Thursday, June 16, 2022

Do Brain Aneurysms Go Away

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Unruptured Brain Aneurysm Symptoms And Diagnosis

Do Aortic Aneurysms Go Away or Heal On Their Own

Approximately 2 to 5 percent of the population have aneurysms and, if it doesnt rupture, most people only find it by chance. Most unruptured brain aneurysms do not cause any symptoms. Some people discover them in a brain scan that they receive for a different reason, such as a head injury or headaches.

Doctors dont fully understand what causes brain aneurysms to form, but a few factors increase the risk of developing one:

  • Smoking
  • High blood pressure
  • Family history of aneurysms

Your doctor may recommend screening if you have two or more family members who have had a brain aneurysm.

What Is A Brain Aneurysm

A brain aneurysm is a bulge in a weak area of a blood vessel in or around your brain. The constant pressure of blood flow pushes the weakened section outward, creating a blister-like bump.

When blood rushes into this bulge, the aneurysm stretches even further. Its similar to how a balloon gets thinner and is more likely to pop as it fills with air. If the aneurysm leaks or ruptures , it causes bleeding in your brain. Sometimes it causes a hemorrhagic stroke, bleeding in or around the brain that can lead to brain damage and be fatal.

These aneurysms are also called cerebral aneurysms. Cerebral means in the brain.

Treating An Unruptured Brain Aneurysm

We have two different paths we can follow for a patient who has an aneurysm that hasnt burst, explains Dr. Ludwig.

  • Wait and watch. If your aneurysm is in a very low risk category , it is unlikely to cause future problems. Well watch it to make sure it isnt growing, but statistics show that many small aneurysms dont need to be treated. You can live your entire life with one and never have an issue, Dr. Ludwig says.
  • Surgery to repair the brain aneurysm. If the aneurysm is large, in a dangerous location, or doctors believe the risk of rupture is significant, surgery is typically recommended. The most common surgery, according to Dr. Ludwig, locates and repairs the bulge by going through an artery in the leg or arm. Surgery blocks the blood flow to the aneurysm, he says. The surgery requires only a one-day hospital stay and many patients return to work within three days with one very small incision to show for it.
  • Less common is a surgical treatment for brain aneurysms that requires opening the skull and making the repair. Both procedures are still done it just depends on specific characteristics of the aneurysm as to which surgery would be best, says Dr. Ludwig.

    Thanks to technology that evolves at light speed Dr. Ludwig says surgeries increasingly are becoming easier and safer. We started using one new device, a pre-shaped intra-aneurysmal mesh, as soon as the FDA approved it. We were the first in Dayton to use it.

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    What Is A Cerebral Aneurysm

    A cerebral aneurysm is a weak or thin spot on an artery in the brain that balloons or bulges out and fills with blood. The bulging aneurysm can put pressure on the nerves or brain tissue. It may also burst or rupture, spilling blood into the surrounding tissue . A ruptured aneurysm can cause serious health problems such as hemorrhagic stroke, brain damage, coma, and even death.

    Some cerebral aneurysms, particularly those that are very small, do not bleed or cause other problems. These types of aneurysms are usually detected during imaging tests for other medical conditions. Cerebral aneurysms can occur anywhere in the brain, but most form in the major arteries along the base of the skull.

    Brain aneurysms can occur in anyone and at any age. They are most common in adults between the ages of 30 and 60 and are more common in women than in men. People with certain inherited disorders are also at higher risk.

    All cerebral aneurysms have the potential to rupture and cause bleeding within the brain or surrounding area. Approximately 30,000 Americans per year suffer a brain aneurysm rupture. Much less is known about how many people have cerebral aneurysms, since they dont always cause symptoms. There are no proven statistics but a consensus of scientific papers indicate that between 3 and 5 percent of Americans may have an aneurysm in their lifetime.

