What is a Brain Aneurysm? Let's talk about it!

Have you ever wondered what would happen if a small blood vessel inside your brain developed a small balloon-like structure, grew large, and burst? That's what we're going to talk about today, a brain aneurysm. You've probably heard this term before. Don't worry, let's explain it simply.

What is a brain aneurysm?

Simply put, a cerebral aneurysm is a condition in which a weak spot in a blood vessel (we call it an artery) in or around your brain swells up and bulges out like a balloon. Think of it like a weak spot in a water pipe, causing the water pressure to cause that spot to bulge. As blood flows through it, the pressure pushes the weak spot further out, forming a small bulge.

As blood fills the balloon-like structure rapidly, the aneurysm expands. This is similar to how a balloon becomes thinner when you blow air into it, making it more likely to burst.

Brain aneurysms can develop anywhere in your brain. However, they most often develop in the major arteries along the base of your skull. Between 10% and 30% of people with a brain aneurysm have more than one aneurysm. Most of the time, these aneurysms are very small and don't cause any symptoms.

However, symptoms only occur when the aneurysm becomes large enough to press on nearby nerves or brain tissue. The most dangerous thing is when the aneurysm ruptures and bleeds (leaks) or bursts open. This can cause bleeding into the brain. A ruptured brain aneurysm can be life-threatening and requires emergency medical treatment. The longer a ruptured aneurysm lasts, the greater the risk of death or permanent disability.

What happens when a brain aneurysm bursts?

When this ruptures, blood leaks into the surrounding brain tissue. We call this a ``Hemorrhage''. This blood can put unnecessary pressure on the brain tissue and cause the brain to swell. Usually, at this time, a severe headache called a ``Thunderclap headache'' occurs along with other symptoms.

A ruptured brain aneurysm can cause serious health problems. Here are a few examples:

• Subarachnoid hemorrhage (SAH) : This is bleeding into the space between the thin membranes that cover and protect your brain (we call this the `arachnoid layer`). 90% of SAHs are caused by a ruptured brain aneurysm.
• Hemorrhagic stroke : This is bleeding into the space between your skull and your brain.

These conditions can cause permanent brain damage, or other complications such as:

• Vasospasm : This is when the blood vessels become narrowed or stiff, reducing the amount of oxygen reaching the brain.
• Hydrocephalus : This is when cerebrospinal fluid or blood accumulates around the brain, putting excessive pressure on the brain.
• Seizures : A seizure is a temporary, uncontrolled increase in electrical activity in the brain. This can worsen brain damage caused by a ruptured aneurysm.
• Coma : This is a state of unconsciousness that lasts from days to weeks.
• Death : About 50% of patients die from a ruptured brain aneurysm.

Who gets brain aneurysms?

Brain aneurysms can develop in anyone, at any age. However, they most often affect people between the ages of 30 and 60. They are also slightly more common in women.

How common is this aneurysm?

In a country like the United States, about 6% of the population has an unruptured aneurysm. However, ruptured brain aneurysms are not as common. Approximately 30,000 people in the United States develop this condition each year.

What are the symptoms of a brain aneurysm?

The symptoms of a brain aneurysm vary depending on whether it has ruptured or not.

Symptoms of a ruptured aneurysm

These are the symptoms of a ruptured aneurysm:

• Thunderclap headache : This is a sudden, excruciating headache. Many people describe it as "the worst headache of my life."
• Vomiting and nausea.
• Neck stiffness (difficulty bending the neck).
• Blurred vision or double vision.
• Sensitivity to light (photophobia).
• Seizures.
• A drooping eyelid and dilated pupil.
• Pain above and behind the eye.
• Confusion.
• Weakness and/or numbness.
• Loss of consciousness.

If you have one or more of these symptoms, you should call 911 immediately or go to the emergency department of the nearest hospital. This is an emergency!

Sometimes a small amount of blood can leak from a brain aneurysm. This is called a `sentinel bleed.` If this happens, you may get `sentinel headaches` a few days or weeks before the aneurysm bursts.

Symptoms of an unruptured aneurysm

Most of the time, intact brain aneurysms don't cause any symptoms. However, if they get large enough, the balloon-like bulge in the blood vessel can put pressure on nearby nerves or brain tissue, causing symptoms such as:

• Headache.
• Changes in vision.
• Enlarged pupil (dilated pupil).
• Numbness in the head or face.
• Pain above and behind the eye.
• Seizures.

If you have these symptoms, see a doctor as soon as possible.

What causes brain aneurysms?

Brain aneurysms occur when the walls of the arteries in your brain become thin and weak. They often form where the arteries divide. Sometimes, you can be born with a brain aneurysm. This is usually caused by an abnormality in the artery wall (a `birth defect`). Several other factors can cause an artery wall to become weak.

