Discovering You Have An Aneurysm
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.
How Do I Decide What Procedure To Have If I Have A Cerebral Aneurysm
The treatment of choice for an intracranial aneurysm, like all medical decisions, should be agreed upon by both the physician and the patient. In the case of either ruptured or un-ruptured intracranial aneurysms, the treating physician should discuss the risks and benefits of each available treatment option. The physician will usually make recommendations for one treatment over another, depending on the facts of each individual case. Seeking a second opinion, when possible, is usually advisable.
Although unresolved controversies remain as to what the best treatment option is for an individual patient, both surgical clipping and endovascular coiling/stenting are considered to be viable treatment options in the management of cerebral aneurysms today.
How Can A Brain Aneurysm Growth Or New Aneurysm Formation Be Prevented
Once an aneurysm is found, it is not expected to resolve on its own. However, aneurysm growth, change, risk of aneurysm rupture, or new aneurysm formation can be reduced by having a healthy lifestyle. Steps you can take include:
- Exercise regularly without excessive heavy lifting.
- Eat a balanced diet.
- Get help for alcohol or drug use disorder and dont use cocaine or other stimulant drugs.
- Control high blood pressure with medications and lifestyle changes.
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Whos At Risk For A Brain Aneurysm
Brain aneurysms can affect anyone, but people with atherosclerosis are at high risk of forming brain aneurysms.
The Brain Aneurysm Foundation also states that brain aneurysms are most common in people between 35 and 60 years old. Women are more likely to get aneurysms than men due to low estrogen levels after menopause. If aneurysms run in your immediate family, your risk of having one is higher.
Other risk factors for brain aneurysms include:
- older age
If you have an aneurysm that is leaking, you may only experience a sudden, severe headache.
Seek emergency medical attention right away if you experience one or more of these symptoms.
How Are Cerebral Aneurysms Treated
Not all cerebral aneurysms require treatment. Some very small unruptured aneurysms that are not associated with any factors suggesting a higher risk of rupture may be safely left alone and monitored with MRA or CTA to detect any growth. It is important to aggressively treat any coexisting medical problems and risk factors.
Treatments for unruptured cerebral aneurysms that have not shown symptoms have some potentially serious complications and should be carefully weighed against the predicted rupture risk.
Treatment considerations for unruptured aneurysms A doctor will consider a variety of factors when determining the best option for treating an unruptured aneurysm, including:
- type, size, and location of the aneurysm
- risk of rupture
- the persons age and health
- personal and family medical history
- risk of treatment.
Individuals should also take the following steps to reduce the risk of aneurysm rupture:
- carefully control blood pressure
- avoid cocaine use or other stimulant drugs.
Treatments for unruptured and ruptured cerebral aneurysms Surgery, endovascular treatments, or other therapies are often recommended to manage symptoms and prevent damage from unruptured and ruptured aneurysms.SurgeryThere are a few surgical options available for treating cerebral aneurysms. These procedures carry some risk such as possible damage to other blood vessels, the potential for aneurysm recurrence and rebleeding, and a risk of stroke.
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How Is A Diagnosis Made
Most people find out they have an unruptured aneurysm by chance during a scan for some other medical problem. If you are experiencing symptoms and your primary care doctor suspects an aneurysm, you may be referred to a neurosurgeon. The surgeon will learn as much about your symptoms, current and previous medical problems, current medications, family history, and perform a physical exam. Diagnostic tests are used to help determine the aneurysm’s location, size, type, and involvement with other structures.
- Computed Tomography scan is a noninvasive X-ray to review the anatomical structures within the brain and to detect bleeding in or around the brain. CT angiography involves the injection of contrast into the blood stream to view the arteries of the brain.
- Angiogram is an invasive procedure, where a catheter is inserted into an artery and passed through the blood vessels to the brain. Once the catheter is in place, a contrast dye is injected into the bloodstream and the x-ray images are taken.
- Magnetic Resonance Angiography scan is a noninvasive test, which uses a magnetic field and radio-frequency waves to give a detailed view of the soft tissues of your brain. An MRA involves the injection of contrast into the blood stream to examine the blood vessels, as well as the soft tissues of the brain.
Will I Need Surgery To Treat An Unruptured Brain Aneurysm
For an unruptured brain aneurysm, your doctor will decide whether it’s better to treat the aneurysm now or monitor you carefully .
Certain aneurysms are more likely to bleed, or rupture. A rupture is a critical and potentially life-threatening situation. Your care team will determine how likely the aneurysm is to rupture so it can plan your treatment.
If treatment is necessary, your doctor will consider which treatment is best for your circumstances. The two most effective treatments for brain aneurysms today are:
- Microsurgical clipping: Neurosurgeons make a small opening in the skull and place a titanium clip to prevent blood from flowing into an aneurysm.
