Brain aneurysm: diagnosis and treatment 

Brain Aneurysm Awareness Month is observed in September to educate people about the disease that is seen in 2% of the population.
Brain aneurysm: diagnosis and treatment 

KOCHI:  Brain Aneurysm Awareness Month is observed in September to educate people about the disease that is seen in 2% of the population. It is all about raising awareness, prevention, warning signs and more.  Aneurysm affect blood vessels in which weak areas bulge outward like a balloon. When it expands beyond its capacity, it tends to rupture, resulting in bleeding into the brain, and or surrounding Cerebrospinal Fluid (CSF), which can even lead to life-threatening situations.

What causes brain aneurysm?

The weakening of the walls of the blood vessel can be due to congenital causes, but more commonly this occurs when there is increased stress on weak areas of blood vessels. Factors like diabetes, hypertension, smoking, and substance abuse can also weaken the walls of blood vessels. These areas further bulge to form an aneurysm and rupture when blood pressure shoots up suddenly.

How common is a brain aneurysm?

The incidence is higher in individuals with lifestyle diseases like hypertension and diabetes. Aneurysms are also detected before rupture when scanning of the brain is done.

What are the symptoms of a brain aneurysm?

Unruptured brains are usually asymptomatic. Headache and vision abnormalities occur rarely when there is compression on the neighbouring areas of the brain. When an aneurysm ruptures, severe headache, vomiting, visual disturbance, seizures, limb weakness or loss of consciousness are the sudden symptoms, if not managed immediately with interventional procedures, it can be life-threatening. 

What happens when the aneurysm ruptures?

When it ruptures, blood rushes out from blood vessels into the brain or the fluid surrounding the brain. If the rupture is small, bleeding stops temporarily for some time, this can enable one to get treatment and prevent further life-threatening bleeding to an extent. If the rupture is large, it will rapidly increase in size and can exert pressure and damage the brain resulting in coma or death. About 50% of patients with ruptured aneurysms die within three months, out of which, close to a quarter lose their lives within 24 hours. Those surviving also can have significant brain damage. Prompt treatment can reduce the chance of mortality and brain damage.

What are the reasons for an aneurysm to rupture?

Aneurysms rupture when there is increased pressure on their walls, especially due to increased blood pressure. Thus, situations that can cause increased blood pressure like, stressful conditions, doing heavy work or not taking  BP medications regularly can lead to a rupture. 

How are brain aneurysms diagnosed?

Scanning techniques like CT Angiography, MR Angiography helps in diagnosing aneurysm. Advanced testing like digital subtraction angiography is also another option for prompt diagnosis.

When to treat?

Once diagnosed, most aneurysms should be treated as early as possible, especially ruptured aneurysms. A second rupture will cause irreversible damage and lead to death.

How are aneurysms treated?

Aneurysms are treated either by open or pinhole surgery through blood vessels. However, in both techniques, the blood flow to the aneurysm is blocked. Open surgical treatment which is performed by a neurosurgeon is done by creating a small opening in the skull and placing a metal clip at the base of the aneurysm. Most of the aneurysms can be treated using minimally invasive pinhole surgery like an angiogram. The treatment, which is done by a neuro-interventional radiologist, is performed by passing small tubes and devices through blood vessels under live visualisation using scanning techniques like X-rays. In this technique, the blood flowing to the aneurysm sac is blocked using various devices like coils, stents etc.

How long does it take a patient to recover?  

In case of unruptured aneurysm, hospital stay will be less. Patients who underwent pinhole interventional treatment can get discharged in two days and resume normal activities when compared to open surgery, which requires more time. For ruptured aneurysms, hospital stays will be more prolonged as it takes time to recover from the damage caused by the rupture to the brain structures. 

Mind and body

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