Understanding Cerebral Aneurysms: Treatment to Prevent Rupture
What Is a Cerebral Aneurysm?
A cerebral aneurysm is a condition in which a weakened area of an artery in the brain becomes abnormally thin and bulges outward, forming a sac-like structure.
Possible contributing factors include:
๐ Atherosclerosis or hardening of the arteries
๐ Chronic high blood pressure
๐ Inflammation of the arteries
๐ Weakness or abnormalities of the blood-vessel wall
When a cerebral aneurysm is not detected and treated appropriately, it may gradually enlarge and eventually rupture. This can cause subarachnoid haemorrhage, a life-threatening emergency requiring immediate medical care.
Why Is a Cerebral Aneurysm Dangerous?
An unruptured cerebral aneurysm often causes no symptoms. Many people are therefore unaware of the condition until the aneurysm ruptures and causes bleeding into the space surrounding the brain.
A ruptured aneurysm may cause several serious effects.
๐ Blood released from the aneurysm can rapidly increase pressure inside the skull, causing severe damage to the brain.
๐ The leaked blood may trigger severe narrowing of other brain arteries, known as vasospasm. This can reduce blood flow to parts of the brain and lead to cerebral ischaemia, stroke, or paralysis.
๐ Blood coming into direct contact with brain tissue may damage brain cells, trigger inflammation, and cause rapid cell death.
The mortality rate following a ruptured cerebral aneurysm may be approximately 30–50%. Survivors may also face a high risk of permanent disability due to brain damage.
Other possible complications include:
๐ Hydrocephalus or fluid accumulation in the brain
๐ Nervous-system infection
๐ Seizures following the haemorrhage
๐ Long-term neurological impairment
These complications require close monitoring because they may significantly affect recovery and quality of life.
Warning Signs Before a Cerebral Aneurysm Ruptures
Most unruptured cerebral aneurysms do not produce warning signs and are often discovered accidentally during brain imaging performed for another reason.
However, some patients may experience symptoms that can be divided into two main groups.
Symptoms Caused by Pressure on Nerves or Brain Tissue
When an aneurysm becomes larger, it may press against nearby structures, particularly nerves involved in vision, eye movement, and facial function.
Possible symptoms include:
๐ Persistent pain around or behind one eye
๐ Blurred vision or double vision
๐ Drooping of one eyelid
๐ One pupil appearing noticeably larger than the other
๐ Numbness or weakness on one side of the face
These symptoms are often persistent rather than intermittent. They should not be ignored because they may indicate that the aneurysm is enlarging and could lead to a serious neurological emergency.
Sentinel Headache
A sentinel headache is a sudden and severe headache caused by a small leak of blood from an aneurysm into the subarachnoid space, where cerebrospinal fluid circulates.
This headache may occur several days or weeks before the aneurysm ruptures completely and causes a major subarachnoid haemorrhage.
The pain may gradually improve after a few days, causing the patient to mistake it for an ordinary headache. However, it may be a warning that the aneurysm is at risk of rupturing within days or weeks.
Seek immediate medical attention when a sudden severe headache occurs with symptoms such as:
๐ Nausea or vomiting
๐ Sensitivity to light
๐ Double vision
๐ Neck stiffness
๐ Sudden weakness on one side of the body
๐ Numbness in part of the body
๐ Difficulty speaking
How Is a Cerebral Aneurysm Diagnosed?
The diagnostic method depends on the patient’s symptoms and whether the aneurysm is suspected to have ruptured.
Screening for an Unruptured Aneurysm
People at high risk who do not yet have symptoms may be advised to undergo screening. This may include those who:
๐ Have two or more family members with cerebral aneurysms
๐ Have symptoms that may result from an aneurysm pressing on nearby nerves
A non-invasive examination such as magnetic resonance angiography, or MRA, may be used. MRA provides images of the brain’s blood vessels and can detect relatively small aneurysms.
Diagnosis When a Ruptured Aneurysm Is Suspected
When a patient arrives at hospital with a sudden, extremely severe headache, diagnosis must be performed as quickly as possible.
CT Scan of the Brain
A brain CT scan is highly effective for detecting bleeding within the brain or around the brain’s membranes.
