Brain Aneurysm

Brain Aneurysm & AVM Program at Robert Wood Johnson University Hospital

The Brain Aneurysm & AVM Program at Robert Wood Johnson University Hospital — in partnership with Robert Wood Johnson Medical School — offers high-quality care for brain aneurysm patients through a multidisciplinary approach. Our board-certified neurologists and neurosurgeons utilize the latest technology and our department is making strides in changing the way brain aneurysms are treated nationwide. Our diagnostic tools and treatment techniques are paving the way for better outcomes for individuals suffering from ruptured brain aneurysms.

A ruptured aneurysm is a serious medical emergency requiring immediate treatment. If you suspect that you or someone you know has suffered from a ruptured brain aneurysm, call 9-1-1 for immediate transportation to your nearest emergency room. Do not attempt to drive yourself or have someone else drive you. The emergency medical treatment (EMT) team in the ambulance will be able to provide potentially life-saving treatment en-route to the hospital.

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What Is a Brain Aneurysm?

Hearing the word “aneurysm” alone is enough to cause fear. Knowing more about aneurysms, though, can empower you to make better health care decisions for yourself or a loved one.

To understand a brain aneurysm, also called a cerebral aneurysm or intercranial aneurysm, it helps to have a visual explanation. The brain needs a steady supply of nutrients from oxygen-rich blood, which is delivered by arteries. Arteries are the blood vessels that carry oxygenated blood from the heart to the rest of the body. If an artery in the brain begins to balloon out, it can weaken the blood vessel. Although most of these bulging blood vessels never burst, the weakened blood vessel may leak or explode. Arteries anywhere in the brain can develop aneurysms, but they are usually located in the major arteries deep within the structure of the brain. Bleeding in the brain is called a hemorrhagic stroke.

Nine out of ten brain aneurysms do not present with any symptoms. These aneurysms are quite small, less than 5 millimeters, and have a low risk of rupture.

Ruptured brain aneurysms are quite rare but represent a serious medical emergency. Many people who have ruptured brain aneurysms experience them suddenly, with no warning, and were never aware they had an unruptured aneurysm before. The rate of brain damage, permanent disability, and death resulting from a ruptured brain aneurysm is very high.

How Common Are Brain Aneurysms?

Brain aneurysms are much more common than many think; in fact, the Brain Aneurysm Foundation states that 1 in 50 people live with an unruptured brain aneurysm at any given time. Most of these individuals will never notice any of the tell-tale signs of a ruptured brain aneurysm, such as an extremely severe headache indicative of a brain bleed. Brain ‎aneurysms can cause sudden death, with nearly 500,000 victims dying worldwide every year.‬‬‬

Although it’s not clear why they occur in some people and not in others, the following factors may contribute to brain aneurysms:

  • Family history: If your parents or siblings have had brain aneurysms, you are at a particularly high risk.
  • Cigarette smoking: While smoking isn’t known to be a direct causative factor of a brain aneurysm, as many as 72% of all aneurysm patients are smokers, according to a 2000 study by the Pennsylvania State University College of Medicine.
  • Traumatic brain injuries: Brain bleeds are more likely after a severe head injury.
  • Ehlers-Danlos syndrome, polycystic kidney disease, and Marfan’s syndrome: These connective tissue diseases can weaken the blood vessels.
  • Infections: If the artery walls become infected, a mycoctic aneurysm can occur.
  • Chronic high blood pressure: Hypertension is the leading cause of subarachnoid hemorrhage, according to the American Stroke Association.
  • Drug abuse: Alcohol or illicit drug abuse, particularly of cocaine, puts you at a higher risk of a brain aneurysm.
  • Older age: Most brain aneurysm patients are over the age of 40.
  • Previous brain aneurysm: According to the American Stroke Association, having one aneurysm puts you at a 15 to 20% chance of having another in the future.
  • Gender: Women are more likely to develop a brain aneurysm.
  • Race: African Americans and those of Caribbean descent are more likely than whites to have a brain aneurysm.

Brain Aneurysm Symptoms

Symptoms of brain aneurysms vary based on whether or not they have burst.

