• Aneurysm - What is it?
• Aneurysm - Symptoms
• Detecting Brain Aneurysms
• Brain Aneurysm - Treatment options
   
• Standards of Medical Care
• Legal Options

A brain (cerebral) aneurysm is a bulging or ballooning out of part of the wall of an artery in the brain. The disorder may result from congenital defects or from other conditions such as high blood pressure, atherosclerosis (the build-up of fatty deposits in the arteries), or head trauma. Cerebral aneurysms can occur at any age, although they are more common in adults than in children and are slightly more common in women than in men. The signs and symptoms of an unruptured cerebral aneurysm will partly depend on its size and rate of growth. For example, a small, unchanging aneurysm will generally produce no symptoms, whereas a larger aneurysm that is steadily growing may produce symptoms such as loss of feeling in the face or problems with the eyes. Immediately before an aneurysm ruptures, an individual may experience such symptoms as a sudden and usually severe headache, nausea, vision impairment, vomiting, and loss of consciousness. Rupture of a cerebral aneurysm usually results in bleeding in the brain, causing a hemorrhagic stroke. Or blood can leak into the area surrounding the brain and develop into an intracranial hematoma (a blood clot within the skull). Rebleeding, hydrocephalus (the excessive accumulation of cerebrospinal fluid), vasospasm (spasm of the blood vessels), or additional aneurysms may also occur.

Although people with unruptured brain aneurysms may have headaches, this is often not associated with the actual aneurysm. Most people with unruptured brain aneurysms are completely free of symptoms, while others may experience some or all of the following symptoms, which suggest an aneurysm:

• Cranial Nerve Palsy
• Dilated Pupils
• Double Vision
• Pain Above and Behind Eye
• Localized Headache

People who suffer a ruptured brain aneurysm (subarachnoid hemorrhage) will often have warning signs. The following warning signs precede about 40% of major ruptures:

• Localized Headache
• Nausea & Vomiting
• Stiff Neck
• Blurred or Double Vision
• Sensitivity to Light (photophobia)
• Loss of Sensation

• CT scan of the brain. A CT scan (Computed Tomography) uses x-rays and a computer to create cross-sectional pictures of the brain. It is good at showing abnormal pools of blood, such as from a burst aneurysm, but is not as sensitive as some other methods.
• CT Angiogram (CTA). This combines a CT scan with injection of contrast dye into a vein. The dye travels to the brain and highlights arteries.
• MRI scan of the brain (Magnetic Resonance Imaging). This uses magnetic waves instead of x-rays and creates a more detailed image than CT scan.
• MRA (Magnetic Resonance Angiography). This scan combines a regular MRI with the contrast dye, which is injected into a major vein. Like the CTA, this dye travels to the brain arteries, and images are created using an MRI. This creates a more enhanced image.
• Angiogram or arteriogram. In this technique, contrast dye is injected directly into an artery in the neck and X-ray pictures are taken as the dye travels into the arteries in the brain. This produces the most detailed images of arteries of the techniques currently used, but also has some risks that the other procedures do not.

The treatment of an aneurysm is often determined by its size. Traditional surgery is performed by a neurosurgeon, however, the patient may also have the option to select endovascular treatment or "coiling," a less invasive option with fewer risks.

As in other endovascular treatments of conditions such as stroke or angioplasty, a catheter is inserted in the groin area and threaded through the vessels to the site of the aneurysm. Detachable platinum coils are then dispensed through the catheter and placed carefully inside the aneurysm. The number of coils used depends on the size of the aneurysm.

As an aneurysm is really a "ballooning" in a weakened area of a vessel wall, the goal of "coiling" is to pack the aneurysm tightly to close off blood flow into the aneurysm thereby preventing its rupture. Occasionally, it is necessary to add more coils at a later time to complete treatment.

Certain aneurysms may be treated by blocking the artery from which the aneurysm arises using coils or detachable balloons. Additional new methods of aneurysm treatment are in development.

Hospitalization time varies from patient to patient. A 1 or 2-day hospitalization may be possible for certain patients who have not had a hemorrhage, but patients who have had a recent brain hemorrhage from a ruptured aneurysm may expect to be hospitalized at least 10-14 days minimum. A follow-up x-ray, MR scan, or an angiogram may be performed to evaluate the position of the coils.

Patients may be placed on a blood thinner such as aspirin after the procedure, which may be continued after discharge.