A cerebral aneurysm is a condition in which there is a bulge in a blood vessel in the brain. The appearance of this condition is generally said to resemble a berry hanging on a stalk.

A cerebral aneurysm can leak or burst, called a rupture, which can then cause bleeding in the brain. Often, a ruptured cerebral aneurysm can occur in the space between the brain and the thin tissue that surrounds the brain. This type of bleeding is referred to as a subarachnoid hemorrhage.

However, most cerebral aneurysms do not rupture or cause health problems. These aneurysms are usually detected during certain tests for other health conditions.

Management of unruptured cerebral aneurysms can be done in some cases to prevent rupture. However, it is important to be evaluated by a doctor first. According to Cleveland Clinic, What Are Brain Aneurysms?

Reason

The exact cause of a cerebral aneurysm is not known. However, several factors are thought to increase the risk of developing this condition. A number of factors are known to increase the risk of arterial wall weakness and the development of cerebral aneurysms and rupture of these aneurysms.

Aneurysms are more common in adults than in children. In addition, this condition is also more commonly observed in women compared to men.

Some of the risk factors associated with cerebral aneurysms are:

• Old age
• Have a smoking habit
• Have high blood pressure or hypertension
• Use of illegal drugs, especially cocaine
• Consuming excessive amounts of alcohol
• Have certain health conditions, such as congenital connective tissue disorders that cause weakness of the blood vessels, polycystic kidney disease, an abnormal narrowing of the aorta, and malformations of the arteries and veins of the brain
• Have a family member with a history of cerebral aneurysm

Symptom

Generally, in ruptured cerebral aneurysms, severe headache is one of the most common main symptoms. These headaches are often described as the worst headaches ever experienced.

Signs and symptoms of a ruptured cerebral aneurysm include:

• Headaches that are very severe and occur suddenly
• Nausea and vomiting
• Stiffness in the neck
• Blurred or double vision
• Sensitivity to light
• Seizure
• Drooping eyelids
• Loss of consciousness
• Confusion

In some cases, a leaking aneurysm can cause symptoms such as a very severe headache that occurs suddenly. In addition, more severe rupture can occur after untreated leaks.

Unruptured aneurysms are generally asymptomatic, especially if they are small. However, an unruptured but large aneurysm can put pressure on the tissues and nerves in the brain, which can cause several signs and symptoms, such as:

• Pain above or behind one eye
• Eye pupil dilation
• Changes in vision or double vision
• Immune feeling on one side of the face

Diagnosis

The diagnosis of a cerebral aneurysm is generally determined through a detailed medical interview, direct physical examination, and certain investigations.

If a person experiences a sudden and very severe headache or other symptoms that can be associated with a ruptured aneurysm, an examination or series of examinations may be performed. The goal is to determine whether the person has experienced bleeding in the space between the brain and surrounding tissue, or bleeding in other locations.

If bleeding appears, the doctor will determine if it is caused by a ruptured cerebral aneurysm. In patients who show signs and symptoms of an unruptured aneurysm, such as pain behind the eye, changes in vision, or double vision, several tests may also be performed to identify the presence of an aneurysm.

Some of the diagnostic tests that can be done are:

• Computerized tomography (CT). This examination can generally be done to see if there is bleeding in the brain. During this examination, an injection of a dye can also be performed, which makes it easier to observe blood flow in the brain to evaluate for an aneurysm. A variation of this CT examination is referred to as CT angiography.
• Cerebrospinal fluid examination. In patients with subarachnoid hemorrhage, red blood cells can be seen in the fluid that covers the brain and spinal cord, known as cerebrospinal fluid.

The doctor may ask for a cerebrospinal fluid examination if a person shows symptoms of a ruptured cerebral aneurysm, but the results of the CT examination do not show any signs of bleeding.

• Magnetic resonance imaging (MRI). An MRI scan uses a magnetic field and radio waves to produce detailed brain images. One type of MRI that specializes in detailed evaluation of the arteries, called MRI angiography, can detect the presence of an aneurysm.
• Cerebral angiogram. In this procedure, also known as a cerebral arteriogram, a thin, flexible catheter is inserted through a large artery, usually in the inner thigh, to an artery in the brain.

A special dye is inserted into the catheter to get to the arteries in the brain. Serial X-ray examinations can be done to see details of the condition of the arteries and detect the presence of aneurysms.

This test is more invasive than other tests. Usually performed when other diagnostic tests have not been able to provide adequate information.

Handling

There are several types of treatment for cerebral aneurysms, including:

• Surgery. There are two types of surgery that can be performed on cerebral aneurysms.

Surgical clipping is a procedure to open part of the skull bone to evaluate the aneurysm and place a small metal clip at the aneurysm site. Endovascular coiling is a procedure of placing a catheter through the artery in the thigh aimed at the aneurysm site and followed by the installation of soft platinum wire to close the aneurysm from the artery.

Both procedures have their respective potential risks. Therefore it is very important to discuss carefully with the doctor first.

• flow diverters. This technique involves placing an implant that resembles a stent, which diverts blood flow from the aneurysm sac. This diversion prevents blood flow to the aneurysm site and stimulates the reconstruction of the arterial shape.
• Other treatments for ruptured aneurysms. Other treatments that can be performed on a ruptured aneurysm include pain medication, medication to prevent calcium from entering the cells and blood vessel walls, anti-seizure medication, surgery with certain techniques, and several other types of medications and procedures.

Determining treatment for an unruptured aneurysm requires careful consideration and discussion with the doctor, to discuss the benefits and risks.

Several factors that are generally considered in determining the appropriate treatment recommendations are the size, location, and appearance of the aneurysm, age and overall health, a history of ruptured aneurysms in family members, and the presence of congenital diseases that can increase the risk of aneurysm rupture.

Prevention

In patients with unruptured cerebral aneurysms, several lifestyle changes can be made to reduce the risk of rupture, including:

• Avoid smoking and using illegal drugs
• Eat a healthy diet and do regular physical activity