Cerebral Aneurysms
Cerebral (brain) aneurysm refers to an unusual dilation of a blood vessel surrounding the brain, sometimes resembling a balloon-like structure, where the entire blood vessel expands. These aneurysms are estimated to be present in 3-5% of the general population, with a higher occurrence in individuals older than 30 years old, and nearly double in frequency in women compared to men. When aneurysms rupture, they produce subarachnoid hemorrhage, or bleeding into the brain, which can be life-threatening, and sometimes devastating to neurological function. When aneurysms are detected before they rupture, treatment can be considered to prevent a future potential rupture. Treatment options consist of microsurgical clipping, and endovascular coiling and/or stenting. Each treatment option is tailored to the individual patient’s age, risk factors, and aneurysm configuration and location.
-
The precise cause of many cerebral aneurysms is not fully understood. Typically, aneurysms are believed to originate from a weakened section of the blood vessel wall. In some cases, aneurysms may be congenital defects in the lining of blood vessels, leading to ongoing enlargement throughout the person's life. A familial connection seems to exist in aneurysm development, with a higher incidence in first-degree relatives, particularly siblings. Rarely, multiple occurrences of aneurysms are reported.
-
In some cases, an expanding cerebral aneurysm can compress neighboring neurological structures, leading to symptoms such as facial pain, visual changes, or seizures. However, it is common for symptoms not to manifest until the aneurysm ruptures. The rupture of a cerebral aneurysm typically happens suddenly and without warning. Symptoms of a ruptured aneurysm can include loss of consciousness, severe headache accompanied by nausea or vomiting, stiff neck, numbness or reduced sensation in any part of the body, difficulty moving any part of the body, drooping eyelids, blurred vision, seizure, and/or changes in mental status.
-
Currently, 3-dimensional spiral CT angiography or magnetic resonance angiography (MRA) of the brain are the customary diagnostic procedures used for cerebral aneurysms. Cerebral angiography, which involves injecting dye into the bloodstream and capturing video x-rays of blood vessels, offers more precise images of the brain's blood vessels, often enabling visualization of the precise aneurysm location.
-
To effectively manage ruptured cerebral aneurysms, prompt medical attention is crucial. The primary aim is to stabilize the immediate symptoms and prevent further bleeding. Upon admission to the hospital, the patient's vital signs including blood pressure, respiration, and circulation are closely monitored and regulated. The location, size, and extent of the bleeding determine the course of treatment, which may involve the use of catheters similar to those used in cerebral angiography by a neuroradiologist. In some cases, the aneurysm can be occluded and bleeding stopped by the insertion of small metal coils or other inert materials through endovascular embolization. However, this approach achieves successful aneurysm occlusion in certain cases.