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Brain Aneurysm by Deanna M. Neff, MPH

Definition

An aneurysm is an outpouching of a blood vessel wall. This can occur anywhere there are blood vessels, including in the brain. The bulging, blood-filled pocket can put pressure on parts of the brain, potentially causing symptoms. In addition, the blood vessel can rupture (hemorrhage). Early detection and diagnosis may help prevent severe or fatal complications in some patients. Many aneurysms go unnoticed for a lifetime and cause no symptoms.

Brain Aneurysm

Causes

Aneurysms form in areas where the artery wall becomes thin or weak. Thinning artery walls and resulting aneurysms can be caused by a number of factors. Common causes include:

Congenital (present at birth) weakness in artery wall
High blood pressure
Infection
Trauma or injury to the brain
Tumor
Plaque build-up on artery walls

Risk Factors

These factors increase your chance of developing a brain aneurysm. These risk factors also increase your chance of a rupture. Adults are more likely to develop an aneurysm than children. Females are at slightly higher risk. Tell your doctor if you have any of these risk factors:

Old age
Genetic diseases (circulatory, connective tissue, or polycystic kidney disease)
Family history of aneurysms
Smoking
Heavy alcohol use
Drug abuse
High blood pressure
Tumors
Traumatic head injury
Arteriovenous malformations

Symptoms

If you have any of these symptoms, do not assume it is due to a brain aneurysm. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

Pain behind the eye
Numbness, sometimes on one side of the face or body
Weakness on one side of the body or face
Vision changes
Drooping eyelid
Differences between the size of the pupils
Speech impairment

Most aneurysms do not cause symptoms until they leak or rupture. A leaking or ruptured aneurysm may cause:

Headache
Nausea
Vomiting
Stiff neck
Confusion or sleepiness
Loss of consciousness
Seizures

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:

Brain imaging, such as CT scan (x-rays seen on a computer) or MRI (magnetic waves are used to view images of the body)
Catheter , MRI , or CT angiography (dye contrast test to view the arteries and veins)
Spinal fluid analysis

Treatment

Talk with your doctor about the best treatment plan for you. Other medical conditions; lifestyle factors; as well as the type, size, and location of the aneurysm will direct treatment. For a known aneurysm that is not leaking or ruptured, treatment options include the following:

Monitoring

Your doctor may need to monitor you to see if the aneurysm gets larger or begins to leak.

Medicines

Medicines are not used to fix an aneurysm. Medicines may be used to help lower blood pressure, treat pain, or stop side effects of the aneurysm, like seizures.

Endovascular Embolization

During this procedure, a catheter is thread up to the aneurysm. Coils, a special liquid, or balloons are used to fill the aneurysm and stop circulation, causing it to clot. This may need to be done more than once.

Surgery

Surgical options include microvascular clipping or occlusion.

Microvascular clipping—A neurosurgeon cuts off blood flow to the aneurysm.
Microvascular occlusion—A neurosurgeon clamps off the entire artery leading to the aneurysm. Sometimes a bypass procedure (rerouting a new blood vessel) is done too.

Prevention

In many cases, there is no known way to prevent an aneurysm from forming. To help reduce your chances of getting a brain aneurysm or having it burst, take the following steps:

Control high blood pressure
Stop smoking
Avoid recreational drug use
Discuss with your doctor:
- Benefits and risks of oral contraceptives
- Whether it is safe to use daily aspirin or other pain medicines that may thin the blood

RESOURCES:

The Brain Aneurysm Foundation http://www.bafound.org/
National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/

CANADIAN RESOURCES:

Brain Injury Association of Alberta http://www.biaa.ca/
Heart and Stroke Foundation Canada http://ww2.heartandstroke.ca/

References:

Brain Aneurysm Foundation Information website. Available at: http://www.bafound.org/info/factors.php . Accessed May 10, 2010.
Cerebral Aneurysm. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated May 2011. Accessed May 29, 2011
Kirchheimer S. Subarachnoid hemorrhage. EBSCO Patient Education Reference Center. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=1034 . Published March 1, 2010. Accessed April 26, 2010.
Mayo Clinic. Brain aneurysm. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/brain-aneurysm/DS00582 . Accessed October 28, 2010.
National Institute of Neurological Disorders and Stroke. Cerebral aneurysm fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/cerebral_aneurysm/detail_cerebral_aneurysm.htm . Updated February 3, 2010. Accessed April 26, 2010.
Vlak M, Rinkel, Gabriel J, et al. Trigger factors and their attributable risk for rupture of intracranial aneurysms: a case-crossover study. Stroke . 2011 May 5.

Last reviewed June 2012 by Rimas Lukas, MD

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