About brain aneurysm(cerebral aneurysm)

What is brain aneurysm(cerebral aneurysm)?

Brain aneurysm 

An aneurysm is a ballooning at a weak spot in an artery wall. An aneurysm's walls can be thin enough to rupture. The illustration shows an individual with an unruptured aneurysm. The inset shows what happens when the aneurysm ruptures.

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A brain aneurysm (AN-yoo-riz-um) is a bulge or ballooning in a blood vessel in the brain. An aneurysm often looks like a berry hanging on a stem.

A brain aneurysm can leak or rupture, causing bleeding into the brain (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.

A ruptured aneurysm quickly becomes life-threatening and requires prompt medical treatment.

Most brain aneurysms, however, don't rupture, create health problems or cause symptoms. Such aneurysms are often detected during tests for other conditions.

Treatment for an unruptured brain aneurysm may be appropriate in some cases and may prevent a rupture in the future. Talk with your health care provider to ensure you understand the best options for your specific needs.



What are the symptoms for brain aneurysm(cerebral aneurysm)?

A sudden, severe Headache is the key symptom of a ruptured aneurysm. This Headache is often described as the "worst headache" ever experienced.

In addition to a severe headache, common signs and symptoms of a ruptured aneurysm 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. This leaking may cause only a sudden, extremely severe headache.

A more severe rupture often follows leaking.

Unruptured aneurysm

An unruptured brain aneurysm may produce no symptoms, particularly if it's small. However, a larger unruptured aneurysm may press on brain tissues and nerves, possibly causing:

  • Pain above and behind one eye
  • A dilated pupil
  • A change in vision or double vision
  • Numbness of one side of the face



What are the causes for brain aneurysm(cerebral aneurysm)?

The causes of most brain aneurysm are unknown, but a range of factors may increase your risk.



What are the treatments for brain aneurysm(cerebral aneurysm)?

Surgery Brain aneurysm surgery

Mayo Clinic surgeons performing an endovascular procedure for brain aneurysm

There are two common treatment options for a ruptured brain aneurysm.

  • Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then the neurosurgeon places a tiny metal clip on the neck of the aneurysm to stop blood flow into it.
  • Endovascular treatment is a less invasive procedure than surgical clipping. The surgeon inserts a catheter into an artery, usually in your wrist or groin, and threads it through your body to the aneurysm.

    The surgeon then uses a device — a flow diverter, an intraluminal flow disrupter, a stent or coils — or different combinations of various devices to destroy the aneurysm from inside the blood vessel.

Both procedures pose potential risks, particularly bleeding in the brain or loss of blood flow to the brain. The endovascular coil is less invasive and may be initially safer, but it may carry a slightly higher risk of needing a repeat procedure in the future due to the aneurysm reopening.

Flow diverters

Newer treatments available for brain aneurysm include tubular stent-like implants (flow diverters) that work by diverting blood flow away from an aneurysm sac. The diversion stops blood movement within the aneurysm and stimulates the body to heal the site, encouraging reconstruction of the parent artery. Flow diverters may be particularly useful in larger aneurysms that can't be safely treated with other options.

Your neurosurgeon or interventional neuroradiologist, in collaboration with your neurologist, will make a recommendation based on the size, location and overall appearance of the brain aneurysm, your ability to undergo a procedure, and other factors.

Other treatments for ruptured aneurysms

Other treatments for 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 medications may lessen the risk of having serious symptoms from the erratic narrowing of blood vessels (vasospasm) that may be a complication of a ruptured aneurysm.

    One of these medications, nimodipine (Nymalize), has been shown to reduce the risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage from a ruptured aneurysm.

  • Interventions to prevent stroke from insufficient blood flow include IV injections of a drug to dilate the blood vessels, which elevates blood pressure to overcome the resistance of narrowed blood vessels.

    An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain caused by vasospasm. A drug known as a vasodilator also may be used to expand blood vessels in the affected area.

  • Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid and others. Their use has been debated by several experts, and is generally subject to caregiver discretion, based on the medical needs of each individual.
  • Ventricular or lumbar draining catheters and shunt surgery can lessen pressure on the brain from excess cerebrospinal fluid (hydrocephalus) associated with a ruptured aneurysm. A catheter may be placed in the spaces that are filled with fluid inside the brain or in the area surrounding the brain and spinal cord to drain the excess fluid into an external bag.