The following birth factors can affect the health of your arteries and increase your risk of developing a brain aneurysm:

• `(Vascular Ehlers-Danlos syndrome)`
• ``(Autosomal dominant polycystic kidney disease)''
• `(Marfan syndrome)`
• `(Fibromuscular dysplasia)`
• Arteriovenous malformation
• A close family member (biological brother, sister, or parent) has a history of having a brain aneurysm.

Here are other conditions and habits that can weaken your artery walls over time:

• Smoking.
• High blood pressure.
• Drug use, especially cocaine.
• Excessive alcohol use.

What causes a brain aneurysm to burst?

The same factors that contribute to the formation of a brain aneurysm can also cause it to rupture and bleed.

Researchers believe that high blood pressure is the main cause of aneurysm rupture. When blood pressure increases, the pressure exerted by the blood on the walls of the blood vessels increases. There are several situations in which high blood pressure can cause a brain aneurysm to rupture:

• Ongoing stress is a severe feeling, like sudden anger.
• Excessive strain when lifting, pulling, or pushing something heavy (e.g., lifting weights, moving furniture).
• Not taking proper medication for high blood pressure that you already have.

There are several other factors that determine the likelihood of an aneurysm bursting:

• Size and shape : Small aneurysms are less likely to rupture than large, irregularly shaped aneurysms.
• Growth : If an aneurysm grows larger over time, it is more likely to rupture.
• Location : Aneurysms in the posterior communicating arteries at the back of the brain and the anterior communicating artery at the front of the brain are more likely to rupture than aneurysms in other parts of the brain.
• Ethnicity : People of Japanese or Finnish descent are at higher risk of aneurysm rupture.
• Older age : People over 70 years of age are at higher risk of aneurysm rupture.

People who have more than one brain aneurysm or who have previously had a bleed from an aneurysm are at the highest risk of a brain aneurysm bursting.

How to diagnose a brain aneurysm?

Many people with unruptured brain aneurysms don't even know they have one. A doctor may find it by chance when you have an MRI or CT scan of your brain for another medical reason.

If you have symptoms of a brain aneurysm, such as a severe headache, you should call 911 or go to the hospital immediately. A doctor will order tests to see if a brain aneurysm has ruptured. These tests may include:

• (CT - computed tomography scan) : This is the first imaging test a doctor will order to check for bleeding in the brain. A ``CT scan`` uses X-rays and a computer to take cross-sectional images of your body. Doctors may also use a test called ``CT angiogram (CTA)``. This can take more detailed pictures of the blood flow in the arteries of the brain. A ``CTA`` can show the size, location, and shape of an aneurysm, whether it is unruptured or ruptured.
• (MRI - magnetic resonance imaging scan) : An MRI uses a large magnet, radio waves, and a computer to take detailed pictures of your brain. Magnetic resonance angiography (MRA) takes detailed pictures of the arteries in the brain and shows the size, location, and shape of an aneurysm.
• Cerebral angiography : This is a test done by a neurosurgeon or interventional neuroradiologist. They insert a catheter into a blood vessel in your groin or wrist and thread it into your brain to take more detailed pictures of the arteries in your neck and brain. This imaging test can find blockages in the arteries in your brain or neck. It can also identify weak spots in an artery, such as an aneurysm. Doctors use this test to determine the cause of bleeding in the brain and the exact location, size, and shape of an aneurysm.
• (Cerebrospinal fluid - CSF analysis) : This test measures the substances in the fluid that surrounds and protects your brain and spinal cord (`spinal cord`). A doctor takes a sample of `CSF` by taking a `spinal tap` or `lumbar puncture`. This analysis can find out if there is bleeding around the brain.

How are brain aneurysms treated?

The main goal of brain aneurysm treatment is to stop or reduce the bleeding into the aneurysm. A `leaking` or `ruptured` brain aneurysm requires `emergency surgery`. Depending on your condition, an unruptured aneurysm may or may not require treatment.

Your medical team will recommend the treatment option(s) that are most appropriate for you, based on your vascular anatomy, the size and location of the aneurysm, and several other factors.

In general, ruptured aneurysms take longer to heal than unruptured aneurysms.

Microvascular clipping for brain aneurysms

In this surgery, a neurosurgeon makes a small hole in your skull and goes to the location of the aneurysm. Using a very small microscope and instruments, the surgeon places a small metal clip at the base of the aneurysm and closes it. This stops the bleeding inside the aneurysm. This surgery can stop bleeding in the brain or prevent an unruptured aneurysm from getting bigger or bursting.

The healing time for ruptured (several weeks to months) and unruptured (usually two to four weeks) aneurysms varies. Aneurysms that are completely clipped usually do not bleed again (recur).

Endovascular coiling for brain aneurysms

In this procedure, a neurosurgeon or interventional neuroradiologist inserts a catheter (a flexible tube) into a blood vessel in your groin or wrist and threads it into your brain. Through the catheter, the doctor inserts a small coil of very soft wire into the aneurysm.

After the doctor inserts this coil into the aneurysm, it changes the blood flow pattern inside the aneurysm and forms a blood clot. This blood clot stops the flow of blood into the aneurysm, creating a seal, like a clip.

