What is Cerebral Aneurysm – Symptoms, Diagnosis and Treatments

In a cerebral aneurysm, a bulge develops inside the brain's artery, which contains blood and is susceptible to rupturing without any prior indications. Such a medical condition can lead to brain damage, coma, stroke or death if left untreated.

Here is what you must know about this disease, its types, symptoms, treatment procedures, and more.

A cerebral aneurysm, also known as a ‘brain aneurysm’, is the formation of a bulge within an artery that supplies blood to the brain. It generally develops within a weaker part of the blood vessels’ inner layer. Due to this bulging aneurysm, brain tissues and nerves get pressurised. Generally, this aneurysm is found just inside the skull, within an area known as ‘subarachnoid space’.

The size of the aneurysm inside the blood vessel can be 1/8-1 inch. Giant aneurysms with a size of 1 inch are difficult to cure and, therefore, can be life-threatening. A cerebral aneurysm can form at any age in anyone. However, the most common patients of this disease fall in the age group between 30 and 60, and comparatively, most of them are women.

A cerebral aneurysm is classified into three types, as mentioned below:

1. Saccular Aneurysm: It is a sac-like formation of an aneurysm containing blood. This bulging develops within the main artery or its branches.
2. Fusiform Aneurysm: In this type of aneurysm, balloon-like bulges develop on every side of the blood vessel.
3. Mycotic Aneurysm: Mycotic aneurysm forms because of an infection within the arteries that carry blood within brain tissues. As a result of the infection, the artery walls weaken and become thinner, due to which the bulging takes shape.

Symptoms of cerebral aneurysm vary as per its severity. Hence, listed the severe conditions of cerebral aneurysm below along with their possible symptoms.

1. Unruptured Aneurysm

A large cerebral aneurysm can cause immense pressure on nerves and tissues within the brain that may cause the following symptoms:

• Pain in eyes
• Weakness
• Paralysis on one side of the face
• A dilated pupil
• Double vision or change in vision

2. Ruptured Aneurysm

If the aneurysm bursts or ruptures, it causes severe headaches along with the following conditions:

• Nausea
• Vomiting
• Double vision
• Sensitivity to light
• Stiff neck
• Seizures
• Loss of consciousness
• Cardiac arrest

3. Leaking Aneurysm

Sometimes, an aneurysm gets a tiny leakage which causes a minute amount of bleeding or ‘sentinel bleeding’ within the brain. As a result, a patient may feel:

• Immense headache
• There is also a size-wise classification of aneurysms, as mentioned below:
  • Small Aneurysm: A diameter below 11 mm
  • Large Aneurysm: A diameter between 11 mm and 25 mm
  • Giant Aneurysm: A diameter of more than 25 mm

The cerebral aneurysm occurs mainly due to thin vessel walls. Since the branching points are thinner and weaker, this area naturally becomes more vulnerable to this condition.

Following are some causes of brain aneurysm:

• Growing age
• Consumption of alcohol
• Smoking
• Intake of prohibited drugs, including amphetamine and cocaine
• High blood pressure
• Infection
• Head injury
• Atherosclerosis or an abnormal formation of plaque within the inner lining of a blood vessel

Following are some of the inherited risk factors of cerebral aneurysm:

• Arteriovenous Malformation (AVM): An abnormal conjunction point of vein and artery.
• Alpha-Glucosidase Deficiency: It happens due to the inadequacy of the enzyme that converts glycogen into glucose.
• Fibromuscular Dysplasia: An arterial disorder that affects large and medium arteries of women.
• Alpha 1-Antitrypsin Deficiency: It is a genetic disorder that causes hepatitis, emphysema and cirrhosis.
• Coarctation Aorta: In this medical condition, the aorta or the main artery that comes out of the heart becomes narrow.
• Hereditary Hemorrhagic Telangiectasia: A hereditary disorder that forms blood vessels without capillaries. It is mainly between veins and arteries.
• Ehlers-Danlos Syndrome: A disorder that develops in connective tissues.
• Tuberous Sclerosis: It is a kind of neurocutaneous disorder causing tumours within the brain or skeletal bone.
• Polycystic Kidney Disease or PCKD: In this genetic disorder, a cyst forms within the kidney. This cyst may cause immense pressure in blood vessels.
• Noonan's Syndrome: It is also a genetic disorder that causes abnormal muscle development in any part of the human body.

