Cerebral aneurysms can occur in anyone at any age. They are more common in adults than in children and slightly more common in women than men. People with certain inherited disorders are at greater risk.
All cerebral aneurysms have the potential to rupture and cause bleeding into the brain. The reported incidence of ruptured aneurysm is about 10 per 100,000 people per year (about 27,000 patients per year in the U.S.), commonly found in people between 30 and 60. The possible risk factors for rupture include hypertension, alcohol abuse, drug abuse (particularly cocaine), and smoking. Moreover, the state and size affect the risk of aneurysm rupture.
What are the dangers?
Aneurysms can burst and bleed into the brain, causing serious complications such as hemorrhagic stroke, permanent nerve damage, or both. Once it explodes, the aneurysm may burst again and again to bleed into the brain and may occur additional aneurysms. Typically, the break may cause a subarachnoid hemorrhage, bleeding into the space between the skull and brain. A delayed but serious complication of subarachnoid hemorrhage is hydrocephalus, where the excessive accumulation of cerebrospinal fluid in the skull dilates fluid pathways called ventricles that can swell and compress brain tissue. Another complication delayed after the rupture is vasospasm, where other vessels in the brain contract and limit blood flow to vital areas of the brain. This reduced blood flow can cause stroke or tissue damage.
What are the symptoms?
Most cerebral aneurysms do not show symptoms until they are too big or explode. Small aneurysms usually do not change will have no symptoms, whereas a larger aneurysm that is steadily growing may compress nerves and tissues. Symptoms may include pain above and behind the eyes, numbness, weakness or paralysis on one side of the face, dilated pupils and changes in vision. When an aneurysm bleeds, the individual may have a sudden intense headache, double vision, nausea, vomiting, stiff neck or unconsciousness. Patients usually describe the headache as “the worst of his life” and is generally different in intensity and severity of other headaches they have had. The headaches warning or “sentinel” may be due to an aneurysm who loses from days to weeks before it breaks. Only a minority of patients have a sentinel headache prior to aneurysm rupture.
Other signs that a cerebral aneurysm has burst include nausea and vomiting associated with a severe headache, a drooping eyelid, sensitivity to light and changes in mental status or consciousness. Some individuals may have seizures, others may lose consciousness briefly or go into prolonged coma. People who have the “worst headache,” especially when combined with other symptoms should seek immediate medical attention.
How are cerebral aneurysms diagnosed?
Most aneurysms go unnoticed until it breaks or is detected by brain imaging that may have been obtained by another condition. It has several diagnostic methods to provide information about the aneurysm and the best form of treatment. The tests are usually obtained after a subarachnoid hemorrhage to confirm the diagnosis of an aneurysm.
Angiography is a dye test used to analyze the arteries or veins. Intracerebral angiography can detect the degree of narrowing or blockage of an artery or blood vessel in the brain, head or neck, and can identify changes in an artery or vein as a weakness, as an aneurysm. It is used to diagnose stroke and to determine the exact location, size and shape of a brain tumor, aneurysm, or blood vessel that has bled. This test is usually performed in the angiography suite in a hospital. After injecting a local anesthetic, a flexible catheter is inserted into an artery and advanced through the body to the affected artery. A small amount of contrast dye (which is highlighted in the films) are released into the bloodstream and allowed to travel to the head and neck. It takes a series of radiographs and recorded the changes, if any.
Computed tomography (CT) scan of the head is a diagnostic tool for fast, painless and noninvasive, which may reveal the presence of a cerebral aneurysm and determine, for those aneurysms that have burst if it has happened to the brain fluid. Often this is the first diagnostic procedure indicated by a physician after a suspected rupture. Radiographs of the head are processed on a computer as two-dimensional cross-sectional images or “slices” of the brain and skull. Occasionally a contrast dye injected into the bloodstream before the test. This process, called CT angiography produces sharper, more detailed images of blood flow and cerebral arteries. CT is usually performed in a testing center or outpatient hospital setting.
Magnetic resonance imaging (MRI) uses computer-generated radio waves and a powerful magnetic field to produce detailed images of the brain and other body structures. Magnetic resonance angiography (MRA) produces more detailed images of blood vessels. Images can be viewed as three-dimensional or two-dimensional cross sections of the brain and vessels. These painless, noninvasive procedures can show the size and shape of an unruptured aneurysm and can detect bleeding in the brain.
May request an analysis of cerebrospinal fluid in suspected rupture of the aneurysm. After applying a local anesthetic, removes a small amount of this fluid (which protects the brain and spinal cord) from the subarachnoid space, located between the spinal cord and surrounding membranes, with a surgical needle and examined to detect any bleeding or brain hemorrhage. In patients with suspected subarachnoid hemorrhage, this procedure is usually done in a hospital.
Tags: Alcohol abuse, Blood vessels, Brain, Cerebral aneurysms, Diagnostic, Hemorrhagic stroke, Hypertension, Smoking,
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