Aneurysm

A brain aneurysm is usually diagnosed using angiography. Angiography is a type of X-ray used to check blood vessels. This involves inserting a needle, usually in the groin, through which a narrow tube called a catheter can be guided into one of your blood vessels.

A brain aneurysm is usually diagnosed using angiography. Angiography is a type of X-ray used to check blood vessels.

This involves inserting a needle, usually in the groin, through which a narrow tube called a catheter can be guided into one of your blood vessels.

Local anaesthetic is used where the needle is inserted, so you won't feel any pain.

Using a series of X-rays displayed on a monitor, the catheter is guided into the blood vessels in the neck that supply the brain with blood.

Once in place, special dye is injected into the arteries of the brain through the catheter.

This dye casts a shadow on an X-ray, so the outline of the blood vessels can be seen and an aneurysm can be recognised if one is present.

Occasionally, angiography may be done using scans instead of X-rays. These scans are called magnetic resonance angiography or CT angiography.

Magnetic resonance angiography (an MRI scan) is usually used to look for aneurysms in the brain that haven't ruptured. This type of scan uses strong magnetic fields and radio waves to produce detailed images of your brain.

CT angiography is usually preferred if it's thought the aneurysm has ruptured and there's bleeding on the brain (subarachnoid haemorrhage).

This type of scan takes a series of X-rays, which are then assembled by a computer into a detailed 3D image.

In some cases, a ruptured aneurysm is not picked up by a CT scan. If a CT scan is negative but your symptoms strongly suggest you have a ruptured aneurysm, a test called a lumbar puncture will usually be carried out.

A lumbar puncture is a procedure where a needle is inserted into the lower part of the spine to remove a sample of the fluid (cerebrospinal fluid) that surrounds and supports the brain and spinal cord. This fluid can be analysed for signs of bleeding.

Screening

There's no routine screening programme for brain aneurysms and it's unlikely that one will be introduced in future.

Screening is only recommended for people thought to have a significant risk of having a brain aneurysm that could rupture at some point in the future.

This would usually only apply to you if you had 2 or more first-degree relatives (father, mother, sister or brother) who experienced a subarachnoid haemorrhage.

If this applies to you, contact your GP. They'll be able to refer you to a specialist clinic for further assessment if needed.

Discovering you have an aneurysm unsuitable for surgical treatment can cause worry and distress, even though the risk of it rupturing is small. Some people have reported regret at getting screened.

There are two common treatment options for a ruptured brain aneurysm.

Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then the neurosurgeon places a tiny metal clip on the neck of the aneurysm to stop blood flow into it.

Endovascular treatment is a less invasive procedure than surgical clipping. The surgeon inserts a catheter into an artery, usually in your wrist or groin, and threads it through your body to the aneurysm.

The surgeon then uses a device — a flow diverter, an intraluminal flow disrupter, a stent or coils — or different combinations of various devices to destroy the aneurysm from inside the blood vessel.

Both procedures pose potential risks, particularly bleeding in the brain or loss of blood flow to the brain. The endovascular coil is less invasive and may be initially safer, but it may carry a slightly higher risk of needing a repeat procedure in the future due to the aneurysm reopening.

Flow diverters

Newer treatments available for brain aneurysm include tubular stent-like implants (flow diverters) that work by diverting blood flow away from an aneurysm sac. The diversion stops blood movement within the aneurysm and stimulates the body to heal the site, encouraging reconstruction of the parent artery. Flow diverters may be particularly useful in larger aneurysms that can't be safely treated with other options.

Your neurosurgeon or interventional neuroradiologist, in collaboration with your neurologist, will make a recommendation based on the size, location and overall appearance of the brain aneurysm, your ability to undergo a procedure, and other factors.

Other treatments for ruptured aneurysms

Other treatments for ruptured brain aneurysms are aimed at relieving symptoms and managing complications.

Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.

Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These medications may lessen the risk of having serious symptoms from the erratic narrowing of blood vessels (vasospasm) that may be a complication of a ruptured aneurysm.

One of these medications, nimodipine (Nymalize), has been shown to reduce the risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage from a ruptured aneurysm.

Interventions to prevent stroke from insufficient blood flow include IV injections of a drug to dilate the blood vessels, which elevates blood pressure to overcome the resistance of narrowed blood vessels.

An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain caused by vasospasm. A drug known as a vasodilator also may be used to expand blood vessels in the affected area.

Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid and others. Their use has been debated by several experts, and is generally subject to caregiver discretion, based on the medical needs of each individual.

Ventricular or lumbar draining catheters and shunt surgery can lessen pressure on the brain from excess cerebrospinal fluid (hydrocephalus) associated with a ruptured aneurysm. A catheter may be placed in the spaces that are filled with fluid inside the brain or in the area surrounding the brain and spinal cord to drain the excess fluid into an external bag.

Sometimes it may then be necessary to introduce a shunt system — which consists of a flexible silicone rubber tube and a valve — that creates a drainage channel starting in the brain and ending in the abdominal cavity.

Rehabilitative therapy. Damage to the brain from a subarachnoid hemorrhage may result in the need for physical, speech and occupational therapy to relearn skills.

Treating unruptured brain aneurysms

Aneurysm clip

Aneurysm clipOpen pop-up dialog boxEndovascular coiling

Endovascular coilingOpen pop-up dialog box

A surgical clip, an endovascular coil or a flow diverter can be used to seal off an unruptured brain aneurysm and help prevent a future rupture. However, in some unruptured aneurysms, the known risks of the procedures may outweigh the potential benefit.

A neurologist, in collaboration with a neurosurgeon or interventional neuroradiologist, can help you determine whether the treatment is appropriate for you.Factors to consider in making treatment recommendations include:

The aneurysm size, location, degree of irregularity of the aneurysm and overall appearance of the aneurysm

Your age and general health

Family history of ruptured aneurysm

Congenital conditions that increase the risk of a ruptured aneurysm

If you have high blood pressure, talk to your health care provider about medication to manage the condition. If you have a brain aneurysm, proper control of blood pressure may lower the risk of rupture.

In addition, if you smoke cigarettes, talk with your care provider about strategies to stop smoking since cigarette smoking is a risk factor for formation, growth and rupture of the aneurysm.

Lifestyle changes to lower your risk

If you have an unruptured brain aneurysm, you may lower the risk of its rupture by making these lifestyle changes:

Don't smoke or use recreational drugs. If you smoke or use recreational drugs, talk to your health care provider about strategies or an appropriate treatment program to help you quit.

Control your blood pressure if you have high blood pressure.

Eat a healthy diet and exercise. Changes in diet and exercise can help lower blood pressure. Talk to your health care provider about changes that are appropriate for you.