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How Common Are Brain Aneurysms

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Recovery After An Aneurysm Rupture

What are Brain Aneurysms and How Common are They?

Though an aneurysm rupturing is an emergency, if people get treated quickly, many can go back to their normal lives shortly after, Levitt says.

How well someone recovers depends on a few different factors. If the person didnt lose consciousness, they have a better chance of responding well to treatment. Being treated at a hospital that quickly recognizes the problem and has doctors who are experts at treating aneurysms is also helpful.

People who are younger or who dont have other medical conditions stand a better chance as well, Levitt says.

You can completely recover from an aneurysm rupture. We see it all the time, he says.

Levitt estimates around 20% of people who have an aneurysm will get another, like what happened to Clarke, but that doesnt mean the second one will ever rupture.

How Is Brain Aneurysm Diagnosed

A brain aneurysm is often found during a brain scan such as CT scan or an MRI. These scans or other scans may also be done if the aneurysm bursts, to show where the bleeding is.

Sometimes your doctor might do a lumbar puncture, which involves taking a sample of the fluid that surrounds your brain and spinal cord by inserting a thin needle into your back. This is to confirm whether you have a subarachnoid haemorrhage.

Sometimes you will have an angiogram, where a thin tube, inserted into your artery along with a special dye, is used to provide detailed information about the aneurysm.

How Are Aneurysms Treated

The modern treatment of aneurysms include surgical clipping, endovascular coiling, floater diversion, vessel sacrifice and observation of the aneurysm. . The selection of therapy depends upon multiple factors including patient’s age, disease state, medical conditions, aneurysm size and location.

Figure 3. Before Treatment: Hemorrhagic stroke from ruptured intracranial aneurysm.

Figure 4. After Treatment: Bleeding is arrested using detachable coil.

Figure 5. Detachable coil filling aneurysm.

Endovascular occlusion of aneurysms includes the use of detachable coils. This is a angiographic procedure where a small soft catheter is introduced into the blood vessel from the leg artery. From there the catheter is carefully threaded up into the brain and the tip of the catheter is placed in the aneurysm . Then through the catheter small soft coils are introduced into the aneurysm to block it completely .

Figure 6. The catheter is carefully threaded up into the brain.

Figure 7. Endovascular occlusion of aneurysms includes the use of detachable coils.

This technique of treating aneurysms with coils was invented at UCLA in 1990 and the first patient in the world was treated here in 1991. Since then, more than 1300 patients have been treated with this technique at UCLA.

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Unruptured Aneurysms & Ruptured Aneurysms

Most brain aneurysms form without any symptoms. An unruptured brain aneurysm may be found during brain imaging such as an MRI when a patient is being screened for another condition. If an aneurysm is discovered, it’s important to see a neurosurgeon who is an expert in diagnosing, managing, and treating brain aneurysms. Certain people may be at a higher risk for brain aneurysm. If you discover that you are at a high risk, it’s important to discuss screening tests with your doctor.

A ruptured brain aneurysm is a serious condition and requires immediate medical attention. Symptoms of a ruptured aneurysm most often include sudden onset of a severe headache most patients describe as the worst headache they have felt in their life.

Coping With Changes After A Brain Aneurysm

Cerebral Aneurysm Stock Vector

A brain aneurysm can have a variety of effects depending on how much blood there is and the damage it does to the brain tissue or other arteries. There can be changes to cognitive and physical abilities, vision, balance, and more. Its important to keep in mind that treating the brain aneurysm will not reverse the effects it has caused.

That means that once youre in recovery, you may have to learn new ways to complete activities of daily living .

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What Causes A Cerebral Aneurysm

Cerebral aneurysms form when the walls of the arteries in the brain become thin and weaken. Aneurysms typically form at branch points in arteries because these sections are the weakest. Occasionally, cerebral aneurysms may be present from birth, usually resulting from an abnormality in an artery wall.

Risk factors for developing an aneurysm

Sometimes cerebral aneurysms are the result of inherited risk factors, including:

  • genetic connective tissue disorders that weaken artery walls
  • polycystic kidney disease
  • arteriovenous malformations
  • history of aneurysm in a first-degree family member .

