, right? But rather than being unnecessarily scared about this, it's more important to be aware of it. So today, we'll talk about it very simply, in a way that you can understand.
Simply put, what is an aneurysm?
Think of a balloon. If we keep blowing on it, some parts become weak and it pops out like a little bubble, right? The same thing happens in the blood vessels in our brain.
When a blood vessel that supplies blood to the brain becomes weak at a certain point, and blood continues to flow through it at a rapid rate, the weak spot bulges out like a balloon. That bulge is called an aneurysm . These can grow to the size of a small berry.
Although the name sounds scary, most aneurysms do not cause any symptoms or health problems. A person can live their entire life without knowing they have an aneurysm, without any problems.
However, very rarely, this aneurysm can grow larger, leak blood slowly, or rupture suddenly. When it ruptures and bleeds into the brain, it is called a hemorrhagic stroke. This is a very serious, life-threatening medical emergency. In such cases, immediate hospital treatment is required.
What are the types and sizes of aneurysms?
Aneurysms can be divided into several main types. Let's take a look at what they are.
| Aneurysm Type | Description |
|---|---|
| Saccular Aneurysm | This is the most common type. It forms a bubble outside the blood vessel, resembling a berry hanging from a vine. This is why it is also called a "berry aneurysm." |
| Fusiform Aneurysm | These don't form like a bubble. Instead, the walls of the blood vessel swell all around, widening that area. These are not very common. |
| Mycotic Aneurysm | A type of aneurysm that develops when the wall of a blood vessel weakens due to an infection such as bacteria or fungi. This is also very rare. |
These aneurysms can be of various sizes.
- Small ( SMA ll): Less than 11 millimeters (about the size of a pencil eraser).
- Large: Between 11-25 millimeters (about the size of a 5 rupee coin in Sri Lanka).
- Giant: Larger than 25 millimeters.
What are the symptoms of this? This is what you definitely need to know!
The symptoms of an aneurysm depend on whether it has ruptured or not. This part is very important , so pay close attention.
| Emergency symptoms of a ruptured aneurysm (if you have any of these, go to the ETU immediately!) | |
|---|---|
| |
| Symptoms of an aneurysm that is growing but not bursting (see a doctor immediately) | |
|
Why do these aneurysms form? Who is at higher risk?
There is no single cause for aneurysm formation, but some risk factors have been identified.
Hereditary causes
Some hereditary conditions may increase the risk of developing aneurysms.
- Autosomal dominant polycystic kidney disease is a disease in which cysts form in the kidneys.
- Neurofibromatosis type 1 is a disease that causes tumors to form on the skin and nerves.
- Diseases affecting connective tissue (Marfan syndrome, Ehlers-Danlos syndrome)
Lifestyle-related risk factors
These are the things we can control.
- High Blood Pressure: This is the main and most common risk factor.
- Smoking: People who smoke have a much higher risk of developing aneurysms and of them bursting.
- Family history: If one of your close relatives (mother, father, sibling) has had an aneurysm, you are also at slightly higher risk.
- Age: The risk increases after the age of 40.
- Gender: Women are more likely to develop aneurysms than men.
- Drug use: Use of drugs such as cocaine.
- Excessive alcohol consumption.
How do doctors find this?
If your doctor suspects an aneurysm based on your symptoms, there are several tests to confirm it.
- CT Scan: This takes detailed pictures of the brain. Sometimes a special dye is injected into the brain to make the blood vessels more visible.
- MRI Scan: A magnetic field is used to take very clear pictures of the brain and blood vessels.
- Angiogram: This is the most reliable way to diagnose an aneurysm. In this test, a very thin tube (catheter) is passed through a blood vessel in the leg or arm to the blood vessels in the brain, a special fluid is injected, and a series of X-ray images are taken. This allows the exact location, size, and shape of the aneurysm to be seen.
- Spinal Tap/Lumbar Puncture: If there is a suspicion that an aneurysm has ruptured, a sample of spinal fluid is taken from the spine and tested for blood.
What are the treatments?
Treatment is determined by many factors, including whether the aneurysm has ruptured or not, its size, location, your age, and overall health.
For small, asymptomatic, unruptured aneurysms, it may be possible to avoid any treatment and just watchful waiting. You should discuss this with your doctor to make the best decision.
A ruptured aneurysm must be treated immediately because the risk of it bursting again is very high. There are several main treatment options.
| Treatment method | What happens is simple. |
|---|---|
| Surgical Clipping | A surgery that involves opening the skull. The surgeon locates the aneurysm and places a small metal clip across its neck to stop the bleeding. |
| Endovascular Coiling | This is a procedure that doesn't involve opening the skull. Just like an angiogram, a thin tube is inserted through the leg, and very fine platinum wire coils are passed through it and inserted into the aneurysm. The blood flow to it is then stopped, and a blood clot forms and closes it. |
| Flow Diverter Surgery | A procedure used for large aneurysms. In this procedure, a mesh-like stent is placed inside the blood vessel where the aneurysm is located. This allows blood to flow directly through the aneurysm, rather than bypassing it. |
Take-Home Message
- Most brain aneurysms never rupture. They can be asymptomatic, so don't be unnecessarily alarmed by the name.
- A sudden, severe headache like you've never experienced in your life is a warning sign! If this happens, don't think twice and go to the nearest hospital's Emergency Department (ETU) immediately.
- High blood pressure and smoking are the two biggest enemies. Controlling these two can greatly reduce your risk.
- If a close family member has had an aneurysm, talk to your doctor about it.
- If diagnosed early and treated properly, this condition can be completely cured. Therefore, it is very important to be aware of the symptoms.
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