In this regard, you also need to know that these risk factors only increase the chances of a cerebral aneurysm. One may not develop this disease despite being exposed to one or more of these risk factors. Further, one may encounter aneurysm even though he/she does not have any connection with the aspects mentioned above. You can only stay aware by knowing them.

Cerebral aneurysm can remain unnoticed until it bursts or ruptures, causing severe headaches and other medical conditions. Doctors will first conduct several diagnostic procedures to understand whether there is any trace of blood between the brain and the skull bone.

Following are some of the tests recommended for cerebral aneurysm diagnosis:

• Magnetic Resonance Imaging (MRI): The magnetic field created through the MRI diagnosis process produces detailed two and three-dimensional images of the human brain. It helps in detecting whether there is any bleeding due to ruptures. Further, magnetic resonance angiography helps in capturing clear images of arteries. This angiography helps medical practitioners to know the shape, size, and location of an aneurysm.
• Computed Tomography (CT): Physicians perform a CT scan to know whether there is any leakage of blood inside the skull. In this process, X-rays help in producing a clear image of the skull and brain. Nevertheless, physicians may also inject contrasting dye into the bloodstream before this imaging process. This CT angiography process captures more vivid images of blood flow. In addition, through this process, detecting the location and size of any ruptured or unruptured aneurysm becomes quite easier.
• Cerebral Angiography: Doctors perform this imaging technique to understand if there is any blockage inside arteries that goes into the brain and locate any weak spot in their inner linings. To understand the location and size of an aneurysm, doctors insert a long tube (catheter) and inject a small quantity of contrasting dye into the arteries to be tested. As a result, they get a detailed image of the bulge and know if there are any arterial blockages.
• Cerebrospinal Fluid (CSF) Analysis: In this diagnosis process, doctors try to detect bleeding by analysing cerebrospinal fluid. They collect this chemical from the spine by performing a lumbar puncture process. They insert a needle inside the lumbar spine to collect the fluid. If they find any trace of bleeding by analysing this fluid, they conduct more tests to trace its exact causes.

Not every time do doctors perform treatment procedures. If the unruptured aneurysm is small and no associated factors suggest its rupture, doctors leave it as it is and monitor any growth from time to time.

Further, besides the risk of rupture, doctors consider other aspects, including the patient’s age, health condition, medical history, size of the aneurysm, risk of treatment, etc., before advising on the treatment procedures.

Following are some major treatment processes for ruptured or unruptured aneurysms:

1. Microvascular Clipping

This is an open-brain surgical process in which the surgeons use clothespin-like clips to block blood flow into the aneurysm. At first, a doctor detects the location of the bulge and then inserts a small metal clip inside and attaches it to the aneurysm’s neck. It is a highly effective treatment process and can potentially stop the aneurysm's recurrence.

2. Endovascular Treatment

Following are two different kinds of endovascular treatment processes for aneurysms:

• Platinum Coil Embolization: In this process, the surgeon will insert a catheter (a long and hollow plastic tube) inside an artery and gradually take it to the aneurysm. After this, they pass platinum coils (spiral wires) through that catheter. The detached platinum coils will help in blocking the blood flow inside the aneurysm.
• Flow Diversion Devices: In this treatment, doctors insert a small mesh tube or ‘stent’ inside the artery with the help of a catheter. It reduces the blood flow of an aneurysm. Doctors undergo this treatment process if the aneurysm is large, which is very difficult to control through clipping and platinum coils.

3. Rehabilitative Therapy

Patients who have witnessed subarachnoid haemorrhage may need to undergo speech, physical, and occupational therapies. It can help them regain the functionalities of their organs. This way, they will avoid the chances of permanent disability.

4. Other Treatment Procedures

To reduce symptoms and complications of the aneurysm, doctors can also go for the following treatment processes:

• Antiseizure Drugs: Doctors recommend this drug to prevent seizures if the bulge ruptures.
• Channel-Blocking Drugs: With the intake of this drug, patients can reduce the chances of stroke due to vasospasms.

Although it is difficult to trace the particular reason that causes aneurysms, you can consider the following measures for the prevention of cerebral aneurysms:

• Quit smoking, drugs and alcohol
• Manage stress through exercise, meditation, eating healthy and other healthy practices
• Maintain a healthy blood pressure
• Lower your body's cholesterol level

You should seek medical attention if you witness symptoms like nausea, seizure, severe headache, loss of consciousness, etc. As this disease occurs inside the human brain and you cannot see it from outside, you must undergo the necessary diagnostic procedures without delay to confirm the formation of this bulge inside the artery within the brain.