Other risk factors develop over time and include:

  • untreated high blood pressure
  • cigarette smoking
  • drug abuse, especially cocaine or amphetamines, which raise blood pressure to dangerous levels. Intravenous drug abuse is a cause of infectious mycotic aneurysms.
  • age over 40.

Less common risk factors include:

  • head trauma
  • brain tumor
  • infection in the arterial wall .

Additionally, high blood pressure, cigarette smoking, diabetes, and high cholesterol puts one at risk of atherosclerosis , which can increase the risk of developing a fusiform aneurysm.

Risk factors for an aneurysm to rupture

Not all aneurysms will rupture. Aneurysm characteristics such as size, location, and growth during follow-up evaluation may affect the risk that an aneurysm will rupture. In addition, medical conditions may influence aneurysm rupture.

Risk factors include:

Middle Cerebral Artery Aneurysms

Another common location for brain aneurysms is the MCA. In some patients, you cannot detect abnormalities by just comparing the patients left side to the right sidesince they can be symmetrically abnormal. In this patient, who presented with a diffuse subarachnoid hemorrhage, the CTA revealed an aneurysm arising from the left MCA that was confirmed on a DSA .

Despite the aneurysm arising on the patients left, the hemorrhage was symmetrical in the Sylvian fissures on an axial CT scan. While the distribution of a subarachnoid hemorrhage will occasionally help you find the aneurysm, do not depend on it as a reliable indicator for the bleeding site in patients with more than one aneurysm.

Figure 8. Computed tomography scan showing a diffuse subarachnoid hemorrhage that is symmetrical in the Sylvian fissures from a ruptured left middle cerebral artery , seen here on computed tomography angiography and confirmed on a digital subtraction angiography scan.

Nearly all ruptured aneurysms are found in adults, and the peak age for rupture is 49 years of age. Fusiform aneurysms are frequently secondary to atherosclerosis in adult patients and usually occur in the basilar artery or cavernous segment of the carotid.

However, you may see MCA fusiform aneurysms in young patients. When middle cerebral artery fusiform aneurysms occur in young patients, they have been called dysplastic aneurysms since their etiology and behavior can differ from the usual adult saccular aneurysm.

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What’s The Difference Between A Ruptured And An Unruptured Brain Aneurysm

A ruptured aneurysm, sometimes called a brain bleed, is when blood breaks through the aneurysm’s wall and starts bleeding. This causes severe symptoms, such as a very painful headache like you’ve never felt before, and requires immediate medical care. With rapid, expert treatment, patients can often recover fully.

An unruptured brain aneurysm may cause zero symptoms. People can live with them for years before detection. If a brain aneurysm is unruptured, no blood has broken through the blood vessel walls. This means the “balloon” in your blood vessel remains intact.

For unruptured brain aneurysms, doctors will treat aneurysms that are more likely to bleed and leave certain others alone.

Once a brain aneurysm bleeds, or ruptures, it requires immediate medical care in a medical center designed to handle emergencies. If you think you are experiencing a ruptured brain aneurysm, dial 911 immediately.

Neurosurgeons use specialized procedures to treat ruptured and unruptured brain aneurysms, when appropriate:

  • Microsurgical clipping: Neurosurgeons make a small opening in the skull and then place a titanium clip over the aneurysm to stop blood flow into the aneurysm.
  • Endovascular coiling/stenting: In this newer approach, neurosurgeons place a stent, or tube, or other devices, such as coils, inside a blood vessel or aneurysm to divert blood flow away from an aneurysm.

What Are The Symptoms Of Brain Aneurysm

Brain Aneurysm Overview Animation

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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What Are The Common Locations For Brain Aneurysms

There are six common locations of brain aneurysms that may be the cause of a subarachnoid hemorrhage:

  • Anterior communicating artery
  • Posterior inferior cerebellar artery
  • Middle cerebral artery bifurcation
  • Distal carotid artery apex
  • Since the anterior communicating artery and posterior communicating artery are the most common sites for aneurysm formation, you should start your search there when looking for a brain aneurysm on CT. Most aneurysms arise near the circle of Willis, the MCA bifurcation, and PICA origin.