- Endovascular coiling: 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.
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Diagnosing The Growth And Treatment
Diagnosing the growth is possible by carrying out tests that include MRI scan, CT scan, x-ray, angiography, and echocardiography. With the help of it, the specialist will be in a position to locate an aneurysm along with its size and structure. It will help in measuring the diameter of an aneurysm. The doctor terms the severity of the condition based on the size of an aneurysm.
If the dimension is below 5 cm, the specialist will consider a treatment that helps in reducing the growth of an aneurysm. The therapy includes a change in the diet plan that helps in lowering cholesterol and high blood pressure. If the individual has the habit of using tobacco, the patient will refer to a therapist who helps in reducing it or quitting altogether.
When the dimensional is near to 5 cm or in excess of it, the doctor will opt for a surgery. Surgery for aortic aneurysm includes open repair and endovascular repair. Performing an operation will be helpful in preventing a rupture. However, the doctor does not proceed with the process blindly. He considers the following factors to ensure prompt recovery:
Risk Factors For Rupture Of A Brain Aneurysm
All brain aneurysms are at risk of bleeding. If you have a brain aneurysm, it is not possible to know which path it will follow over the course of the next few years or over the course of your life.
There are several factors associated with a higher chance of brain aneurysm rupture:
- Increase in size of the aneurysm
- Alcohol use
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What Is The Usual Damage To The Brain After An Aneurysm Bleeds
Once an aneurysm bleeds, the chance of death is about 40% and the chance of some brain damage is about 66 %, even if the aneurysm is treated. If the aneurysm isnt treated quickly enough, another bleed may occur from the already ruptured aneurysm.
Vasospasm is a common complication following a ruptured aneurysm. This can lead to further brain damage. Other problems may include hydrocephalus , difficulty breathing that requires a mechanical ventilator, and infection.
Why is the damage so extensive after bleeding? After blood enters the brain and the space around it, direct damage to the brain tissue and brain function results. The amount of damage is usually related to the amount of blood. Damage is due to the increased pressure and swelling from bleeding directly into the brain tissue, or from local cellular damage to brain tissue from irritation of blood in the space between the brain and the skull.
Blood can also irritate and damage the normal blood vessels and cause vasospasm . This can interrupt normal blood flow to the healthy brain tissue and can cause even more brain damage. This is called an ischemic stroke.
Will treating a ruptured aneurysm reverse or improve brain damage? Once an aneurysm bleeds and brain damage occurs, treating the aneurysm will not reverse the damage. Treatment helps prevent more bleeding.
How Will I Know If A Brain Aneurysm Has Ruptured
When an aneurysm ruptures, it causes a severe headache like no other you’ve ever felt.
If a brain aneurysm has ruptured, time is of the essence. Rapid medical care is critical to getting the necessary treatment for a successful recovery. With immediate, expert care, a full recovery is often possible.
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Growth Not Size Of Brain Aneurysms Biggest Risk For Rupture
Brain aneurysms even small ones are more likely to rupture if they are growing, a new study has shown. The discovery counters current guidelines and emphasizes the need for regular monitoring and earlier treatment.
“Our results suggest that all aneurysms can grow, and all can rupture but they are more likely to rupture if they are growing. We conclude that all aneurysms of any size need to be followed. If they are growing then treatment should be considered. Following patients is not such a big deal. It only involves an annual outpatient CT scan. This should not be prohibitively expensive,” lead investigator J. Pablo Villablanca, MD, University of California Los Angeles Medical Center, told Medscape Medical News.
The study was in Radiology on July 2.
Dr. Villablanca explained that the rupturing of brain aneurysms has an extremely high mortality rate.
“In North America there are about 30,000 ruptures a year. Of these about 70% die, so it is a catastrophic event and it is crucial to try and understand which aneurysms are at risk of rupturing.”
The most authoritative study so far ISUIA, conducted in 2003 showed that the largest aneurysms were the ones most likely to rupture, he noted.
“In their population of 1500 patients there were no ruptures of aneurysms of less than 7 mm. So because of this it is now recommended to follow more closely and consider treatment of aneurysms larger than 7 mm.”
Dr. J. Pablo Villablanca
Can You Survive A Burst Aneurysm
Ruptured brain aneurysms are fatal in about 50% of cases. Of those who survive, about 66% suffer some permanent neurological deficit. Approximately 15% of people with a ruptured aneurysm die before reaching the hospital. Most of the deaths are due to rapid and massive brain injury from the initial bleeding.