    What Treatments Are Available

    What is a brain aneurysm? Symptoms, causes, treatment and more

    Observation Sometimes the best treatment may be to simply watch the aneurysm over time and reduce your risk of rupture. You should quit smoking, and control high blood pressure. Aneurysms that are small, unruptured, and asymptomatic may be observed with imaging scans every year until the growth or symptoms necessitate surgery. Observation may be the best option for patients with other health conditions.

    Surgical clipping Clipping is an open surgery performed under general anesthesia. An opening is cut in the skull, called a craniotomy. The brain is gently retracted so that the artery with the aneurysm may be located. A small clip is placed across the neck of the aneurysm to block the normal blood flow from entering the aneurysm . The clip is made of titanium and remains on the artery permanently. Recovery time typically is four to six weeks, but symptoms may last longer.

    Artery occlusion and bypassIf the aneurysm is large and inaccessible or the artery is too damaged, the surgeon may perform a bypass surgery. A craniotomy is cut to open the skull and clips are placed to completely block off the artery and aneurysm. The blood flow is then rerouted around the occluded artery by inserting a vessel graft . The graft is a small artery, usually taken from your leg, which is connected above and below the blocked artery so that blood flows through the graft.

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    What Are The Chances Of Surviving A Brain Aneurysm

    People can go their entire lives not knowing they have an unruptured brain aneurysm. As long as its intact, your odds are good. But there is a risk that the brain aneurysm will rupture, which depends on many factors, including aneurysm size, location and several others. If an aneurysm does rupture, it leaks blood into the space surrounding your brain and sometimes into the brain tissue itself, causing a hemorrhagic stroke.

    A ruptured brain aneurysm requires emergency medical treatment. As more time passes with a ruptured aneurysm, the likelihood of death or disability increases. About 75% of people with a ruptured brain aneurysm survive longer than 24 hours. A quarter of the survivors, though, may have life-ending complications within six months.

    Who Performs The Procedure

    Surgical clipping of a cerebral aneurysm is always performed by a neurosurgeon, often one with expertise in cerebrovascular disease. Most cerebrovascular neurosurgeons have had five to seven years of general neurosurgery training and an additional one to two years of specialized cerebrovascular training.

    Endovascular coiling is done either by a neurosurgeon or by an interventional neuroradiologist. An interventional radiologist has undergone extensive training in both radiology and interventional procedures involving the brain and spinal cord. All neurosurgeons that perform endovascular coiling have undergone additional training in endovascular techniques in addition to full neurosurgery training .

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    What Is The Outcome Of Brain Aneurysm

    Brain aneurysms are deadly. About 10% of patients with a ruptured aneurysm die before receiving medical care. If untreated, another 50% will die within a month, with a 20% risk of rebleed by the end of the first two weeks. Aside from the bleeding issues, there is significant risk of artery spasm leading to stroke.

    Survival rates are increased in patients who present early to the hospital. Early diagnosis, aneursym repair, and control of blood vessel spasms with appropriate medications are all associated with increased survival.

    What Are The Symptoms Of An Unruptured Brain Aneurysm

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    The most common signs of an intact aneurysm are headaches. Other signs may include:

    • Vision changes.
    • MRA .
    • CTA .

    Occasionally, a ruptured aneurysm may not show on the initial imaging test. If your symptoms point to a ruptured aneurysm, your doctor may order a lumbar puncture . This test shows whether theres blood in the fluid surrounding your brain.

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    Why The Procedure Is Performed

    If an aneurysm in the brain breaks open , it is an emergency that needs medical treatment in the hospital. Often a rupture is treated with surgery, especially endovascular surgery.

    A person may have an unruptured aneurysm without any symptoms. This kind of aneurysm may be found when an MRI or CT scan of the brain is done for another reason.

    • Not all aneurysms need to be treated right away. Aneurysms that have never bled, especially if they are very small , do not need to be treated right away. These very small aneurysms are less likely to rupture.
    • Your surgeon will help you decide whether it is safer to have surgery to block off the aneurysm before it can break open or to monitor the aneurysm with repeated imaging until surgery becomes necessary. Some small aneurysms will never need surgery.