    Figure 2. Illustration of the circle of Willis highlighting the common sites for an aneurysm.

    Dinr Statistics On Therapeutic Management Of Intracranial Aneurysms

    First aneurysm ever treated with GDC coils in March 6, 1990. Figures updated to June 20, 2012.

    PATIENTS

    Four hundred and twenty patients harboring small incidental aneurysms are being followed up with CTA every 6 months/year looking for aneurysm anatomical and/or morphological changes as sign of impending rupture.

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    Brain Aneurysm Treatment And Recovery

    An unruptured brain aneurysm is normally found during unrelated tests/screenings. A ruptured brain aneurysm will be diagnosed using computerized scans and dye tests. Once a ruptured brain injury is diagnosed, there are a few different treatment options. Doctors will recommend the one best suited to your situation based on factors such as age, location and severity of the aneurysm. These treatment options include:

    • Open surgery which enables the surgeon to place a clip around the base of the aneurysm, preventing blood from entering it
    • Endovascular surgery which happens within the blood vessels. Its a smaller, less-invasive surgery to implant shunts or coils

    Alternatively, doctors may recommend observation and spend more time monitoring the aneurysm.

    Aneurysms Rarely Arise From The Distal Segment Of A Cerebral Artery

    Brain Aneurysm: Causes, Symptoms, Diagnosis &  Treatment

    Nearly all aneurysms, both fusiform and saccular, appear on the proximal portion of the cerebral arteries. However, you may eventually encounter a patient with subarachnoid or parenchymal hemorrhages that are the result of an aneurysm arising from the distal segment of a cerebral artery.

    In our next patient case, the ruptured aneurysm was found beyond the circle of Willis and was unusual in both shape and location.

    Figure 11. A ruptured aneurysm arising from the distal segment of a cerebral artery.

    Distal aneurysms may be secondary to an infection caused by trauma, vasculitis, septic emboli from the heart , or tumor emboli from the heart. Distal aneurysms require further evaluation to properly determine their etiology.

    So, when assessing a brain scan for aneurysms, start your search at the most common sites for aneurysm formation, such as the anterior and posterior communicating artery origins. Remember to search thoroughly, since more than one aneurysm is detected in up to 20% of cases!

    Thats it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. Well help you make the right decisions for yourself and your patients.

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    How Is An Aneurysm Treated

    If your provider discovers that you have an unruptured aneurysm, they’ll monitor your condition closely. The goal of treatment is to prevent the aneurysm from bursting.

    Depending on the aneurysms type, location and size, treatment can include medication or surgery. Your provider may prescribe medications to improve blood flow, lower blood pressure or control cholesterol. These treatments can help slow aneurysm growth and reduce pressure on the artery wall.

    Large aneurysms at risk of bursting may require surgery. You’ll also need surgery if an aneurysm bursts. Types of surgery may include:

    Common Difficulties With Brain Aneurysms

    Perhaps the most troubling aspect of brain aneurysms is that many do not cause very noticeable symptoms. When they do cause symptoms, they often mimic the symptoms of other less serious conditions. Many brain aneurysms do not rupture and remain undetected unless the individual seeks medical testing for unrelated issues, such as persistent headaches or head trauma. Ultimately, it is possible for an individual to have a brain aneurysm and have no idea about the condition or its level of severity.

    When a doctor positively identifies an unruptured brain aneurysm, treatment may be appropriate to prevent the aneurysm from rupturing in the future. The type of treatment typically hinges on the patients overall health, the presence and severity of related symptoms, and the current size of the aneurysm.

    Some risk factors may encourage physicians to push for aneurysm screening in a patient. For example, a family history of brain aneurysms may spur a doctor treating a patient complaining of persistent headaches to screen for aneurysms. African Americans, Hispanics, and women also tend to experience brain aneurysms at higher rates than other groups. While most brain aneurysms develop over time without any single discernible cause, some health conditions can either cause or exacerbate brain aneurysms, such as hypertension.

