Brain Aneurysm Basics
Dr. Christopher Ogilvy and Nurse Practitioner Deidre Buckley
SEPTEMBER 01, 2015
A Q & A with Dr. Christopher Ogilvy and Nurse Practitioner Deidre Buckley
Brain aneurysm — sounds scary, and it can be. Christopher Ogilvy, MD, Director of the Brain Aneurysm Institute at Beth Israel Deaconess Medical Center, and Deidre Buckley, RN, NP, give us a better understanding of brain aneurysms from their expert points of view.
Q. What is a brain aneurysm?
A brain aneurysm is a weak spot in the wall of an artery carrying blood to the brain that causes a bulging or ballooning.
An aneurysm can affect any artery in the body, but ones in the brain may cause serious medical conditions, like a stroke, when they rupture.
Q. What causes a brain aneurysm?
Some aneurysms are associated with genetics — such as those related to tissue disorders or circulatory disorders. Also, risk factors include high blood pressure, smoking, and family history of brain aneurysm.
Q. How is a brain aneurysm diagnosed?
Most of the time, aneurysms go unnoticed until they rupture. Other times, they are discovered during an MRI/MRA done for other reasons.
Q. Are there any signs or symptoms of a brain aneurysm?
Unruptured brain aneurysms typically don’t come with any symptoms. These aneurysms are small in size, usually less than one half inch in diameter. Most of the time, these small aneurysms don’t ever cause trouble throughout a person’s life. However, large unruptured aneurysms can press on the brain or the cranial nerves of the brain, which is when we see symptoms like:
- Localized headache
- Dilated pupils
- Blurred or double vision
- Pain above and behind eye
- Weakness and numbness
- Difficulty speaking
Q. When should one seek medical attention?
If you experience some or all of these symptoms, you should immediately get medical attention:
- Sudden severe headache (the worst headache of your life)
- Loss of consciousness
- Stiff neck
- Sudden blurred or double vision
- Sudden pain above/behind the eye or difficulty seeing
- Sudden change in mental status/awareness
- Sudden trouble walking or dizziness
- Sudden weakness and numbness
- Sensitivity to light (photophobia)
- Drooping eyelid
Q. How are aneurysms treated?
The treatment depends on many factors, and whether the aneurysm is unruptured or ruptured.
There are many considerations when evaluating a patient with an unruptured aneurysm. For example, is there a risk of hemorrhage? What is the size and location of the aneurysm? We consider family history, age and health of the patient. We also consider all risks before recommending treatment.
Increasingly, minimally invasive approaches are used to treat most aneurysms, but for some patients open surgery is better. At BIDMC, multi-disciplinary team considers every case and helps each patient make the best treatment choice.
Observation: For small, unruptured aneurysms that are asymptomatic, we may observe them with scans (MRA) at various intervals to monitor for growth. Your team will determine how often the aneurysm should be monitored.
Clipping: Clipping is one way to treat ruptured and unruptured aneurysms. In this procedure, an opening is made in the skull and a small clip is placed across the neck of the aneurysm so that it blocks the blood flow from entering the aneurysm. The clip remains permanently.
Coiling: In this procedure, a catheter is inserted, usually in the groin, and the clinician guides the catheter through the artery in the thigh to the aneurysm. The wire guided through the catheter coils up inside the aneurysm, disrupts the blood flow and causes the blood to clot. This clotting seals off the aneurysm from the artery.
Artery occlusion and bypass: If clipping or coiling is not an option due to aneurysm size, location, or perforating vessels, a bypass may be done and the aneurysm safely blocked. In a bypass, blood flow can be redirected (bypassed) around the blocked artery. With the advent of newer endovascular techniques, this is seldom needed.
New devices provide greater options to treat challenging aneurysms. There are stents (metal mesh in the shape of a tube that can be placed inside a blood vessel), which can treat wide-neck aneurysms. They can be used in addition to the coils.
A Pipeline Embolization Device (PED) is a flexible, tube-shaped piece of mesh that is placed inside the artery, diverting blood up the artery away from the aneurysm. As blood flow slows in the aneurysm, it clots, sealing of the aneurysm. The device was approved for use in 2011 and has since been used with carefully selected patients to successfully treat large and difficult to access aneurysms.
Brain Aneurysm Facts
» Approximately 6 million people in the U.S. have
an unruptured brain aneurysm, or 1 in 50.
» Approximately 30,000 people in the U.S. suffer a ruptured brain aneurysm each year.
» Brain aneurysms are fatal in about 40 percent of all cases.
» Of the survivors, approximately 66 percent will have some permanent disability.
» Ruptured brain aneurysms account for 3 to 5 percent of all first-time strokes.