Aneurysm

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    can draw normal vessels, then bulge, then leak and rupture, result in weakness, one side paralysis

    [Source: NIH]

    What is an aneurysm?

    An aneurysm is a bulging artery that occurs where the arterial wall is weak. The enlarged artery inflates in the weak area, and the walls can continue to weaken over time, increasing the risk of a rupture. An aneurysm is often compared to the inflation of a balloon.

    How will having an aneurysm affect me?

    When aneurysms rupture, they cause bleeding into the space that surrounds the brain. This is known as subarachnoid hemorrhage, and this can cause brain damage, stroke, coma or even death in severe cases. After the first hemorrhage, 46% of patients die, and if there happens to be a second hemorrhage, about 80% of patients die [1].

    Other complications include hydrocephalus, where spaces in the brain that produce cerebrospinal fluid are enlarged, difficulty breathing, and brain infection. Blood can also irritate normal vessels and cause vasospasm or constriction of vessels, interrupting normal blood flow to brain tissue, causing an Ischemic Stroke.

    What does having an aneurysm feel like?

    Due to the potential urgency of this medical diagnosis, it is very important to look out for the key warning indicators and symptoms of ruptured aneurysms, so that they can be diagnosed quickly and necessary treatment methods can be applied. 

    When an aneurysm has ruptured, the patient should immediately be rushed to the hospital in an EMERGENCY VEHICLE (in case lifesaving procedures and skills are required from first responders). 

    Symptoms of ruptured aneurysms include:

    Hemorrhagic stroke (bleeding directly into the brain)

    • Weakness or paralysis in arms/legs
    • Seizure

    Sudden, severe headache (blinding pain)

    Vomiting

    Drooping eyelids/dilated pupils

    Pain above and behind eyes

    Loss of consciousness

    Sudden confusion

    Aneurysms can rupture at any time, but some triggers include stress and strong emotions which lead to high blood pressure, and the intake of blood thinners or some prescription drugs.

    Unruptured aneurysms, on the other hand, tend to present as asymptomatic and are small in size (less than 10 millimetres in diameter [2]). They are thus often found incidentally during general medical examinations or health screenings for other conditions. 

    Sometimes, the unruptured aneurysm applies pressure on surrounding areas of the brain, such as the nerves to the eyes. This can cause related symptoms such as headaches and eye pain.

    What are the risk factors of aneuryssms?

    Some of the things which may increase your risk of having an aneurysm include: 

    Ageing

    Hypertension

    Family history of aneurysms

    Excessive alcohol consumption (especially binge drinking)

    Cigarette smoking

    Use of harmful drugs (e.g. Cocaine)

    Head injuries

    Poor diet and minimal exercise

    The risk of women developing brain aneurysms is 60% to 65% greater than in men [3]. Knowing your risk factors will help you to make lifestyle changes if you are at risk of developing aneurysms.

    How are aneurysms diagnosed?

    Your doctor might employ the following diagnostic methods in order to properly diagnose an aneurysm:

    Cerebral Angiogram. During a cerebral angiogram, your doctor will insert a small, thin tube known as a catheter into an artery in the leg. Your doctor will then pass it up to the blood vessels in the brain.

    Imaging. Your doctor may make use of imaging such as X-Ray, CT and MRI scans to diagnose your aneurysm. This will allow your doctor to have a detailed look at the brain tissue and blood vessels in your brain which will help to locate and diagnose an aneurysm.

    Magnetic resonance angiography (MRA). An MRA is a non-invasive diagnostic procedure that uses a combination of MRI and intravenous contrast dye to visualise blood vessels on the MRI image.

    Once an aneurysm is found, a patient usually has around a 20% chance of developing another [4].

    How do I prevent myself from getting an aneurysm?

    You can analyse their own risk factors and also consult a doctor regarding their own risks of developing aneurysms. You can lower your risk of aneurysm formation and rupture if you make gradual changes to your lifestyle habits, such as:

    Quitting smoking

    Controlling high blood pressure/hypertension

    Avoiding drug abuse

    Avoiding alcohol abuse 

    It is much easier to alter your lifestyle habits and make better choices, rather than surgically fix a ruptured aneurysm when it arises, or deal with the consequences of a ruptured aneurysm.

    What are the conditions related to aneurysms?

    People experiencing the following existing conditions could have a higher risk of developing brain aneurysms:

    Atherosclerosis (hardening of arterial walls)

    Alpha-glucosidase deficiency

    Alpha 1-antitrypsin deficiency

    Arteriovenous malformation (AVM)

    An abnormal connection between an artery and a vein

    How are aneurysms treated?

    Treatment for aneurysms include:

    Microsurgical clipping. This involves blocking the blood supply to an aneurysm through the use of a metal clip that remains within the brain. 

    Endovascular coiling. This is a minimally-invasive technique, therefore an incision in the skull is not required to treat the aneurysm. Instead, a small catheter is passed through the groin and into the artery that contains the aneurysm. Platinum coils are released into the artery which block blood flow to the aneurysm, causing it to shrink. This procedure allows patients to return to daily activities within 2 days, and there is minimal pain and discomfort.

    Flow diversion with stents. In this treatment, a device is placed in the parent blood vessel to divert blood flow from the aneurysm. Blood flow can usually be observed to reduce almost immediately, and the aneurysm could close completely up to 6 months after the procedure.

    Talk to your doctor about these options and about diagnosis if you suspect you or someone you know might have a brain aneurysm.

    Sources

    1. Brain Aneurysm Symptoms & Treatment | Pacific Stroke & Neurovascular Center. (n.d.). Pacific Stroke and Neurovascular Center. Retrieved December 7, 2020, from https://www.pacificneuroscienceinstitute.org/stroke-neurovascular/conditions-and-treatments/aneurysm/
    2. Brain Aneurysm Symptoms Are Similar to Stroke: True or False? (2019, August 6). Health Essentials from Cleveland Clinic. https://health.clevelandclinic.org/brain-aneurysms-symptoms-are-similar-to-stroke-true-or-false/
    3. Cerebral Aneurysm. (n.d.). Www.Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/cerebral-aneurysm
    4. Kieffer, S. (n.d.). Ruptured Brain Aneurysms | Types of Aneurysms | Johns Hopkins Aneurysm Center. Www.Hopkinsmedicine.org. Retrieved December 7, 2020, from https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/aneurysm/types/ruptured_brain_aneurysm.html
    5. The ‘other’ stroke: How brain aneurysms affect stroke risk | Brain | UT Southwestern Medical Center. (n.d.). Utswmed.org. Retrieved December 7, 2020, from https://utswmed.org/medblog/brain-aneurysm-stroke/
    6. Warning Signs/Symptoms – Brain Aneurysm Foundation. (2016). Brain Aneurysm Foundation. https://bafound.org/about-brain-aneurysms/brain-aneurysm-basics/warning-signs-symptoms/
    7. What You Should Know About Cerebral Aneurysms. (2018). Www.Stroke.org. https://www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds/what-you-should-know-about-cerebral-aneurysms