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    What Happens When An Aneurysm Bursts

    If an aneurysm does burst, what happens next depends on how much it bleeds. Many times, aneurysms will rupture, bleed a little and then clot on their own. This often allows enough time for the person to get to the hospital and undergo emergency treatment to prevent further bleeding.

    If an aneurysm doesnt stop bleeding quickly, not much can be done, unfortunately too much bleeding will cause sudden death.

    For aneurysms that do stop bleeding, that doesnt mean the risk is averted, however its absolutely an emergency.

    Whats dangerous about leaving it untreated is the incidence of recurrent rupture is high, about 20% in the first two weeks. The mortality of re-rupture is as high as 80%, Levitt says.

    Because of this, all suspected aneurysms are treated as quickly as possible, he says.

    Posterior Communicating Artery Aneurysms

    What are the Symptoms of an Aneurysm?

    The second location where youll commonly find brain aneurysms is the PCoA. You should be able to locate the posterior communicating arteries that connect the internal carotid artery with the posterior circulation in patients with a complete circle of Willis. The posterior cerebral arteries can be seen curving around the midbrain on CTA and magnetic resonance angiography .

    Figure 4. A magnetic resonance angiography scan illustrating the location of the posterior communicating arteries as they connect the internal carotid arteries, with the posterior cerebral arteries , seen here curving around the midbrain.

    Lets take a look at a case

    When a 45-year-old patient presented with a severe headache and sensitivity to bright light , a CT was obtained in the emergency room. The CT demonstrated a diffuse subarachnoid hemorrhage filling the interpeduncular cistern, the ambient cisterns, and the Sylvian fissures. Additional imaging was ordered to determine if a ruptured aneurysm was the source of the hemorrhage.

    A volume-rendered CTA scan revealed a saccular aneurysm arising near the patients posterior communicating artery. This was confirmed on the digital subtraction angiography examination.

    Figure 5. Computed tomography , volume-rendered computed tomography angiography , and digital subtraction angiography scans demonstrating diffuse subarachnoid hemorrhaging caused by a ruptured posterior communicating artery.

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    What Are Future Directions For The Treatment Of 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.

    How We Care For Brain Aneurysms

    At Boston Childrens Hospital, our Cerebrovascular Surgery and Interventions Center cares for children and young adults with brain aneurysms and other conditions affecting the blood vessels in and around the brain and spine. The center uses minimally invasive as well as surgical techniques to find and treat these conditions before they cause bleeding or serious brain injury.

    If your childs aneurysm is small and doesnt pose an immediate health risk, a common course of treatment is to monitor it carefully. Should your child need surgery to treat a brain aneurysm, there are two common approaches to treatment:

    Endovascular treatment for an aneurysm involves a neurosurgeon and neurointerventional radiologist placing a hollow plastic tube into an artery and threading it through the body to the aneurysm. The surgeon then guides a wire through the catheter and into the aneurysm, where the wire coils up and seals off the artery supplying it with blood.

    Open surgery involves a neurosurgeon locating the blood vessel that feeds the aneurysm and placing a small metal clip on the neck of the aneurysm to stop the blood flow.

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    How Is A Brain Aneurysm Treated

    A ruptured aneurysm requires emergency treatment to decrease the likelihood that it will bleed again. Unruptured small aneurysms have low risk of rupture and generally can be monitored regularly. But as their size increases, so does the risk. Larger aneurysms generally are recommended for treatment. Overall, there are many factors that contribute to predicting the future risk of rupture that your neurosurgeon will synthesize together and weigh against your risks of treatment.

    The treatment goal for both ruptured and unruptured aneurysm is to reduce the risk of future rupture. This can be done through two ways:

    • Endovascular treatment is performed from within the blood vessel by threading a catheter through a blood vessel, up through the body guided by x-ray, to the aneurysm to provide treatment through processes known as coiling and stenting.
    • Surgical clipping is a more conventional surgery that requires a bony window in the skull to expose the aneurysm. The neurosurgeon, under a microscope, places a metal clip at the neck of the aneurysm to prevent blood flow into the aneurysm sac.

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