Aneurysm definition
Cerebral aneurysms (aneurysms in the head) are abnormal bulges that form in the walls of brain arteries due to localized weakening. These weak spots often result from changes in the middle layer of the vessel wall and the elastic fibers that normally provide structural support. Most aneurysms are saccular, shaped like small berries, while other forms such as fusiform, dissecting, or infection-related aneurysms are much less common. They typically develop in the arteries of the Circle of Willis, affecting both the anterior and posterior circulations.
Epidemiology
Aneurysms are present in roughly 2–3% of the population. Those that have not ruptured often show no symptoms and are discovered incidentally during brain imaging. Once an aneurysm ruptures, it can cause a subarachnoid hemorrhage (SAH), which contributes significantly to stroke-related deaths. Women, particularly after menopause, are at a higher risk compared to men.
Risk Factors (Aneurysms Causes)
Genetic and Congenital Factors:
Connective tissue disorders like Ehlers-Danlos or Marfan syndrome.
Polycystic kidney disease.
Family history increases the likelihood of aneurysm formation.
Vascular and Lifestyle Factors:
Chronic high blood pressure that stresses arterial walls.
Hardening of arteries (atherosclerosis) or damaged vessel linings.
Cigarette smoking is the most significant lifestyle-related contributor.
Other Contributing Factors:
Hormonal changes, particularly low estrogen levels in women after menopause.
Prior head injury or a history of brain hemorrhage.
Aneurysms Symptoms
Unruptured Aneurysms:
Frequently silent, but may occasionally cause persistent headaches.
Pressure on nearby cranial nerves can result in eyelid drooping or double vision.
Subtle changes in neurological performance may be present.
Ruptured Aneurysms:
Sudden, intense headache often described as “the worst headache of one’s life.”
Nausea, vomiting, and light sensitivity.
Confusion, difficulty speaking, or temporary loss of consciousness.
Neurological deficits like weakness on one side, speech difficulties, or vision loss.
Diagnostic Techniques
Non-invasive Imaging
Magnetic Resonance Angiography (MRA): Helpful to locate aneurysms and evaluate their size and relation to adjacent vessels.
Computed Tomography Angiography (CTA): Excellent for detecting early bleeding and analyzing aneurysm shape.
Invasive Imaging
Digital Subtraction Angiography (DSA): Offers detailed visualization of aneurysm size, shape, and branching arteries.
Magnetic Resonance Imaging and/or Computed Tomography (MRI and CT):
These techniques are employed to detect hemorrhage resulting from a ruptured aneurysm. They help assess the extent and severity of bleeding in the brain.
Treatment Options
Treatment depends on aneurysm size, location, rupture risk, patient age, and overall health.
1. Microsurgical Clipping:
Open skull surgery to place a clip at the aneurysm neck. Ensures complete closure with very low recurrence rates.
Particularly recommended for wide-necked aneurysms, irregularly shaped, complex aneurysms and anterior circulation aneurysms.
2. Endovascular Coiling:
A catheter-guided procedure inserting coils to fill the aneurysm and promote clot formation.
Slightly higher chance of recurrence compared to clipping.
Suitable for smaller aneurysms or patients at high surgical risk.
3. Observation:
Small, low-risk aneurysms may be observed with regular MRI or CT imaging.
Blood pressure management, smoking cessation, and cholesterol control are essential.
Medications like antiplatelet agents may be considered alongside interventional treatments when necessary.
Management of Cerebral Aneurysms
Management of unruptured cerebral aneurysms requires a personalized approach, taking into account patient characteristics, the location and shape of the aneurysm, the predicted risk of rupture, and any accompanying risk factors. Risk analyses are performed, and based on the findings, either a surgical plan may be developed or close follow-up with radiological examinations may be conducted.
In contrast, the management of ruptured cerebral aneurysms is entirely different; these cases are considered neurosurgical emergencies. Early interventions such as microsurgical clipping or endovascular coiling/stenting are critically important in reducing rebleeding and mortality. Therefore, rapid diagnosis and timely intervention are life-saving.
Managing Complications
Vasospasm: Narrowing of brain arteries after rupture; treated with medications to improve blood flow.
Rebleeding: Requires urgent intervention through surgical or endovascular procedures.
Hydrocephalus: Accumulation of cerebrospinal fluid may require drainage or shunt placement.
Conclusion
Cerebral aneurysms (aneurysms in the brain) are serious but manageable with timely detection and personalized treatment. Early diagnosis, control of risk factors, and selecting the right therapeutic strategy—whether surgical, endovascular, or observation—can prevent complications and improve long-term outcomes. Awareness and proactive management are essential for patient safety and recovery.