A little peek inside your head? Let's talk about brain aneurysms.

Have you ever had a headache that was so severe that it was unbearable? It felt like lightning had struck your head, or like a bomb had exploded? Sometimes we think of these things as just a normal headache, but they can be a sign of a very serious health condition. One such condition that requires urgent attention is what we are talking about today, a "Brain Aneurysm ." Hearing this name can be scary, but it is very important to be aware of it.

Simply put, what is an aneurysm?

Imagine that there is a pipe that carries water. One part of this pipe is a little weak, it's old. Then, as the water flows faster, that weak part starts to bulge out a little, like a little balloon. The same thing happens if something happens to a blood vessel, or artery, inside our brain .

A brain aneurysm, or as doctors call it, a cerebral aneurysm, is a weak wall in an artery around or within the brain that bulges out under the pressure of blood, forming a bulge.

Every time our heart beats, blood flows through the arteries of the brain under pressure. As this pressure continues to hit that weakened area, it gradually gets bigger. Just like when we blow air into a balloon, it gets thinner and bigger. The bigger it gets, the more likely it is to burst.

Although these aneurysms can form anywhere in the brain, they most often form in the major arteries at the base of our skull. Some people (about 10% - 30%) may have more than one aneurysm. But the good news is that most of these aneurysms are very small. They don't cause any symptoms.

Symptoms only begin to appear when the aneurysm becomes large enough to press on surrounding brain tissue or nerves. The most dangerous situation is when the aneurysm leaks blood or ruptures completely. This can cause bleeding inside the brain.

What happens if an aneurysm bursts?

When an aneurysm bursts, blood leaks into the surrounding brain tissue. This is called a hemorrhage . This blood puts extra pressure on the brain tissue, causing the brain to swell. The main symptom that usually occurs is a sudden, unimaginably severe headache called a "thunderclap headache ."

A ruptured aneurysm can cause serious health problems, such as:

• Subarachnoid Hemorrhage (SAH): This is bleeding into the space between the brain and the thin membrane that covers the brain (the arachnoid layer). 90% of these bleeds are caused by a ruptured aneurysm.
• Hemorrhagic Stroke : A stroke caused by bleeding into the space between the skull and the brain.

These conditions can cause permanent brain damage and other serious complications .

Who gets aneurysms? How common is it?

This condition can develop at any age, and anyone can develop it. However, people between the ages of 30 and 60 are at higher risk. Also, research has shown that this condition is slightly more common in women than in men.

Although there is no specific data on this in Sri Lanka, it is estimated that about 6% of the population in countries like the United States has an unruptured aneurysm. This means that this is not as rare as one might think. However, aneurysm ruptures are not that common.

What are the symptoms of an aneurysm?

The symptoms of this vary depending on whether the aneurysm has ruptured or not. Understanding this difference can help save your life.

Sometimes, before an aneurysm ruptures, it can leak a little blood. This is called a sentinel bleed . During this time, a warning headache (sentinel headache) can occur a few days or weeks before the big one. If you have an unusual, severe headache, never ignore it. See a doctor right away.

Why do these aneurysms form? What are the risk factors?

Aneurysms form when the walls of the arteries in the brain become thin and weak. They usually occur at the branching points of the arteries. Sometimes a person is born with a weakness in the artery wall. In addition, a number of other factors can affect this.

Hereditary factors

These are things that we cannot control and are genetically inherited.

• Some hereditary conditions: For example, `Vascular Ehlers-Danlos syndrome`, `Autosomal dominant polycystic kidney disease`, `Marfan syndrome`, `Fibromuscular dysplasia`.
• Arteriovenous malformation is an abnormal connection between the arteries and veins in the brain.
• If a close family member (mother, father, sibling) has had an aneurysm, you are also at higher risk.

Our lifestyle and other health conditions

These are things we can change and control.

• Smoking: This is a major enemy that damages the arterial walls.
• High Blood Pressure: Uncontrolled high blood pressure causes constant pressure on the artery walls.
• Drug use: Especially drugs like cocaine.
• Excessive alcohol consumption.

What are the causes of an aneurysm bursting?

The same factors that contribute to the formation of an aneurysm also contribute to its rupture. Researchers believe that high blood pressure is the main cause of an aneurysm rupture. When blood pressure increases, blood pushes harder against the walls of the artery.

When blood pressure suddenly rises and an aneurysm can burst:

• A strong feeling, such as ongoing stress or sudden outbursts of anger.
• The effort required to lift something heavy (when lifting weights, moving furniture).
• Knowing you have high blood pressure but not taking the right medication for it.

In addition, factors such as the size, shape, and location of the aneurysm also affect whether it will rupture or not.

How to recognize this condition?

Many people with unruptured aneurysms don't even know they have one. They are often discovered incidentally during an MRI or CT scan of the brain for another reason.

However, if you experience symptoms of a ruptured aneurysm (especially that severe headache), you should go to a hospital's emergency room immediately. There, doctors will run a series of tests to confirm whether there is bleeding.

• CT (Computed Tomography) Scan: This can quickly check for bleeding in the brain. Sometimes a special scan called a `CT Angiogram (CTA)` is done, which can get clearer images of the blood vessels.
• MRI (Magnetic Resonance Imaging) scan: This can produce very detailed images of the brain and blood vessels.
• Cerebral Angiography: In this, a neurosurgeon inserts a small tube (catheter) through the groin or wrist, guides it into the blood vessels of the brain, and very precisely checks the location, size, and shape of the aneurysm.
• Cerebrospinal fluid (CSF) test: A lumbar puncture can detect bleeding around the brain.

What are the treatments?

The main goal of treatment is to stop the bleeding from the aneurysm. A ruptured aneurysm is a medical emergency that requires emergency surgery. Whether or not to treat an unruptured aneurysm depends on your condition.

Main treatment methods

1. Microvascular Clipping: This is an open surgery. The neurosurgeon makes a small hole in the skull and goes to the location of the aneurysm. Then, like a clothespin, a small metal clip is placed around the neck of the aneurysm, completely cutting off the blood flow to it.

2. Endovascular Coiling: This involves making a small incision. A small tube (catheter) inserted through the groin or wrist is used to insert very fine wire coils into the aneurysm. These coils cause a blood clot to form inside the aneurysm, stopping the flow of blood to it.

3. Flow Diversion Stents: This is also done without an incision. A mesh-like tube (stent) is inserted into the blood vessel where the aneurysm is located. This directs the blood flow directly through the vessel, bypassing the aneurysm.

What do you do for an unruptured aneurysm?

If you have a small, asymptomatic aneurysm and no other risk factors, your doctor may decide not to treat it.

The decision to have surgery or not is made based on many factors, including your age, overall health, the size and location of the aneurysm, and your family history. Talk openly with your doctor about this.

What can you say about the future?

In the case of a ruptured aneurysm, the outcome depends on your age, health, the amount of blood lost, and how quickly you receive treatment. Sadly, about 25% of people die within 24 hours of a ruptured aneurysm. The death rate is about 50% within three months.

About 66% of survivors suffer some form of permanent brain damage. However, with early treatment and good rehabilitation , some recover with little or no disability.

However, many people with small, unruptured aneurysms live long lives without any symptoms or any effects from it.