Cerebral Aneurysms

A cerebral aneurysm is an area of the blood vessel in the brain which becomes weakened over time. As the area becomes weaker, it begins to bulge out like a tiny balloon. The more pressure on the balloon, the higher the risk of a leak or break in the area. When the balloon leaks or ruptures, blood escapes into the surrounding tissue, causing a hemorrhage. Sometimes the aneurysm does not rupture but causes pressure on one of the small nerves leaving the brain.

Aneurysms occur in about 2 percent of the general U.S. population and can be caused by one or more of the following:

High blood pressure or hardening of the arteries in the brain.
A blood clot that goes to the brain.
Some types of infection (called Mycotic aneurysm).
Injury or trauma to the head.
Genetics or a condition you were born with.
Possible habitual use of cocaine.

Signs and symptoms

The most common presenting problem from an aneurysm is rupture with bleeding into the subarchnoid spaces, which is called a subarchnoid hemorrhage. With a subarachnoid hemorrhage the person:

Feels a sudden onset of a severe headache, usually described as "the worst headache ever" and may feel like an explosion, a band or vice around the head. The headache may be accompanied by nausea and vomiting.
May feel dizzy or may even lose consciousness.
May have double vision or become very sensitive to light shining in the eyes.
Sometimes may complain of neck pain.
May become drowsy and difficult to awaken.

If these symptoms occur, it is best to seek medical attention immediately.

Diagnostic tests

If your health-care provider suspects an aneurysm or a subarachnoid hemorrhage, you likely will be admitted to the hospital, and the following tests usually are performed:

CT scan

A special X-ray to see if there is bleeding into the brain tissue.

Lumbar Puncture (LP)

In patients with a negative CT scan, a lumbar puncture may be recommended. A numbing medicine is injected into the spine area of the back, and a needle is placed into the fluid space of the spinal canal. Fluid (called cerebrospinal fluid) is then taken to test for blood and other elements. The procedure takes about 15 minutes and is performed at the bedside. The patient is recommended to lie flat in bed for four to six hours to prevent further headache.

Angiogram

This is an important test in the diagnosis of an aneurysm. The test is performed in a special X-ray room and takes approximately one hour. An angiogram involves injection of a contrast dye through a special tube and watching how that dye circulates through the blood vessels of the brain. Your radiologist will explain the test in further detail.

While in the hospital, you likely will be in the intensive care unit. Specially trained nurses will be checking your blood pressure, heart rate and breathing frequently. You also will be awakened about every hour to check your pupils, test your strength and ask questions to test your thinking. You may not be able to eat at first, so an intravenous (IV) line will be inserted into a vein to give plenty of fluid. Medications for pain, sedation and a stool softener likely will be given. It is important to get plenty of rest, so you may be in a darkened room. Try to keep as quiet and comfortable as possible.

Treatment

Treatment of aneurysm usually involves surgery. The surgery may occur within the first few days or may be postponed until the patient is stable, and able to tolerate a major surgical procedure. Your neurosurgeon will discuss the surgery in detail. In some cases, the aneurysm may need treatment with small coils placed inside the aneurysm through a catheter advanced through the blood vessels.

Questions you may want to ask

How long will the surgery take?
What is the recovery time after surgery?
Will I need rehabilitation after surgery?
Will I need any additional surgery?

Reducing the risk

Sometimes you can reduce the risk of an aneurysm or the rupture of an aneurysm by doing the following:

Keep your blood pressure under control.
Stop or avoid smoking.
Check with your health-care provider before and during oral contraceptive therapy.
Keep your weight within normal limits for your age and height.
Avoid daily stressful situations or have some ways to reduce your stress.
Avoid use of cocaine.