    How Are Aneurysms Treated

    With important medical advances throughout the neurosurgical, neurological and endovascular fields, treatment for brain aneurysms is more promising than it was several years ago.

    There are more effective and less invasive treatment options for patients, who in years past, would have been told they had inoperable aneurysms. Doctors consider several factors when deciding which treatment option is best for a particular patient. These include size, location, and type of aneurysm ruptured versus unruptured condition of the patient and medical history.

    Two surgical and one endovascular options are available for treating brain aneurysms, all of which carry some risk to the patient . Options are described below:

    Microvascular clipping involves cutting off the flow of blood to the aneurysm. Under anesthesia, a section of the skull is removed and the aneurysm is located. The neurosurgeon uses a microscope to isolate the blood vessel that feeds the aneurysm and places a small, metal, clothespin-like clip on the aneurysms neck, halting its blood supply. The clip remains in the patient and prevents the risk of future bleeding. The piece of the skull is then replaced and the scalp is closed. Clipping has been shown to be highly effective, depending on the location, shape, and size of the aneurysm. In general, aneurysms that are completely clipped surgically do not return.

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    Getting Ready For The Treatment Or Surgery

    Depending on the analysis results, the doctor will inform about the treatment or the surgical procedure in detail. It is necessary to follow the instructions to ensure that the individual is ready for the treatment or surgery. About 80% of the cases involve correction of the diet and placing the patient under observation. It is because not all aneurysms rupture leading to the requirement of surgery.

    What Are The Symptoms Of Brain Aneurysm

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    Many people have a brain aneurysm without realising it. It may only be found when the person has a brain scan for another reason. Usually there are no symptoms. Sometimes, if the aneurysm becomes very large, it can cause pain behind the eyes, numbness, weakness, vision changes or paralysis on the side of the face.

    When an aneurysm bursts, it causes a sudden and extremely bad headache.

    Other symptoms of a burst aneurysm include:

    • double vision or sensitivity to light
    • loss of consciousness
    • cardiac arrest

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    Researching The Future Of Aneurysm Treatments

    At U-M we are on the cutting edge of research into aneurysms and related disorders, and are currently studying how to make better coils, evaluating how different coils work and how aneurysms heal with them. We are dedicated to bringing the latest in research, diagnosis and treatment to aneurysm and subarachnoid hemorrhage patients.

    What Is The Brain Aneurysm Survival Rate

    About six million US citizens have a silent brain aneurysm that hasn’t ruptured. This amounts to about 1 in 50 individuals. These people are usually safe and don’t know they have an aneurysm. A few cases of brain aneurysm can rupture and this is when the brain aneurysm rate goes way down.

    About 8 to 10 individuals per 100,000 in the US will have their aneurysm break open. This is a rate of about one rupture every 18 minutes. When the brain aneurysm ruptures, about 40 percent of the time, the rupture is fatal. Those that do not die generally have some permanent brain damage or residual deficits at a rate of about 66 percent.

    When the brain aneurysm ruptures, it leads to a subarachnoid hemorrhage, which is a very dangerous condition and which decreases the brain aneurysm survival rate. About 15 percent of these people never make it alive to the hospital. Instead, there is significant bleeding and brain injury that can’t be fixed with medicines or surgery.

    Your age and your usual state of health, along with the location and size of the aneurysm, will affect survival rate of brain aneurysm largely.

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    How Is Brain Aneurysm Treated

    Treatment of an unruptured aneurysm may depend on its size and location. If the aneurysm is very small, you will probably be recommended to have regular scans to monitor it, and treatment for any other conditions, such as high blood pressure.

    If you have had a burst aneurysm, you will be told to stay in bed and to take pain relief medication for any pain you might have. You will then have surgery to clip the aneurysm so that it does not bleed again.

