Brain Aneurysms - Neurology

Brain Aneurysms – An Overview

Aneurysms are defined in the medical field as dilation or bulge in the wall of an artery.  The most common site for aneurysms is in the aorta, the largest artery in the body that extends from the heart down through the chest and abdomen until it branches off into the comment iliac arteries of each thigh.

Brain aneurysms often occur in older individuals; most often in the carotid arteries found on either side of the neck. As such, aneurysms don't often form in the brain, but in these carotid arteries. Older individuals are more apt to have aneurysms in the carotid arteries that lead to the brain than younger individuals.

Aneurysms may also form in the arteries inside the brain, known as cerebral arteries.  In the case of her cerebral aneurysm rupturing, bleeding into brain tissue, known as intracerebral hemorrhage may occur, and can lead to a stroke.  However, because of their small size, cerebral aneurysms are often difficult to see and treat.

What causes an aneurysm?

In many cases, aneurysms, or weakened blood vessel walls, are caused by high blood pressure inside a particular artery. The weakened area of the artery wall is forced outward, much as a balloon filled with too much air. In cases where an aneurysm is not treated, the possibility of rupture occurs, followed by internal bleeding.

The most common cause of aneurysms is atherosclerosis, or "hardening of the arteries" that weakens the artery walls. Inflammatory diseases, traumatic injury, and hereditary or genetic tissue disorders may also lead to the development of an aneurysm. High blood pressure and/or atherosclerosis are the most common causes of aneurysms in older people.

Symptoms of a brain aneurysm

Sometimes, a person experiences no symptoms of a brain aneurysm. However, individuals of both sexes over the age of 50 should be aware of potential signs and symptoms of the condition.

A cerebral aneurysm in a brain artery produces:

  • Headaches (many have described these headaches as throbbing)
  • Weakness (maybe noticed on one or both sides of the body)
  • Paralysis (noticed on one or both sides of the body, depending on the location of the aneurysm in the brain)
  • Numbness (this may be felt in the fingers, the hands, the shoulder, or on one side of the body or both, depending on the location of the brain aneurysm)
  • Severe pain behind the eye. Such pain may also be accompanied by partial blindness or vision changes. For some individuals, the size of the pupils may differ.

Risk of developing aneurysm increases with:

  • Family history of aneurysms
  • Diagnosis of atherosclerosis
  • Diagnosis of high blood pressure
  • Connective tissue disorders or polycystic disease
  • Trauma or injury
  • Smoking
  • Age (aneurysms are more commonly diagnosed in those over 50 years of age.

Diagnosing an aneurysm

An aneurysm is often diagnosed only after a person feels pain, numbness or a sense of pulsing in the area of the body where the weakened blood vessel is located. In some cases, this pulsing, or the presence of an aneurysm, can cause pain that doesn't go away.  Many have described the pain of an aneurysm as excruciating.

However, while pain is an indication that something is wrong, it can often come too late.  As well, many people may be diagnosed with an aneurysm but don't have any symptoms.  Aneurysms are often discovered during routine physical examinations, ultrasonography, or x-ray imaging procedures.

A diagnostic test known as ultrasonography is the most effective for detecting and sizing an aneurysm. Computed tomography (or CT scans) of the location may also be performed following intravenous injection of a radiopaque dye that will show up on x-rays.  Magnetic resonance imaging (MRI) is also an extremely accurate tool to diagnose an aneurysm.

Because most aneurysms measure less than 5 cm (or 2 inches) wide, they typically don't rupture. Larger aneurysms require surgery, but in some cases, surgery may be considered too risky for the patient.

Treatment options

Treatments of aneurysms depend on the size and location. One of the most common dangers of aneurysms, other than rupture, is the formation of blood clots that can form inside the aneurysm. When these blood clots known as emboli, break free, they flow into the blood vessel and have the potential of blocking the artery. When the blood flow to the brain is limited or stopped, stroke and even death may occur.

Aneurysms located in the carotid arteries rarely rupture, but that doesn't mean they can't.  Surgical repair is most often recommended for carotid aneurysms.

Emergency treatment is recommended for an individual who has symptoms of a ruptured aneurysm. In such cases, treatment may include mesh stents or patches to repair the damaged artery wall. A vascular procedure that includes plugging or clogging the blood vessel and then creating a new pathway for blood flow around the weakened area are common.

In optimal cases, the aneurysm is removed and replaced with an artificial blood vessel or graft. In other cases, wrapping the damaged blood vessel with a protective sleeve to prevent it from rupturing is also recommended.

Not all aneurysms require treatment, and it should be emphasized that treating carotid or brain arteries may carry risks. The location and size of the aneurysm must be taken into consideration, as well as the age, overall health, and symptoms of the individual.

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