Flow diversion stents for brain aneurysms

In this procedure, a neurosurgeon or interventional neuroradiologist inserts a catheter into a blood vessel in your groin or wrist and threads it into your brain. Through the catheter, the doctor inserts a mesh tube into the part of the blood vessel where the aneurysm is located. This mesh diverts (or "diverts") your blood flow away from the aneurysm instead of going into it.

WEB device for brain aneurysms

In this method, as mentioned above, the doctor inserts a metal mesh-like cube or sphere into the aneurysm through a catheter into the brain. This also works like a coil. That is, it creates a seal over the aneurysm, stopping blood from flowing to it and preventing it from getting bigger or bursting.

Additional treatments for a ruptured brain aneurysm

If you have a ruptured aneurysm, your medical team will use additional treatments to try to control your symptoms and prevent complications. These treatments may include:

• Antiseizure medications : These medications help prevent seizures associated with a ruptured aneurysm.
• Calcium channel blockers : These drugs help reduce the risk of stroke caused by vasospasm.
• Shunt : This is a tube that helps move cerebrospinal fluid (CSF) from the brain to another part of the body. This can help prevent hydrocephalus.

People who have had a ruptured aneurysm often need physical therapy, speech therapy, and occupational therapy to regain lost function and learn to live with a permanent disability.

Do I need treatment for an unruptured brain aneurysm?

If you have a small, unruptured brain aneurysm that is not causing symptoms, and you have no other relevant risk factors, your doctor may recommend not treating it.

Instead, your doctor will order imaging tests from time to time to monitor for any changes or growth. They will also advise you to quit smoking if you smoke and to keep your blood pressure under control.

If you develop symptoms, or if there is a change in the aneurysm during a repeat imaging test, you should seek medical attention immediately.

If you have symptoms, risk factors, and/or the aneurysm is large, you and your doctor will discuss the pros, cons, and options for surgery and/or endovascular treatment. This decision will depend on several factors, including:

• your age.
• Your overall health and any other illnesses you may have.
• The location, size, and other characteristics of the aneurysm.
• Your vascular anatomy.
• Family history of disease.
• Risk of explosion.

How can you reduce the risk of developing an aneurysm?

You can't prevent or change some risk factors for brain aneurysms, such as your age or genetic conditions. However, you can do the following to reduce your risk of developing a brain aneurysm:

• Maintaining healthy blood pressure with medication and/or lifestyle changes.
• Not smoking or quitting smoking.
• Getting help for alcohol use disorder and/or substance use disorder, and not using stimulants like cocaine.

What is the prognosis of a ruptured brain aneurysm?

The prognosis for recovery from a ruptured brain aneurysm depends on several factors, including:

• Your age and overall health.
• Whether you have pre-existing neurological conditions.
• Location of the aneurysm.
• How much blood was lost from the aneurysm.
• How quickly you received treatment.
• Whether the treatment for the aneurysm was successful.

About 25% of people who have a ruptured brain aneurysm die within 24 hours. About 50% die from complications within three months of the rupture.

Of those who survive, about 66% suffer permanent brain damage. Some people recover with little or no disability.

Can you live a long time with a brain aneurysm?

Many people with small, unruptured brain aneurysms never experience symptoms, and it doesn't affect their health.

However, the mortality rate of ruptured brain aneurysms is very high.

When should I see my doctor about a brain aneurysm?

If you have an unruptured brain aneurysm, you will need to see your doctor regularly to monitor the size of the aneurysm and control risk factors, such as high blood pressure.

If you have had a previous ruptured brain aneurysm, you will need to see your medical team regularly to monitor for possible complications and to make sure you don't develop another aneurysm.

If you have a sudden, severe headache with or without stroke symptoms, it could be a sign of a brain aneurysm. Call 911 or go to a hospital emergency room immediately. The sooner you get medical help, the better your chances of saving your life.

If you have an unruptured brain aneurysm, talk to your doctor about the pros and cons of different treatment and management options. They are ready to help you.

The most important things to keep in mind (Take-Home Message)

Okay, so let's remind you of some things you need to keep in mind from what we've talked about:

• A brain aneurysm is a bulge-like bulge in a weak spot in a blood vessel in the brain.
• Most of the time, small aneurysms don't cause symptoms. However, if you experience a sudden, severe headache, like "the worst headache of your life," it could be a sign of a ruptured aneurysm. If this happens, you should go to the hospital immediately.
• Things like high blood pressure and smoking are the main causes of aneurysm formation and rupture.
• Doctors decide whether or not to treat people with unruptured aneurysms based on several factors.
• A ruptured aneurysm is a life-threatening emergency. Prompt treatment is essential.
• The risk of developing an aneurysm can be reduced by living a healthy lifestyle and controlling risk factors.

If you have any further questions about this, don't hesitate to talk to your doctor. They will explain this to you further.

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