Aneurysm

Fast facts

• Brain aneurysm s are common and aren’t serious if they are small
• If an aneurysm bursts, it is called a haemorrhagic stroke
• Many aneurysm s have no symptoms until they grow large or burst

What is an aneurysm ?

An aneurysm is a localised, balloon-like bulge in the wall of a blood vessel, usually an artery. This bulge occurs due to a weakness in the vessel wall, which can be caused by a variety of factors, including high blood pressure, atherosclerosis, and genetic conditions. Due to the weakness, the wall is susceptible to rupturing. If it ruptures, blood is spilt into different parts of the brain and is known as a haemorrhagic stroke.

Aneurysms can develop in various parts of the body, but they most commonly occur in the brain (cerebral aneurysm ), the aorta (abdominal or thoracic aortic aneurysm ), and other arteries such as those in the legs (peripheral aneurysm ).

Symptoms

Aneurysms often develop silently, meaning they may not cause any symptoms until they become large or rupture. However, if the aneurysm does not burst, it may put pressure on the brain causing pain, dilated pupils, vision changes, face numbness. If the aneurysm bursts, symptoms may include a sudden and severe headache, nausea/vomiting, still neck, vision changes, seizure light sensitivity, confusion, loss of consciousness.

Risk Factors

The people most likely to have an aneurysm are:

• People aged 30 – 60 years
• People who are smokers, high blood pressure, alcohol and illicit drug use
• Family history of aneurysm s
• Females are more likely to have an aneurysm than men

Complications

Aneurysms can directly damage or kill brain cells and increase pressure inside the skull. Complications can include:

• Rupturing = The most serious complication of an aneurysm is rupture. This occurs when the aneurysm bursts, leading to internal bleeding. A ruptured aneurysm is a medical emergency.
• Re-bleeding = Even after an initial rupture, there is a risk of re-bleeding, especially within the first few days. This can significantly worsen outcomes and is one reason why early surgical or endovascular treatment is often recommended.
• Narrowing of blood vessels (vasospasm) = Following a rupture, nearby blood vessels may tighten unpredictably, a condition known as vasospasm. This reduces blood flow to parts of the brain and can cause delayed cerebral ischemia, leading to additional brain damage or stroke.
• Build up of fluid (hydrocephalus) =Bleeding in the brain can block the normal flow of cerebrospinal fluid (CSF), leading to a build up of fluid in the brain, known as Hydrocephalus . This increases pressure inside the skull and may require treatment with a Temporary or Permanent drain or shunt.
• Seizures = Both ruptured and unruptured brain aneurysm s can lead to seizures, either due to bleeding or pressure on brain tissue. In some cases, long-term anti-seizure medication may be needed.

Testing and Treatment

Aneurysms are often detected through imaging tests, especially if they are suspected due to symptoms or are found incidentally during tests for other conditions. Common diagnostic methods include:

• CT Scan: Provides detailed images of the blood vessels and can help detect aneurysm s in various parts of the body.
• MRI: Useful for detecting aneurysm s, particularly in the brain.
• Angiography: Involves using a contrast dye to visualize blood flow and identify aneurysm s.

The treatment for an aneurysm depends on its size, location, and whether it has ruptured. Common approaches include:

1. Monitoring: Small, unruptured aneurysm s may be monitored regularly with imaging to ensure they are not growing.
2. Medications: Controlling blood pressure and cholesterol can help manage the risk of an aneurysm growing or rupturing.
3. Surgery:
   • Open surgery: Involves removing the damaged section of the artery and replacing it with a graft.
   • Endovascular repair: A less invasive procedure where a stent graft is placed inside the artery to reinforce the weak spot.
4. Emergency treatment: If an aneurysm ruptures, emergency surgery is required to stop the bleeding and repair the artery. The outcome depends on the location of the aneurysm and the speed of treatment.