Cerebral Aneurysm

Heard of Aditya Dev? He was a famous Indian bodybuilder, entertainer, and dancer with dwarfism. He was recognized in 2006 as “the world’s smallest body builder” but lost his life at the age of 23 in 2013 after fighting with a brain aneurysm.

A cerebral aneurysm is a weak or thin spot on the wall of the artery that supplies blood to the brain. A bulging aneurysm puts pressure on the nerve surrounding the brain tissue. Sometimes, it may also rupture and leak, spill blood into the brain (subarachnoid hemorrhage) that eventually results in a stroke. This condition requires immediate treatment as it quickly becomes life-threatening. The most common location of brain aneurysms is in the network of blood vessels at the base of the brain called as a circle of Willis. Appropriate and immediate treatment in some cases may prevent the risk of rupture in future.

It is estimated that nearly 15% of patients with aneurysmal subarachnoid hemorrhage die before reaching the hospital.

 

Cerebral Aneurysm Causes

Aneurysms develop due to thinning of arterial walls. Aneurysms often form at the branches of the arteries as those sections of the vessels are weaker and commonly occur in arteries at the base of the brain.

Cerebral Aneurysm Symptoms

Most brain aneurysms do not show symptoms till the very last stage. The symptoms often come suddenly and depend on the areas of the brain affected. The common symptoms include pain above and behind the eye, numbness, weakness and paralysis on one side of the face, dilated pupil and vision changes.

When an aneurysm hemorrhages, following symptoms are seen:

  • Sudden and severe headache
  • Double vision
  • Nausea and vomiting
  • Loss of consciousness
  • Change in mental status
  • Seizures (rare)

Risk factors

People with a family history of brain aneurysms, elderly people, women, smokers (increase brain rupturing), and people with hypertension are more likely to have an aneurysm.

The risk factors present at birth include:

  • Inherited connective tissue disorders such as Ehlers-Danos syndrome weakens the blood vessels.
  • Polycystic kidney disease results in fluid-filled sacs in the kidneys and increases blood pressure.
  • Cerebral arteriovenous malformation, an abnormal connection between arteries and veins in the brain interrupts the normal flow of blood between them.

Complications

Rupturing and bleeding in a brain aneurysm usually, lasts only for few seconds but can cause severe damage or even kill the surrounding cells. It also increases the pressure inside the skull causing disruption of blood and oxygen supply, eventually leading to loss of consciousness or death.

Complications that usually develop after the rupture of an aneurysm include rebleeding, vasospasm (narrowing of blood vessels), hydrocephalus, and hyponatremia (low sodium levels in the blood).

If you experience a severe headache or other symptoms related to a ruptured aneurysm, consult the doctor immediately. As unruptured brain aneurysms do not cause any symptoms, only tests can detect the condition. The diagnostic tests include

  • Computed tomography (CT) scan : This is a specialized X-ray exam and the first test to determine bleeding in the brain. The test produces 2-D slices/images of the brain.

  • Computed tomography angiogram (CTA) scan : This test is the more precise method of evaluating blood vessels than a standard CT scan. The test uses a combination of CT scanning, special computer techniques, and contrast material (dye) that is injected into the blood to produce images of the blood vessels.

  • Magnetic resonance imaging (MRI) : This test is similar to CTA and uses a magnetic field and radio waves to create detailed images (2D or 3D) of the brain.

  • Cerebral angiogram : This is an X-ray test in which a catheter is inserted into a blood vessel in the groin to reach the affected area. A dye is then injected into the cerebral artery. A series of images then reveals the details about the conditions of arteries and the site of the ruptured aneurysm.

Not all the cerebral aneurysm burst. Two treatment options are highly considered.

Medications: Medications are recommended for relieving symptoms and complications.

  • Pain relievers (e.g., Acetaminophen)
  • Calcium channel blockers (e.g., Nimodipine) – to prevent calcium from entering the blood vessels and prevent narrowing
  • Antiseizure medications (e.g., Levetiracetam, phenytoin, and valproic acid)
Surgery

Surgical clipping: A section of your skull is removed to assess the aneurysm and locate the damaged blood vessel. A tiny metal clip is then placed on the neck of the aneurysm to stop blood flow.

Endovascular coiling: The surgeon inserts a hollow plastic tube into the artery, usually the groin and threads it through the body to reach the affected part. A soft platinum wire is pushed through the catheter into the aneurysm. This wire coils and disrupts the blood flow and causes the blood to clot, which seals off the blood from the artery.

You may lower the risk of rupturing brain aneurysm by making few lifestyle changes:

  • Don’t smoke or use recreational drugs.
  • Eat a healthy diet and exercise regularly.
  • Limit caffeine intake as it may cause a sudden increase in blood pressure.
  • Avoid straining caused by lifting the heavy weight which increases the blood pressure.

FAQ- Cerebral Aneurysm

Aneurysms often form at the branches of the arteries as those sections of the vessels are weaker and commonly occur in arteries at the base of the brain. Aneurysms develop due to thinning of arterial walls.

Signs & Symptoms of cerebral aneurysm are Sudden and severe headache, Double vision, Nausea and vomiting, Loss of consciousness, Change in mental status, Seizures (rare), Risk factors