Unruptured Brain Aneurysm Symptoms

Unruptured brain aneurysms are usually asymptomatic. If they do produce symptoms, they include:

  • Slight pain above/behind one eye
  • One dilated pupil
  • Vision changes, including double vision
  • Facial numbness on one side

Ruptured Brain Aneurysm Symptoms

  • Sudden, extremely severe headache
  • Stiff neck
  • Nausea and vomiting
  • Confusion
  • Blurred vision
  • Light sensitivity
  • Seizure
  • Drooping eyelids
  • Dizziness
  • Drowsiness
  • Loss of consciousness

Leaking Brain Aneurysm Symptoms

If a brain aneurysm starts to leak a slight amount of blood (sentinel bleed), it will causes a sudden, severe headache. Often, a brain aneurysm that previously leaked will rupture in the future.

Brain Aneurysm Diagnosis

Early diagnosis is critical to increasing the likelihood of a healthy recovery and to minimizing the risk of brain damage. Experiencing a sudden, severe headache and symptoms relating to a ruptured aneurysm indicate a medical emergency which must be properly diagnosed in order to determine proper treatment. ‬‬‬

  • Imaging tests: Most patients showing signs of a brain aneurysm receive computerized tomography (CT), computed tomography angiogram (CTA), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) scans. These tests help identify brain bleeding and are a precise way to evaluate the blood vessels of the brain. Cerebral angiograms are another diagnostic test using X-ray technology to find blockages or other blood vessel abnormalities. Because cerebral angiography is more invasive than other imaging tests, it is only utilized if your doctor needs more information to plan your treatment after other testing has been done.
  • Cerebrospinal fluid (CSF) test: Also called a lumbar puncture or spinal tap, this group of tests can also identify brain bleeding and other diseases affecting the central nervous system.
  • Echocardiogram (also called Echo, ECG, or EKG): This test involves a sonogram of the heart to check for fatty material in the arteries, or other substances.

Brain Aneurysm Treatment

Important medical advances in the neurology and neurosurgery fields have made treatment of brain aneurysms much more promising than it was in years past. It’s important to consult with neurology and neurosurgery experts in order to have the best outcome of a brain aneurysm, whether it is unruptured, leaking, or ruptured. Treatment options vary depending on the patient’s age and overall health, as well as the size, shape, and location of the aneurysm. Because each patient and each aneurysm are different, your neurologist and neurosurgeon will evaluate the risk factors for treatment versus non-treatment to decide which technique would be best for you.

Unruptured Brain Aneurysm Treatment

Nine out of ten brain aneurysms never rupture. If your doctor detects you have an unruptured brain aneurysm, surgical treatment may not be necessary, depending on whether the benefits of treatment outweigh the risks inherent in surgery. To keep your aneurysm from rupturing, your doctor will advise you to keep your blood pressure in a healthy range and advise you not to smoke.

If you have a large aneurysm or if you are experiencing painful symptoms, your doctor may recommend surgery. Also, if you have had a previous brain aneurysm rupture, you doctor may recommend surgical treatment.

Ruptured Brain Aneurysms: Surgical Treatment

Ruptured brain aneurysms cannot be cured, and the brain damage they cause cannot be reversed. However, treatment can prevent further bleeding and the damage it would cause. Surgery is recommended to prevent rebleeding by sealing off the burst blood vessel with the use of a clip or coil. Treatment options include:

  • Microsurgical clipping: This procedure closes off the burst blood vessel by clipping the artery which feeds the aneurysm in order to stop the blood flow. The blood vessel is reached by performing craniotomy surgery to create an opening in the skull to reach the brain aneurysm. This treatment technique has been utilized successfully since 1937.
  • Endovascular coiling: This is a newer surgical treatment for ruptured brain aneurysms and has been used on patients since 1991. It is minimally-invasive because it does not require an incision into the skull. Rather, it uses a catheter to reach the burst blood vessel in the brain passed up through the groin. The coils induce clotting of the burst blood vessel and prevent further blood flow in the artery.

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