Brain Aneurysm

Brain aneurysm symptoms will vary depending on severity, location and whether it has ruptured. In many cases, patients with a brain aneurysm that has not ruptured may not experience any symptoms at all. But in cases where the aneurysm is enlarged or pressing on the nerves of the brain, a person might experience:

• Blurry or double vision
• Dilated pupils
• Drooping eyelids
• Pain behind one eye
• Weakness or numbness

When a brain aneurysm ruptures, severe and intense symptoms often result that require immediate action and treatment. Symptoms of a ruptured aneurysm include:

• Blurry or double vision
• Confusion
• Dilated pupils
• Drooping eyelids
• Nausea or vomiting
• Pain above the eye
• Seizure
• Sensitivity to light
• Stiff neck
• The worst headache of your life
• Unconsciousness
• Weakness or numbness

Unruptured Aneurysms

Around 6.7 million individuals in the United States are living with an unruptured brain aneurysm. It's important to note that while most of these aneurysms do not rupture, the guidelines for determining which ones are likely to rupture sometimes fall short. These guidelines mainly take into consideration factors like the aneurysm's size, location, and shape. By analyzing these aspects, neurosurgeons can estimate the risk of rupture over a patient's lifetime.

The majority of aneurysms that do rupture fall within the range of 4 to 7 millimeters in size. Nevertheless, even smaller aneurysms can rupture. Typically, aneurysms larger than 7 millimeters within the brain are recommended for treatment, taking the patient's age into account due to the heightened risk of rupture during their lifetime. However, the decision to pursue treatment remains a topic of ongoing research and is met with some controversy.

At Abrazo Brain and Spine, we empower patients to gain an understanding of this condition, working collaboratively to determine the most suitable treatment path. Unruptured aneurysms are often discovered incidentally during routine scans for other reasons. Recognizing the anxiety that can come with such a diagnosis, we prioritize prompt clinic visits to educate patients about the generally benign nature of unruptured aneurysms in the near term. Typically, these initial visits involve a consultation with a surgeon. Depending on the decision to proceed with treatment, the next step usually involves a catheter angiogram to thoroughly examine the aneurysm and select the optimal treatment approach. This procedure takes place on an inpatient basis.

Following the evaluation, patients are encouraged to involve their families in the decision-making process for their treatment plan. This plan may encompass minimally invasive endovascular procedures or open surgery. Our aim is to provide comprehensive support to patients as they navigate their options here at Abrazo Brain & Spine. Source: Brain Aneurysm Foundation 

Subarachnoid Hemorrhage

This condition involves bleeding within the layer above the brain known as the subarachnoid space. In more than 90% of cases, this bleeding occurs spontaneously and is often due to a ruptured aneurysm. Symptoms usually manifest as a sudden, severe thunderclap headache – often described as the worst headache a person has ever experienced.

Extensive studies conducted over the past two decades have revealed promising outcomes when patients undergo minimally invasive treatments. Consequently, if the aneurysm is amenable to such an approach, it is generally considered the primary treatment option. 

Because brain aneurysms do not typically cause symptoms until they are severe or have ruptured, they are often not diagnosed until that point. If symptoms are exhibited and a doctor believes a brain aneurysm might be the cause, immediate and prompt diagnosis is necessary.

To confirm an aneurysm is present, a doctor will order imaging tests and other diagnostic testing, which may include CT, MRI, cerebral angiography and a cerebrospinal fluid analysis. CT angiography is also commonly used to capture sharp, detailed images of blood flow in the brain.

Diagnostic testing will identify whether and which type of aneurysm (either saccular, which means bulging out on one side, or fusiform, which bulges out on all sides) is present and whether the aneurysm has ruptured or is at risk of rupturing.

Treatment options encompass microsurgical obliteration, often referred to as ""clipping,"" of the aneurysm through brain surgery. In this method, a clip is meticulously placed over the aneurysm. This approach, extensively studied and highly effective, yields excellent results for individuals who are suitable candidates for brain surgery. The risk of recurrence post-surgery is remarkably low, often less than 5%, when the procedure is appropriately performed, resulting in complete aneurysm closure during the operation.

Alternatively, a less invasive endovascular route is available to address brain aneurysms. This technique involves accessing the artery that harbors the aneurysm using small catheters inserted through a tiny puncture in a groin artery. Subsequently, the aneurysm can be sealed using various methods. These include deploying metal coils, implementing flow-diverting stents that redirect blood flow away from the aneurysm, allowing it to clot naturally over time. There are also innovative intrasacular devices that achieve a similar flow diversion effect. Depending on the chosen endovascular approach, patients may or may not need to take dual antiplatelet medications as part of their post-procedural care.