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How Does A Brain Aneurysm Develop
Like most diseases, brain aneurysms develop for reasons that may be congenital or acquired . Although the congenital theory was thought to be more important in the past , it is now thought that acquired reasons are the main ones underlying the development of brain aneurysms. Perhaps the most significant of the acquired reasons are smoking which causes additional stress on the blood vessel wall).
How and why brain aneurysms develop really relate to properties of the wall of the blood vessel. As reviewed elsewhere, the artery wall is made up of a number of layers, each of which plays an important role in the overall strength and resilience of the vessel. In particular, there is only one elastic layer in the brain artery , which itself tends to have many normal openings , and anything that damages this layer will predispose to a brain aneurysm forming in this region of the artery. Also, the smooth muscle layer of brain arteries has certain naturally occurring defects , particularly where artery branch points occur. This makes aneurysms more likely to occur in such regions. In addition, at arterial bifurcations, the forces exerted by the flow of blood tend to be increased relative to other segments along the artery, and any condition which increases blood flow pressure and turbulence will aggravate the tendency for this part of the artery to balloon out as a brain aneurysm.
An aneurysm starts to develop on one side of the arterial wall.
What Should You Avoid If You Have An Aneurysm
Vlak says people who know they have an untreated aneurysm should avoid at least some of the triggers when possible.The eight triggers that increased the risk for the stroke included:Coffee.Vigorous physical exercise.Nose blowing.Sexual intercourse.Straining to defecate.Drinking cola.Being startled.Being angry.May 5, 2011
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Small Unruptured Intracranial Aneurysms Grow Slowly
Small unruptured intracranial aneurysms have low growth and rupture rates, according to a review published online June 6 in the Annals of Internal Medicine.
Ajay Malhotra, M.D., from the Yale School of Medicine and Yale University in New Haven, Conn., and colleagues conducted a systematic literature review and summarized evidence relating to the growth and rupture risk of UIAs 7 mm and smaller and rupture risks for very-small and small aneurysms . Five, 10, and eight studies described the rate of growth of aneurysms that were 3 mm, 5 mm, and 7 mm, respectively, while rupture rates were reported in seven, 11, and 13 studies, respectively.
The researchers found that in all but one study, the annualized growth rate was less than 3 percent for all three size categories. For the three size categories, the annualized rupture rate was 0, < 0.5, and < 1 percent respectively. For growth rates and rupture rates, the strength of evidence was very low and of a low quality, respectively.
“Poor-quality evidence suggests that small UIAs have low growth and rupture rates and very small UIAs have little or no risk for rupture,” the authors write.
One author disclosed financial ties to Philips Healthcare.
How Is An Aneurysm Diagnosed
Special imaging tests can detect a brain aneurysm. In the CTA , patients are placed on a table that slides into a CT scanner. A special contrast material is injected into a vein, and images are taken of the blood vessels to look for abnormalities such as an aneurysm. In the second test, called MRA , patients are placed on a table that slides into a magnetic resonance scanner, and the blood vessels are imaged to detect a cerebral aneurysm.
The most reliable test is called a diagnostic cerebral angiogram. In this test, the patient lies on an X-ray table. A small tube is inserted through a blood vessel in the leg and guided into each of the blood vessels in the neck that go to the brain. Contrast is then injected, and pictures are taken of all the blood vessels in the brain. This test is slightly more invasive and less comfortable.
Beforeanytreatment is considered, a diagnostic cerebral angiogram is usually performed to fully map a plan for therapy.
If one aneurysm forms, will others form? Having one aneurysm means theres about a 20 % chance of having one or more other aneurysms.
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Can Aspirin Decrease The Rate Of Intracranial Aneurysm Growth
- Journal of Neurosurgery Publishing Group
- Researchers investigated whether aspirin can aid in the prevention of intracranial aneurysm rupture by hindering aneurysm growth. The researchers identified 146 patients harboring multiple intracranial aneurysms, five millimeters or less in diameter, that had been observed for at least five years. In this set of patients, the researchers found an association between aspirin use and a decreased rate of aneurysm growth. Growth is important in intracranial aneurysms because it increases the risk of aneurysm rupture.
Researchers conducted a database search to investigate whether aspirin can aid in the prevention of intracranial aneurysm rupture by hindering aneurysm growth. The researchers identified 146 patients harboring multiple intracranial aneurysms, five millimeters or less in diameter, that had been observed for at least five years. In this set of patients, the researchers found an association between aspirin use and a decreased rate of aneurysm growth. Growth is important in intracranial aneurysms because it increases the risk of aneurysm rupture. Detailed findings are found in the article, “Aspirin associated with decreased rate of intracranial aneurysm growth,” by Mario Zanaty, M.D., and colleagues, published today in the Journal of Neurosurgery.
The authors point out that their findings are observational and that future, interventional studies should be conducted.