What is Cerebral Aneurysm?

A cerebral aneurysm is a weak or thin spot on a brain’s blood vessel that balloons out and fills with blood. This aneurysm can put pressure on a nerve or surrounding brain tissue or rupture, spilling blood into surrounding tissue (hemorrhage).

A cerebral aneurysm can occur anywhere in the brain, but most develop along arteries that run between the underside of the brain and the base of the skull. Some small cerebral aneurysms do not bleed or cause other problems and may be discovered on an imaging study for another condition.

Baptist Health is known for advanced, superior care in diagnosing and treating cerebral aneurysm. Our 24/7 inpatient neurology and neurosurgery services, as well as our outpatient and Home Health physical, occupational, cognitive and speech therapy services are available to help treat people with cerebral aneurysms. In addition, we have the region’s only advanced 3Tesla MRI, MRI spectroscopy and functional MRI technology to accurately diagnose all manner of neurologic disease, including cerebral aneurysm.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Symptoms of Cerebral Aneurysm? 

Cerebral aneurysm symptoms depend on if the aneurysm is ruptured or intact. Ruptured aneurysm symptoms may include:

• A drooping eyelid
• A sudden, very severe headache
• Blurred or double vision
• Confusion
• Loss of consciousness
• Nausea and/or vomiting
• Seizures
• Sensitivity to light
• Stiff neck

Intact aneurysms typically do not have symptoms and are most often discovered during tests for other conditions that may present with these symptoms:

• A dilated pupil
• A drooping eyelid
• Changes in vision/double vision
• Numbness, weakness or paralysis on one side of face
• Pain above and behind one eye

Diagnosis

To determine if someone has a cerebral aneurysm, we use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Cerebral angiogram: During this procedure, the physician inserts a thin, flexible catheter into a large artery — typically in the groin — and threads it past the heart to the arteries in the brain. He or she then injects a special dye into the catheter that travels to arteries throughout the brain. A series of X-ray images can then reveal details about the conditions of the arteries and the site of an aneurysm.

Cerebrospinal fluid test: The physician may order a test of the cerebrospinal fluid if symptoms of a ruptured aneurysm are present but a CT scan hasn’t shown evidence of bleeding. The procedure, which draws fluid from the spine with a needle, is called a lumbar puncture or spinal tap.

Computerized tomography (CT) scan: This test uses X-rays and computers to create images of the brain. A special CT scan called a CTA (CT angiogram) uses a special dye to highlight and visualize the blood vessels of the brain to find an aneurysm.

Magnetic resonance imaging (MRI): This test uses a powerful magnet and radio waves to produce images of the brain. A type of MRI that assesses the arteries in detail (MRI angiography) may detect and visualize an aneurysm.

Causes

Cerebral aneurysms develop as a result of thinning artery walls. Aneurysms often form at branches in arteries because those sections of the vessel are weaker. Cerebral aneurysm may be inherited or related to a disease or defect, but some lifestyle factors do increase the risk of developing one. They include:

• Drug abuse, especially cocaine use
• Hardening of the arteries (arteriosclerosis)
• Heavy alcohol consumption
• High blood pressure
• Smoking 

Risk Factors

Risk factors that may contribute to cerebral aneurysm include:

Abnormally narrow aorta: This birth defect, also known as coarctation of the aorta, means the large blood vessel that delivers oxygen-rich blood from the heart to the body is narrower than usual.
Aging: Most aneurysms develop in adults over the age of 40.

Cerebral arteriovenous malformation: This birth defect is an abnormal connection between arteries and veins in the brain which interrupts the normal flow of blood between them.

Family history of brain aneurysm: This risk sometimes runs in families, and a person may be more likely to develop an aneurysm particularly if a first-degree relative, such as a parent, brother or sister, had a brain aneurysm.

Gender: Women are more frequently affected. Lower estrogen levels after menopause may play a role.

Head injury: A traumatic injury may play a role in an aneurysm’s formation or rupture.

Inherited connective tissue disorders: Certain hereditary conditions, like Ehlers-Danlos syndrome or Marfan syndrome, can weaken blood vessels.

Polycystic kidney disease: This inherited disorder causes fluid-filled sacs to develop in the kidneys and increases blood pressure.

Prevention

There is no known way to prevent all types of cerebral aneurysm, but you can lower your risk by:

• Avoiding illegal drug use
• Eating healthy and maintaining a healthy weight
• Exercising regularly
• Getting regular check-ups
• Quitting smoking
• Reducing alcohol consumption

Prognosis

A person with an intact (unruptured) brain aneurysm has about a 1 percent or less chance of the aneurysm rupturing. Those with large aneurysms have a much higher risk of rupture. The survival rate for ruptured brain aneurysm is approximately 60 percent, and – for those who survive and recover – about two-thirds will have some permanent neurological defect or stroke.

Treatment and Recovery

Treatment for a cerebral aneurysm may include:

Medications

Common drugs prescribed to relieve symptoms and manage complications include:

• Anti-seizure medications
• Calcium channel blockers, which prevent narrowing spasms of blood vessel walls
• Injected drugs called vasopressors
• Pain relievers for headache

Monitoring

Surgical procedures can be used to seal off an intact (unruptured) brain aneurysm and help prevent a future rupture. But, in many cases, known risks of the procedures may outweigh the potential benefit. A neurosurgeon will determine if such procedures are appropriate. In the meantime, a physician may suggest monitoring through imaging scans and control of high blood pressure.

Rehabilitative Therapy

After a rupture, a person may need physical, speech and/or occupational therapy to relearn skills.

Surgical Procedures

Two common treatments for a ruptured cerebral aneurysm include:

• Endovascular coiling: During this procedure, the surgeon inserts a hollow plastic catheter into an artery, typically in the groin, and threads it through the body and to the aneurysm. He or she then pushes a soft platinum wire through the catheter and into the aneurysm. The wire coils inside, causing a blood clot and sealing the aneurysm.
• Surgical clipping: During this procedure, the surgeon removes a section of the skull to access the aneurysm and places a small metal clip on the neck of the aneurysm to stop blood flow.

Complications

Ruptured cerebral aneurysms can cause complications including:

Hydrocephalus: When an aneurysm rupture results in bleeding in the space between the brain and surrounding tissue, blood can block circulation of the fluid surrounding the brain and spinal cord. This can cause excessive accumulation of this fluid in the brain, leading to brain damage.

Hyponatremia: Hemorrhage from a ruptured brain aneurysm can disrupt the balance of sodium in the blood. This may occur from damage to the hypothalamus, an area near the base of the brain. A drop in blood sodium levels can lead to swelling of brain cells and permanent damage.

Re-bleeding: A ruptured aneurysm is at risk of bleeding again, causing further damage to the brain.

Vasospasm: After an aneurysm ruptures, blood vessels in the brain may narrow erratically. This condition can limit blood flow to brain cells, causing a stroke.