A brain aneurysm is a bulge or ballooning in the blood vessel of the brain which may leak or rupture, causing bleeding into the brain which is called subarachnoid hemorrhage.
The brain aneurysms result from a combination of hemodynamic stresses and acquired degenerative changes within the arterial wall. There are some predisposing factors for aneurysms like Adult polycystic kidney disease or marfan’s syndrome. The bifurcations of brain arteries may develop weak spots which can balloon out and fill with blood. These blood filled outpourings from arterial wall are called aneurysms. There are other rare causes of aneurysms like infections of the arterial wall, tumors, trauma and drug abuse, especially cocaine.
Brain aneurysms are a relatively more common occurrence than one would think, most aneurysms, though, remain small and are never diagnosed. Most of the brain aneurysms present with SAH. (bleed in the lining of the brain due to rupture of the aneurysms). Some, however, may gradually become larger and exert pressure on surrounding brain tissue and nerves and may be diagnosed because of stroke-like symptoms including like headache, weakness/numbness of one side of the face, vision disturbances or a dilated pupil.
The symptoms and warning signs of an aneurysm vary based on whether it’s ruptured or not. Symptoms of a ruptured aneurysm include sudden, severe headache, “the worst headache of my life”, vomiting, neck pain, double vision, drooping eyelid, altered mental state, unconsciousness, convulsions.
An unruptured aneurysm may present with headache, blurred or double vision, weakness of any half of the body or stroke like symptoms.
Ruptured aneurysms are medical emergencies. There is high risk of re-rupture of ruptured aneurysm in the first two weeks of initial rupture which may be fatal.
Unless an aneurysm ruptures, it may be difficult to diagnose the condition. CT and MRI scans help to confirm brain hemorrhage. Cerebral angiograms (DSA)help to locate the aneurysm. it is the gold standard test for aneurysm diagnosis.
The treatment of a brain aneurysm depends on many factors like its location, size, cause and major risk factors in the particular case. The ultimate goal is two fold – to prevent re- rupture and management of effects of Subarachnoid hemorrhage.
Management of Aneurysm: There are two common treatment procedures for a ruptured brain aneurysm – Surgical Clipping and Endovascular Coiling.
Endovascular coiling is a minimally invasive brain surgery performed through a small hole in the groin. A catheter is inserted into an artery in your groin from where it is threaded to the site of the aneurysm. Multiple coils are placed within the aneurysm sac disrupting the blood flow into the aneurysm and thus preventing rupture. Endovascular treatment can be performed using multiple technique. They are Balloon assisted coiling, Stent assisted coiling, multiple different configuration of stents like X, Y etc., Telescoping stents, Flow Diverters with or without coils, Newer devices like WEB.
Flow diverters are a recent addition to the armamentarium of endovascular Therapy of Aneurysms leading to long term stable occlusions of Qneurysms especially the Giant Aneuryrsms.
Management of Effects of SAH:
Vasospasm is an important effect of SAH leading to narrowing of the arteries of the Brain. It can be managed by infusion of certain chemicals into the brain arteries using endovascular techniques.
In cases of unruptured brain aneurysms, the need for one of the above procedures will depend on several factors and the ultimate decision will be taken by your doctor. Adequate blood pressure control, smoking and other recreational drugs cessation, will also help reduce the risk of rupture in a case of unruptured brain aneurysm.