Brain Aneurysm: Symptoms, Causes & Treatment

A brain aneurysm is a bulge that forms in a weak area of a blood vessel wall in the brain. This bulge increases the risk of rupture, which can lead to a hemorrhagic stroke, permanent brain damage, or even coma or death, depending on the amount of bleeding and the area of the brain affected.

In most cases, an unruptured brain aneurysm does not cause any symptoms. However, when it ruptures, it can trigger a sudden, extremely severe headache that may worsen over time, along with nausea, vomiting, or loss of consciousness.

Treatment for a brain aneurysm is managed by a multidisciplinary team (including a neurologist, a neurosurgeon, and an interventional neuroradiologist) and may involve regular monitoring, medication, or surgery. Surgery is typically recommended when the aneurysm has already ruptured or is at high risk of rupture.

Brain aneurysm symptoms

The most common symptoms of a brain aneurysm include:

• Sudden and severe headache;

• Nausea or vomiting;

• Stiff neck or lower back pain when bending the neck;

• Blurred or double vision;

• Dilated pupils and/or drooping eyelids;

• Sensitivity to light;

• Drowsiness, confusion, loss of consciousness, or fainting;

• Seizures in some cases.

These symptoms usually appear when a brain aneurysm ruptures, causing bleeding in the brain. Some people may also describe a warm sensation in the head or a feeling that something is “leaking.”

In cases of small hemorrhages or leaky vessels, a person might experience sudden or intense headaches days or weeks before the aneurysm fully ruptures.

When these symptoms occur, it’s crucial to seek emergency medical care right away to start proper treatment. In many cases, though, a brain aneurysm causes no symptoms and is discovered incidentally during imaging tests done for other reasons.

Confirming a diagnosis

A brain aneurysm is diagnosed by a neurologist based on a clinical evaluation and imaging tests such as angiography, computed tomography (CT) angiography, or magnetic resonance imaging (MRI).

A CT scan is especially useful and highly sensitive when performed within six hours of the onset of symptoms. If the CT results are negative but the doctor still suspects a subarachnoid hemorrhage, a lumbar puncture may be ordered to analyze the cerebrospinal fluid that surrounds the brain and spinal cord.

What causes a brain aneurysm?

A brain aneurysm develops when the wall of an artery in the brain becomes weak or thin, causing it to bulge outward like a small balloon. This increases the risk of rupture and bleeding in the brain.

Risk factors that may increase the chances of developing a brain aneurysm include:

• High blood pressure;

• Smoking;

• Older age;

• Excessive alcohol use;

• Atherosclerosis;

• Use of drugs such as cocaine, methamphetamine, or amphetamines;

• Head injury or trauma;

• Family history of aneurysms.

Certain genetic conditions can also raise the risk of a brain aneurysm, such as polycystic kidney disease, tuberous sclerosis, Ehlers-Danlos syndrome, fibromuscular dysplasia, and congenital abnormalities in blood vessels of the brain.

Treatment options

Treatment for a brain aneurysm depends on its size, location, and severity.

1. Monitoring

Monitoring is recommended for small, unruptured aneurysms, for people with high surgical risk, or for aneurysms located in areas that are difficult to reach surgically. In these cases, doctors may suggest regular imaging tests to monitor whether the aneurysm is growing or changing shape.

Managing risk factors is also very important; this includes controlling blood pressure, maintaining a healthy diet, quitting smoking, and avoiding drug use, particularly cocaine.

2. Medication

Certain medications may be prescribed to help control blood pressure, lower the risk of stroke, and prevent seizures. These may include calcium channel blockers (such as nimodipine), anticonvulsants (such as levetiracetam), and antihypertensive drugs (such as beta-blockers or ACE inhibitors). All these medications should be prescribed and closely monitored by a doctor.

3. Surgery

In some cases, a neurosurgeon may recommend endovascular surgery, which involves placing a stent to prevent rupture.

Because this is a delicate procedure that carries a risk of rupture during the intervention, the potential risks and benefits must be carefully evaluated and discussed with the patient and their family.

Can a brain aneurysm be cured?

A brain aneurysm can often be successfully treated, depending on its size, severity, the chosen treatment method, and whether complications occur. In many cases, especially when surgical clipping is performed, there is potential for full recovery and a greatly reduced risk of the aneurysm recurring.

However, with other treatments such as endovascular coiling, there is a possibility that the aneurysm could reappear over time. For this reason, regular follow-up imaging is important to monitor for any changes and ensure the aneurysm remains stable.

Possible complications

A ruptured brain aneurysm can lead to several complications, including:

• Subdural hematoma;

• Hemorrhagic stroke;

• Permanent brain injury;

• Coma or death;

• Vasospasm;

• Hydrocephalus;

• Paralysis or loss of sensation in parts of the body or face.

After a rupture, some people may also experience speech difficulties, vision problems, memory and concentration issues, or seizures.

Rehabilitation may include physical, speech, and occupational therapy to help restore function and adapt to any long-term disabilities.

People who have already had a brain aneurysm also have a higher risk of developing another one in the future.