Cerebral AneurysmA cerebral aneurysm (also known as an intracranial or intracerebral aneurysm) is a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood. The bulging aneurysm can put pressure on a nerve or surrounding brain tissue. It may also leak or rupture, spilling blood into the surrounding tissue (called a hemorrhage). Some cerebral aneurysms, particularly those that are very small, do not bleed or cause other problems. Cerebral aneurysms can occur anywhere in the brain, but most are located along a loop of arteries that run between the underside of the brain and the base of the skull.
CausesAneurysms in the brain occur when there is a weakened area in the wall of a blood vessel. An aneurysm may be present from birth (congenital) or it may develop later in life. (For example, after a blood vessel is injured.)
There are many different types of aneurysms. A berry aneurysm can vary in size from a few millimeters to over a centimeter. Giant berry aneurysms can reach well over 2 centimeters. These are more common in adults. Multiple berry aneurysms are inherited more often than other types of aneurysms.
Other types of cerebral aneurysm involve widening of an entire blood vessel, or they may appear as a "ballooning out" of part of a blood vessel. Such aneurysms can occur in any blood vessel that supplies the brain. Trauma and infection, which can injure the blood vessel wall, can cause such aneurysms.
SymptomsAneurysms usually cause no symptoms unless they rupture and cause bleeding into the brain. Often, an aneurysm is found when a CT scan or MRI is performed for another reason. Symptoms occur if the aneurysm pushes on nearby structures in the brain.
Symptoms depend on what structure the aneurysm pushes on, but may include: -
- Double vision
- Loss of vision
- Eye pain
- Neck pain
Exams And TestsAn eye exam may show increased pressure within the brain (raised intracranial pressure), including swelling of the optic nerve or bleeding into the retina of the eye.
The following tests may be used to diagnose cerebral aneurysm and determine the cause of bleeding within the brain:
- CT scan of the head
- CSF exam (spinal tap)
- MRI of the head (CT scans may be better at showing bleeding in the brain)
- Cerebral angiography or spiral CT scan angiography of the head to reveal the location and size of the aneurysm
- Electroencephalogram (EEG) if seizures occur
Can Cerebral Aneurysms Be Prevented?
There are no known ways to prevent a cerebral aneurysm from forming. People with a diagnosed brain aneurysm should carefully control high blood pressure, stop smoking, and avoid cocaine use or other stimulant drugs. They should also consult with a doctor about the benefits and risks of taking aspirin or other drugs that thin the blood. Women should check with their doctors about the use of oral contraceptives.
TreatmentSymptoms often do not appear until bleeding (a rupture) occurs. A ruptured cerebral aneurysm is an emergency condition. The goal of treatment is to control symptoms and prevent further bleeding. Lowering blood pressure can reduce the risk.
Neurosurgery is the main treatment for cerebral aneurysm. The base of the aneurysm is closed off with clamps, sutures, or other materials that prevent blood flow through the aneurysm.
In many cases, an alternative to surgery can be done by placing special coils or stents into the aneurysm through the arteries, which causes a clot to form and prevents further bleeding. This approach is considered less invasive than brain surgery, and in the appropriate circumstances, it is regarded as the best form of treatment.
If surgery cannot be done because of the patient's overall condition or the aneurym's location or size, medical treatment is similar to treatment for subarachnoid hemorrhage.
Treatment may involve: -
- Complete bedrest and activity restrictions
- Drugs to prevent seizures
- Medicines to control headaches and blood pressure
Once the aneurysm is repaired, prevention of stroke due to blood vessel spasm may be necessary. This may include intravenous fluids, certain medications, and actually letting one's blood pressure run high.
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