However, when the amount of bleeding is very small or the symptoms began several days earlier, the haemorrhage may be less clearly visible.
CT Angiography
CT angiography, or CTA, combines CT imaging with an injection of contrast material into a vein.
It produces detailed three-dimensional images that allow doctors to assess:
๐ The location of the aneurysm
๐ Its size and shape
๐ The structure of the affected blood vessel
๐ Other narrowed or blocked blood vessels
Lumbar Puncture
When other examinations do not show bleeding but the patient’s symptoms strongly suggest subarachnoid haemorrhage, a lumbar puncture may be performed.
A sample of cerebrospinal fluid is examined for red blood cells or other evidence of bleeding around the brain.
Cerebral Angiography for Confirmation and Treatment Planning
Cerebral angiography provides detailed images of blood flow and the aneurysm from multiple angles.
A small catheter is inserted into an artery and guided towards the brain’s blood vessels. Contrast material is then injected to create clear images.
This examination is often performed to:
๐ Confirm the results of other imaging tests
๐ Assess the exact structure of the aneurysm
๐ Plan the most appropriate treatment
In some cases, endovascular treatment can be performed during the same procedure.
Treatment of Cerebral Aneurysms
Treatment depends on several factors, including:
๐ The size and location of the aneurysm
๐ Its shape and structural complexity
๐ Whether it has ruptured
๐ The patient’s symptoms and risk factors
๐ The patient’s overall health
The main treatment options include the following.
Aneurysm Clipping
Aneurysm clipping is an open surgical procedure involving a craniotomy to access the affected blood vessel.
The surgeon places a small metal clip across the neck of the aneurysm. This prevents blood from entering the weakened sac and reduces the risk of leakage or rupture.
This method may be suitable for aneurysms that are:
๐ Large
๐ Structurally complex
๐ Unsuitable for endovascular treatment
One advantage is the low likelihood of the aneurysm reopening after successful clipping.
However, possible risks include:
๐ Infection
๐ Bleeding
๐ Injury to brain tissue or nerves
๐ A longer recovery period than less-invasive procedures
Endovascular Coil Embolisation
Endovascular coil embolisation is a minimally invasive treatment that does not require opening the skull.
A small catheter is inserted through an artery in the groin or wrist and guided to the aneurysm. Flexible platinum coils are then placed inside the aneurysm sac.
The coils encourage a blood clot to form inside the aneurysm, preventing blood from continuing to flow into it. This reduces the likelihood that the aneurysm will enlarge or rupture.
Advantages include:
๐ Less pain
๐ Faster recovery
๐ Lower invasiveness than open surgery
However, the aneurysm may occasionally reopen, a condition known as recanalisation. Patients therefore require periodic follow-up examinations with MRA or CTA.
Surgery for Related Brain Complications
Brain surgery may also be required to manage complications caused by a ruptured aneurysm.
For example:
๐ Blood may need to be surgically removed to reduce pressure on the brain.
๐ A drainage tube may be inserted when hydrocephalus causes cerebrospinal fluid to accumulate.
๐ Additional procedures may be needed to control swelling or prevent further brain damage.
When Should You Seek Emergency Care?
A cerebral aneurysm can become immediately life-threatening when it ruptures.
You should seek emergency medical care if you or someone close to you experiences:
๐ A sudden, extremely severe headache unlike any previous headache
๐ The worst headache of their life, also known as a thunderclap headache
๐ Sudden nausea and vomiting with severe headache
๐ Neck stiffness
๐ Loss of consciousness
๐ Sudden weakness, numbness, or difficulty speaking
Early diagnosis and treatment may reduce the risk of severe brain damage, permanent disability, and death.
Specialised Cerebrovascular Care at Phyathai Phaholyothin Hospital
Phyathai Phaholyothin Hospital has a team of specialists in neurosurgery and cerebrovascular disease, supported by advanced diagnostic technology, including:
๐ CT Scan
๐ CT Angiography
๐ MR Angiography
๐ Cerebral Angiography
These technologies support rapid and accurate diagnosis. Standard treatment options include aneurysm clipping and endovascular coiling, helping increase the opportunity for successful treatment and a return to a better quality of life.
Reference :
Independent Writer
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