A cerebral aneurysm is a permanent dilation in one of the blood vessels that carries blood to the brain. When this happens, the dilated portion usually has a thinner wall and, therefore, there is a high risk of a ruptured aneurysm. When a brain aneurysm ruptures, it always causes bleeding that is more or less severe according to the size and amount of blood leaking into the skull.
The most common symptom of a brain aneurysm arises when it ruptures, and is characterized by a extremely intense headache that can arise suddenly or that increases with the passing of time. The feeling that the head is warm and that there is a 'leak' and that it seems that the blood has spread also happens in some people.
Although genetic factors are involved in the causes of an aneurysm, uncontrolled high blood pressure greatly increases the risk of developing a brain aneurysm.
The brain aneurysm can be cured, depending on where you are. But usually, the doctor prefers to indicate a treatment that helps regulate blood pressure, for example, reducing the chances of it rupturing. Surgery is used more often for cases of ruptured aneurysms, but may be indicated to treat specific aneurysms, depending on their location and size, so as to prevent their rupture. This can also be done through an endovascular procedure such as a catheterization, where a stent is placed that protects the vessel, diverting blood flow from the region of the aneurysm, then protecting the vessel from a rupture.
Usually an aneurysm does not cause any symptoms, being accidentally identified in a diagnostic test to the head, such as computed tomography. However, some people with an aneurysm may show signs like constant pain behind the eye, dilated pupils, double vision or tingling in the face.
The most common symptoms normally only arise when the aneurysm ruptures or is leaking. In these cases the symptoms are:
- Very severe and sudden headache that worsens over time;
- Nausea and vomiting;
- Hard neck;
- Double vision;
When these symptoms arise, and whenever there is suspicion of a ruptured aneurysm, it is very important to immediately call for medical help by calling 911 (USA) or 999 (UK), or taking the person immediately to the hospital, to initiate appropriate treatment.
There are also other problems that can cause similar symptoms, such as migraine. So if the headache is severe and appears very often, you should see a general practitioner or a neurologist to identify the correct cause and start the most appropriate treatment.
How to confirm the diagnosis
Generally, to confirm the presence of a cerebral aneurysm the doctor needs to request diagnostic tests to evaluate the brains structures and to identify if there is any dilatation in the blood vessels. Some of the most commonly used tests include computed tomography, magnetic resonance imaging, or cerebral angiography, for example.
What can cause an aneurysm
The exact causes that may lead to the development of a brain aneurysm are not yet known, however, some factors appear to increase the risk include:
- Being a smoker;
- Having uncontrolled high blood pressure;
- Using drugs, especially cocaine;
- Consuming excessive alcoholic beverages;
- Having a family history of brain aneurysms.
In addition, some diseases that are present at birth may also increase the tendency to have an aneurysm, such as polycystic ovary disease, narrowing of the aorta or cerebral malformation.
How is the treatment done
The treatment for an aneurysm is quite variable and may depend not only on the patient's history but also on the size of the aneurysm and whether or not it is leaking. Therefore, the most commonly used treatments include:
1. Unruptured aneurysm
Most of the time, doctors choose not to treat unruptured aneurysms, because the risk of them rupturing during surgery is very high. Therefore, it is normal to do a regular assessment of the size of the dilatation to ensure that the aneurysm is not increasing in size.
In addition, medication may be prescribed to relieve some of the symptoms, like headaches, using Paracetamol, Dipyrone, Ibuprofen, or Levetiracetam, to control the onset of seizures, for example.
However, in some cases the neurologist may choose to perform endovascular surgery with stent placement in order to prevent rupture, but because it is a very delicate procedure due to the risk of it rupturing during the procedure, it must be very well evaluated and the risks must be well explained to the patient and the family.
2. Ruptured aneurysm
When an aneurysm ruptures, it is a medical emergency and so you should go to the hospital immediately to start the proper treatment, which is usually done with surgery to close the vessel that is bleeding inside the brain. The sooner the treatment is done, the less likely it is to develop lesions for a lifetime, as the area of the brain affected will become smaller. When the aneurysm ruptures, it causes symptoms similar to a hemorrhagic stroke.
A brain aneurysm can cause bleeding between the brain and the meninges that cover it, and in this case the bleeding is called the subarachnoid, or it can cause a bleed called intracerebral, which is the bleeding that happens in the middle of the brain.
After an aneurysm the person may have no lesions, but some may have neurological changes similar to those of a stroke, such as difficulty lifting an arm due to lack of strength, difficulty speaking or slow thinking. People who have had an aneurysm have a greater risk of suffering a new one.