    Sometimes it may then be necessary to introduce a shunt system — which consists of a flexible silicone rubber tube and a valve — that creates a drainage channel starting in the brain and ending 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 Aneurysm clip Open pop-up dialog box Close Aneurysm clip Aneurysm clip

A surgical procedure to treat brain aneurysms involves opening the skull, finding the affected artery and then placing a metal clip over the neck of the aneurysm.

Endovascular coiling Open pop-up dialog box Close Endovascular coiling Endovascular coiling

With endovascular coiling, the surgeon feeds a soft, flexible wire into the aneurysm via a catheter. The wire coils inside the aneurysm and seals off the aneurysm from the artery.

A surgical clip, an endovascular coil or a flow diverter can be used to seal off an unruptured brain aneurysm and help prevent a future rupture. However, in some unruptured aneurysms, the known risks of the procedures may outweigh the potential benefit.

A neurologist, in collaboration with a neurosurgeon or interventional neuroradiologist, can help you determine whether the treatment is appropriate for you.

Factors to consider in making treatment recommendations include:

  • The aneurysm size, location, degree of irregularity of the aneurysm and overall appearance of the aneurysm
  • Your age and general health
  • Family history of ruptured aneurysm
  • Congenital conditions that increase the risk of a ruptured aneurysm

If you have high blood pressure, talk to your health care provider about medication 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 since cigarette smoking is a risk factor for formation, growth and rupture of the aneurysm.

Lifestyle changes to lower your risk

If you have an unruptured brain aneurysm, you may lower the risk of its rupture by making these lifestyle changes:

  • Don't smoke or use recreational drugs. If you smoke or use recreational drugs, talk to your health care provider about strategies or an appropriate 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.



What are the risk factors for brain aneurysm(cerebral aneurysm)?

A number of factors can contribute to weakness in an artery wall and increase the risk of a brain aneurysm or aneurysm rupture. Brain aneurysms are more common in adults than in children. They're also more common in women than in men.

Some of these risk factors develop over time, while others are present at birth.

Risk factors that develop over time

These include:

  • Older age
  • Cigarette smoking
  • High blood pressure
  • Drug abuse, particularly the use of cocaine
  • Heavy alcohol consumption

Some types of aneurysms may occur after a head injury or from certain blood infections.

Risk factors present at birth

Some conditions that are present at birth can be associated with an elevated risk of developing a brain aneurysm. These include:

  • Inherited connective tissue disorders, such as Ehlers-Danlos syndrome, that weaken blood vessels
  • Polycystic kidney disease, an inherited disorder that results in fluid-filled sacs in the kidneys and usually increases blood pressure
  • Narrow aorta (coarctation of the aorta), the large blood vessel that delivers oxygen-rich blood from the heart to the body
  • Brain arteriovenous malformation (AVM), in which the arteries and veins in the brain are tangled, interrupting blood flow
  • Family history of brain aneurysm, particularly a first-degree relative, such as a parent, brother, sister or child



Is there a cure/medications for brain aneurysm(cerebral aneurysm)?

A brain aneurysm(cerebral aneurysm) is a dilation along the arterial circulation within the brain. About 85% of the dilations occur in the anterior circulation, which supplies blood to the anterior parts of the brain. The causes include: hemodynamic stress on the internal elastic lamina, vibrations from the turbulence of blood flow, and T-lymphocytes and macrophages mediated inflammation. Patients with advanced age, hypertension, smoking, alcohol abuse and atherosclerosis risk are prone to an aneurysm. They are asymptomatic. However, the rupture causes sudden acute headaches. The headache may accompany the loss of consciousness, meningismus, or nausea and vomiting. Seizures are rare.

Treatment
1. The decision to treat depends on the size, location, age, comorbidities, and whether there is a rupture. The treatments are of two types: surgical and endovascular.
2. The surgical procedure involves blocking the flow of blood into the aneurysm sac by applying a metal clip across the neck of the aneurysm. Accessing the aneurysm requires the removal of a part of the skull, dissection of the dura, and separation from other blood vessels. After the surgery, the skull is secured with a metal plate and screws. The procedure is performed under general anesthesia and in a sterile operating theater.
3. Endovascular coiling is an alternative in which a catheter is inserted through the femoral artery up to the aneurysm, followed by the insertion of a microcatheter.
4. The first catheter contains a platinum coil, which is removed using an electric current.
5. Thromboembolism and intraprocedural aneurysm rupture are the possible complications.

Symptoms
Asymptomatic, unless rupture in the vessels,Thunderbolt headaches,Nausea,Vomiting when ruptured
Conditions
Breakdown of arterial wall integrity in brain
Drugs
NA



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