    Another type of surgery involves threading a thin tube through the artery from the groin and using it to insert a tiny metal coil into the aneurysm. This causes a blood clot, which prevents the aneurysm from bursting.

    If the aneurysm caused a brain haemorrhage, you may need other treatments for complications, such as reduced blood flow to the brain or fluid on the brain.

    Discovering You Have An Aneurysm

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    If you complain of double vision, headaches, pain behind your eyes, or partial paralysis of your face, your doctor likely will test for a brain aneurysm. Sometimes aneurysms are discovered when doctors are running tests for another condition.

    When aneurysms are small and not pushing on the brain or nerves, you may not have any symptoms, says Bryan Ludwig, MD, with the Clinical Neuroscience Institute. We find the aneurysm when were examining the patient for other reasons, so the news is a complete surprise, he says.

    If you have multiple risk factors that make you more likely to have a brain aneurysm, your doctor may want to screen for one. Family history, especially if a first-degree relative had a ruptured aneurysm, would be a reason to check, Dr. Ludwig explains. Other risk factors are high blood pressure, smoking, drug abuse, and advancing age.

    Ruptured aneurysms near the brain can cause the worst headache in your life, says Dr. Ludwig. But with an unruptured aneurysm, you may not have a headache at all. Its a big distinction.

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    Risk Factors For Aneurysm Rupture

    Some aneurysms will never rupture. However, there are also risk factors that can increase the chance of a ruptured aneurysm.

    Some risk factors for rupture are associated with the characteristics of the aneurysm itself. Risk of rupture is raised in brain aneurysms that are:

    • large
    • have grown larger over time
    • located in certain arteries, specifically the posterior communicating arteries and the anterior communicating arteries

    Individual factors that increase the risk of rupture include:

    • having a personal or family history of ruptured aneurysms
    • having high blood pressure

    Safety And Common Complications

    Although the frequencies of certain complications vary according to the intervention, both clipping and coiling share the same complications. Rupture of the aneurysm is one of the most serious complications seen in either procedure. Exact frequencies of ruptures are not well documented, but reported rupture rates range from 2 percent to 3 percent for both coiling and clipping. Rupture can cause massive intracerebral hemorrhage and subsequent coma or death. Although rupture can have catastrophic consequences during either procedure, surgery probably provides a better opportunity to control hemorrhage because of direct access to the ruptured aneurysm and the supplying vessels.

    Ischemic stroke is another serious complication frequently encountered in both clipping and coiling. The pattern and distribution of strokes varies according to the aneurysm location and procedure type.

    The actual length of the procedure, the associated risks, the projected recovery time and the expected prognosis depend on both the location of the aneurysm, the presence/severity of hemorrhage and the patients underlying medical condition. Therefore, each individual case should be discussed with the treating neurosurgeon/physician.

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    Diagnosing A Brain Aneurysm

    A CT scan of the brain is typically the first step in diagnosing an aneurysm or subarachnoid hemorrhage. If only a small amount of blood has leaked, the test may come back negative. In this case, a spinal tap may be done to see how much blood has mixed with the cerebrospinal fluid. If we diagnose an aneurysm, a cerebral angiogram is performed to better understand the aneurysm. During this procedure, dye is injected into your bloodstream and x-rays are taken, which will give our team information on how to best treat your condition. When an abnormality is detected through the imaging study our team of interventional radiologists and neurosurgeons discuss the patient case as a team. We examine clinical issues and plans for treatment together which ensures our patients receive the optimal treatment for their particular situation.

    What Are Future Directions For The Treatment Of Brain Aneurysm

    What Is A Ruptured Brain Aneurysm

    For those who survive an initial aneurysm rupture, blood vessel spasm may be the villain in causing continued brain damage. Experiments to develop new drugs to control vasospasm are ongoing. Molecules that can cause spasm are being identified, and antibodies may be able to be produced to blunt their effect.

    Studies are also looking at the possibility that brain aneurysms may be hereditary, and perhaps screening of high-risk populations may be possible in the future.

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