A brain aneurysm is a life-threatening condition which may rupture and lead to subarachnoid hemorrhage. Approximately 50% of patients with a ruptured brain aneurysm don't make it to the hospital. Timely detection and intervention can significantly reduce morbidity and mortality.
Overview — What is a Brain Aneurysm?
A brain aneurysm is a focal or diffuse outpouching (ballooning) of a brain or neck vessel. It results from a weakness in the vessel wall, which can be congenital or acquired. Aneurysm formation occurs gradually and may take weeks to years to develop.
Some aneurysms can grow very large (up to 5–6 cm) and cause pressure effects on adjacent nerves, resulting in cranial nerve palsy (most commonly the 3rd and 6th nerves).
When an aneurysm can no longer tolerate the pressure from normal blood flow, it bursts and results in brain hemorrhage — especially subarachnoid hemorrhage (SAH), a medical emergency requiring immediate management.
A brain aneurysm can be treated either by the endovascular route (pin-hole procedure) or by open neurosurgical methods (details below).
Symptoms
- 1Sudden, severe headache (“worst headache of life”)
- 2Nausea / vomiting
- 3Neck pain
- 4Altered sensorium
Causes & Risk Factors
- Hypertension
- Diabetes
- Smoking
- Alcohol
- Stress / excessive exertion
- Congenital / genetic factors
When to See a Doctor
If you experience an unexplained persistent headache, sudden drooping of an eyelid, or paralysis, you should immediately consult your physician.
Diagnosis
- For a severe headache (“worst headache of life”), an urgent non-contrast CT scan is required to establish a diagnosis of SAH.
- For recurrent headaches, an MRI brain without contrast is advisable.
- If there is a family history of aneurysms in 2 or more first-degree relatives, MRI brain angiography is advisable for the remaining first-degree relatives.
Treatment / Procedure
A brain aneurysm cannot be cured by medication. It requires intervention — either via the minimally-invasive endovascular route or an open surgical approach.
Endovascular Treatment Options
Simple Coiling
Soft platinum coils are packed into the aneurysm to seal it off from circulation.
Balloon / Stent-Assisted Coiling
A balloon or stent supports the coils in wide-necked aneurysms — including X-stenting and Y-stenting techniques.
Flow Diverter Placement
A fine mesh stent diverts blood flow away from the aneurysm, promoting healing of the vessel wall.
Endosaccular Device Placement
A device deployed within the aneurysm sac to occlude it — ideal for certain wide-necked bifurcation aneurysms.
The choice of modality depends on the morphology of the aneurysm — size, shape, aspect ratio, and whether it is ruptured or unruptured.
Conclusion
A brain aneurysm is a deadly cause of hemorrhagic stroke — but a treatable one if detected in a timely manner.