Brain Aneurysm

Diagnosis of a brain aneurysm

For the diagnosis of a brain aneurysm, several tests and scans are conducted. Some of these imaging techniques are as mentioned:

CT and MRI scans

This helps in creating images of the patient’s brain. In this technique, a person lies on the table that is moved into a CT scanner. A contrast dye is injected track the blood flow and check for the aneurysm in the brain. It can detect an aneurysm larger than 3 to 5 millimetres. MRI can detect an aneurysm more than 3-5 millimetres in size.

Angiogram

This is the most trustworthy and gold standard technique to diagnose an aneurysm. The technique highlights the weak spot in the blood vessel. This is an invasive technique with a catheter being inserted, usually by entering an artery in the groin. A cerebral angiogram gives the treating neurosurgeon the most information to help make the best treatment plan for the patient.

Cerebrospinal fluid test

The doctor will recommend this test if the doctor thinks that the aneurysm is ruptured. In this procedure, a needle is put into the patient to draw spinal fluid and check whether it contains blood or not. If fluid contains blood it means that the aneurysm is ruptured.

Symptoms of a ruptured brain aneurysm

Most aneurysms do not cause any symptoms and patients are unaware of their existence. However, if an aneurysm ruptures it causes a subarachnoid haemorrhage. It is bleeding in the brain and can be life-threatening. This is often associated with an abrupt onset of symptoms like:

Severe headache
Neck pain
Nausea and vomiting
Neck stiffness
Photophobia (Intolerance of bright light)
Seizure
Confusion, or unconsciousness.

Subarachnoid Haemorrhage Treatment

A ruptured aneurysm must be secured as soon as possible to prevent re-bleeding. This is done by endovascular coiling or by craniotomy and clipping.

Endovascular coiling

Aneurysm coiling is usually performed by an expert neuro-radiologist. They will pass a catheter through artery in the groin and navigate through the arterial tree to reach the aneurysm and fill it with platinum coils.

Craniotomy and clipping

A craniotomy and aneurysm clipping is an open surgical procedure involving an incision behind the hairline to open a small window on the skull to reach the outer membrane of the brain (dura). The surgeon opens the covering of the brain to enter corridors within the brain to reach the aneurysm. The aneurysm is treated by placing a spring-loaded clip across its neck to stop it from filling.

Risk factors for a cerebral aneurysm

Brain Aneurysms develop from wear and tear changes of the blood vessel wall. So they occur with increasing frequency as we get older.

Risk factors for brain aneurysm development and rupture include

A family history of aneurysm
Smoking
High blood pressure

Rehabilitation and recovery of a brain aneurysm

Brain aneurysm recovery often requires rehabilitation which includes physical, cognitive, occupational, speech, and swallowing therapy. This generally starts in the hospital and continues on an outpatient basis. Patient and caregiver support groups or web communities play an active part in patient rehabilitation. Generally, rehabilitation programs target the following types of therapies-

Physical therapy

The physical therapy can help the patient to retain balance, strengthen muscles, and help with the coordination in movements.

Speech therapy

This assists patients in speaking and swallowing food.

Occupational therapy

It helps the patient complete daily activity such as dressing, feeding, showering, cooking and other activities.

Other rehabilitation services

Rehabilitation includes many important activities. This helps with improving cognition and making the patient socially interactive

What are the risk factors of a brain aneurysm rupturing?

In many cases, an aneurysm is discovered before it ruptures, often incidentally. In general, the risk of an aneurysm rupturing in the short term is small. Usually less than 1% risk of aneurysms less than 10mm in size rupture per year.

This risk is higher with

Posterior circulation aneurysm
Increasing aneurysm size
An aneurysm that seems to be growing on serial imaging

The risk of aneurysm rupture is also higher in patient who-

Smoker
Have high blood pressure who is not controlled with medications
Have had a subarachnoid haemorrhage
Have a first-degree relative who had a subarachnoid haemorrhage

Even though the risk of rupture for most aneurysms is relatively small in the short term, this risk is cumulative. In the long term, the risk of rupture adds up. For many patients, it is safer to secure an aneurysm with either endovascular technique or microsurgical clipping.

Complications of a brain aneurysm

After a subarachnoid haemorrhage, the patient may develop other complications-

Hydrocephalus

Hydrocephalus is a build-up fluid in the ventricles of the brain that may need a drain.

Stroke

A delayed stroke may occur from inadequate blood supply to parts of the brain. This problem often occurs several days after the initial haemorrhage. It is usually associated with the narrowing of cerebral blood vessels (vasospasm). Patients may need additional intensive treatments to prevent a permanent stroke.

Therefore, patients need to stay in hospital for one or two weeks or longer, for monitoring and treatment after a subarachnoid haemorrhage.

Frequently asked questions

Is treatment required in all aneurysms?

No, all aneurysms would not need a treatment. Whether an aneurysm would require a treatment or not would depend on the size, anatomy and the site of the aneurysm.

Do I get a scar with coiling?

No there will be no scar with coiling.

How long would I be hospitalised after aneurysm treatment?

The length of stay in a hospital varies in patients with a ruptured aneurysm as compared to an unruptured aneurysm. Patients with ruptured aneurysm usually stay in hospital for 2-3 days. Patient with severe subarachnoid haemorrhage would be hospitalised for 3-4 weeks.