- Institute of Neuro Sciences
What is Aneurysm ?
It is an artery disease. Aneurysm literally means bulging. Commonly bulging happens in the weak area of the wall in an artery . Mainly it occurs when the blood vessel is damaged or due to weakness in the wall of the blood vessel.
Bulging of artery is called aneurysm. When the blood pressure is increased then the blood vessel swells at the weak point of the blood vessel. It swells like balloon. The swelling can be small or very large. As the aneurysm grows there is a risk of rupture, this can lead to severe complications or sometimes sudden death may occur.
Signs and symptoms of brain aneurysm :
In most cases no signs and symptoms are seen. It may be discovered during investigation of another disease. When it ruptures the patient may suffer severe sudden headaches that are different from past headache, blurred vision; difficulty in speaking that is changes in speech, neck pain, confusion. The rupture of brain aneurysm ruptures, is called subarachnoid haemorrhage. So, any acute severe headache needs evaluation
Causes for the aneurysm :
Aneurysm may be hereditary. Aneurysm may develop on account of hardening of arteries.
Risk factors :
People who have a brain aneurysm in their family history are more prone to the risk of aneurysm than those who don’t have family history of aneurysm.
Patient with a previous history of brain aneurysm is more likely to have another .
People over the age of 65, especially women are more prone to brain aneurysm.
High blood pressure is one of the major underlying causes. Patients with high blood pressure in their family history, are more likely to have brain aneurysm.
Smoking is another cause.
Diagnosis of the aneurysm :
Brain Aneurysm bleed is mainly diagnosed with the help computed tomography scan (CT). A CT scan can help locate the bleeding area in the brain.
Computed tomography angiogram scan (CTA) is a more precise method used for evaluating blood vessels . In this technique a contrast material or a dye injected into the blood to produce images of blood vessels.
Magnetic resonance angiography (MRA is similar to a CTA technique. In this technique uses magnetic field and radio wave energy provide a 2-dimensional or 3-dimensional picture of the target area.
Cerebral angiogram, is the best way to locate less than 5mm brain aneurysm. However this test carries more risk than the above tests. A catheter is inserted through a blood vessel into the brain, after which specific dye is injected into the artery via the catheter to show up in x-ray images the doctor can evaluate the conditions of the site of a ruptured aneurysm.
How it is treated :
Before going to the treatment your doctor will think about the best treatment for you. The treatment depends on one’s age, size of the aneurysm, any additional risk factors and overall health condition. Surgery of the brain aneurysm is quite risky.
The various methods are -
- Surgical clipping.
How are both these procedures performed ?
During coiling procedure, a small tube like material is inserted into the artery near the aneurysm, with an angiogram performed to identify the aneurysm. Then tube is moved to the aneurysm, by filling it with coils of platinum wire or latex, which further prevents blood from entering the aneurysm. The coiling ensures the aneurysm is less likely to rupture.
In surgical clipping a small metal clip is placed surrounding the base of the aneurysm to isolate it from normal blood circulation, it eventually blocks off the blood flow to it. This decreases the pressure falling on the aneurysm preventing it from rupturing.
However these both options have the risk of damaging blood vessel and causing more bleeding.
After treatment :
The treatment helps to relieve symptoms as well as manage complications.
Usually pain killers are used to manage headaches.
Calcium channel blockers reduce the amount of widening or narrowing of blood vessels. They stop calcium for entering cells of the blood vessel walls.
Some anti seizure drugs may be prescribed after an aneurysm ruptures. Ex : levetiracetam (keppra), phenytoin.
Rehabilitation therapy :
sometimes, in cases of subarachoid hemorrhage, patients face problems like is impaired speech and difficulty in bodily movements. So rehabilitation therapy helps the patients to regain that vital normal functioning.
Outcome of brain aneurysm :
Brain aneurysms are most prevalent in people ages 35-60, but they can occur in children as well. Most of the aneurysms are small, nearly one inch and an estimated 50 to 80percent of all aneurysms do not rupture during the course of person’s lifetime.
Almost 500,000 deaths annually reported world-wide are attributed to brain aneurysm.
It is a serious disease. 10%of the patients die before taking medical care in a situation of ruptured aneurysm. But anyhow survival rates are increased by early presentation of the hospital and early detection of aneurysm repair and control of potential blood vessel spam with medications.
The cost of brain aneurysm treated by clipping via open brain surgery doubles in cost after the aneurysm has ruptured. The cost of brain aneurysm treated by coiling which is less invasive and is done through a catheter, increases by about 70-80% after the aneurysm has ruptured.
Can it be prevented ?
Yes it can be prevented by changing life style habits of the patients. Mainly a large percentage of aneurysms are caused by arteriosclerosis, a vascular disease. The patient must lead a healthy life by trying to quit smoking, keeping cholesterol and blood pressure levels under strict control, eating balanced diet, keeping physically active by following a basic exercise regimen.
Hospitalization and recovery :
For patients with aneurysm that is not ruptured the hospitalization and recovery is much smoother and predictable. In case rupture of the modality of the treatment does influence the hospitalization and recovery.