The process of thickening of blood vessels is known as aneurysm. The blood vessel develops abnormal bulging or swelling causing complications. Aneurysm can happen in any blood vessel. Aneurysm is common in brain where ballooning of blood vessel occurs in the brain. If the blood vessel gets ruptured inside it can cause severe headache, stroke and even death. Aneurysm can be treated by two main approaches by name emboilzation and by surgical clipping.
Types :
Although brain aneurysm is common there are other types of aneurysm given below:-
- Aortic Aneurysm :
It occurs in the major blood vessel (aorta) of the heart. This blood vessel carries pure blood from the heart to other vital organs. Often thickening or ballooning of this blood vessel do not show any symptoms and is diagnosed only in late stages. If aortic aneurysm causes internal bleeding it can be life threatening and fatal.
- Abdominal aortic aneurysm (AAA) :
The blood vessel or aorta that passes through the abdomen gets thickened leading to aneurysm. In some cases it may develop in the thoracic region leading to ballooning of blood vessel in the chest area.
- Brain Aneurysm :
Your brain gets blood supply through 4 major blood vessels that fuse together in a point called Circle of Willis. Often, aneurysm develops in the region where the blood vessel gives out branches. It can rupture inside causing internal bleeding and subarachnoid hemorrhage. Small branching arteries found in the front portion of the brain have less chance for getting ruptured. Your doctor will examine the location and size of the aneurysm to tell you about the chances of rupturing.
- Peripheral Aneurysm :
This type of aneurysm develops in any of the arteries like that of your arm or legs or even on your groin.
Brain Aneurysm Causes :
Two carotid arteries and a pair of vertebral arteries join together at a point called the Circle of Wills. These are the major arteries that supply oxygen to the brain. This point is found at the basal portion of the brain from where several small branches of arteries emerge. There are some weak spots in the artery at the junction of fusion with the main artery. These spots become vulnerable to form aneurysm by developing ballooning pouches in the blood vessels.
It can be caused due to hypertension or trauma or due to sudden excess of blood flow in the weak spots of the arteries. Any severe infections in the artery can damage the artery wall causing aneurysm. Prolonged use of drugs like cocaine can cause inflammation of the arteries leading to aneurysm. A person with family history of aneurysm has increased risk of developing aneurysm. A person who has had aneurysm earlier is likely to develop it again. Brain aneurysm is common in women than in men and people of African American origin have increased chance of developing aneurysm.
Symptoms :
Brain aneurysm will not produce any symptoms. Often aneurysm is not detected until something wrong happens. In severe cases it can cause symptoms like intense headache, numbness, blurred vision and dilated pupil. The headache experienced during leaking aneurysm can be very severe and often it can be the worst headache. For some people it can cause vomiting and nausea. It can produce stiffness in the neck region. Brain aneurysm is likely to rupture inside causing stroke or death. Blood can leak inside the membranes of the brain (meninges) and sometimes blood leakage can occur in the spine (subarachnoid hemorrhage).
Diagnosis :
Your doctor will complete the physical exam and look for the above symptoms. The diagnosis of the aneurysm begins with a degree of suspicion and the symptom of the worst headache. Sometimes the headache can develop due to brain tumor or migraine or stroke also.
He may order for CT scan of the head to check if there is any subarachnoid hemorrhage. If necessary he would perform a lumbar puncture or biopsy to test the blood in the lab. To confirm the diagnosis angiography is done in the brain arteries.
Treatment :
The purpose of treatment is to provide immediate relief for the damaging symptoms and to repair the blood vessel. Two types of treatment namely surgical clipping and embolization are available. The doctor will consider factors like age, health condition and the location of aneurysm before starting the treatment.
In case the patient has small aneurysm which has very low chances of rupturing inside then your doctor will consider other options instead of brain surgery. The biggest concern of the doctor would be to rule out any chance of rupturing of aneurysm inside.
Embolization :
Embolization is minimal invasive treatment that involves placing a metal coil inside the aneurysm to block its further growth. Atreiovenous malformation can also be repaired using this procedure. Prior to the procedure the patient’s blood clotting level and blood pressure are checked along with other functions.
A thin tube known as catheter is inserted into an artery of the arm or leg which is then passed into the area of aneurysm through imaging guidance. Subsequently coil made of platinum with fine diameter is placed within the blood vessel where ballooning has developed and is anchored. This coil would prevent further blood flow into the aneurysm thus preventing leakage.
- Risk involved :
Though it is an invasive procedure, still there is possibility of getting infected. For some people it can cause block at some other place in the brain developing fresh aneurysm. The coil may not work well as expected.
Surgical clipping :
This is done under general anesthesia and it takes 4-6 hours or even more depending on the complexity of location and aneurysm size. Open craniotomy is done by opening the skull and the scalp and metal clipping is placed at the site of aneurysm to block the further blood flow and leakage.
- Risk involved :
Blood clot can develop at the site where clip is placed, swelling of brain can occur, seizure or stroke can happen and infection can develop on the brain. For some people brain surgery can affect or alter their way of speech, language, vision and coordination and mental balance. The side effects can be short lived or permanent.
Both the procedure mentioned above can damage the neighboring blood vessel causing bleeding or spasm. Not all the aneurysm carries high risk. There are people who lead a normal life with aneurysm. Often they do not cause any symptoms and is detected while doing MRI/CT scan of the brain for some other purpose.
Prognosis :
Outcome of brain aneurysm is increasing nowadays due to advanced medical care and minimal invasive procedures. If the patient receives early treatment before any potential blood leakage or rupture there is high chances of survival.