Brain Aneurysm: Symptoms, Risk Factors and Treatment

Brain Aneurysm, also known as a Cerebral Aneurysm, is generally a bulge in a susceptible region of a blood artery in or near your brain. The weakened area is continuously pushed outward by blood flow, resulting in a bump that resembles a blister. The aneurysm widens even further as blood pours into the bulge. It is like a balloon that becomes thinner and more liable to burst as it is filled with air. Your brain bleeds if the aneurysm ruptures or leaks (bursts open). They can affect any age group including children but are more commonly seen after 40 years to 50 years of age. It is a relatively rare condition with reports suggesting that it affects around 76,500–204,100 people in India annually.

Symptoms of a ruptured Brain Aneurysm:

Severe headache is the hallmark feature of Aneurysm rupture. There may be associated vomiting, lots of consciousness, seizures, limb weakness or neurological difficulties. Sometimes aneurysms (especially large/giant) present as mass lesions causing brain compression and leading to neurological difficulties.

The exact cause of a Brain Aneurysm is unknown. There are acquired and coagmented factors which play a role. These include -

• Hypertension
• Smoking
• Infection in the blood
• Cocaine and amphetamine usage
• Damage to the brain due to trauma (generally a result of car crashes)
• Atherosclerosis (which is an accumulation of fat on the walls of the blood vessel)

Who is at risk of having Brain Aneurysms?

• Older Women
• Individuals ranging in age from 40 to 60 years
• Those who have a history of aneurysms in their family
• Those possessing an unusual blood vessels condition, such as cerebral arteritis, fibromuscular dysplasia or arterial dissection
• People who suffer from a connective tissue-related genetic condition Mar fair syndrome
• Patients with renal polycystic disease
• Those born with a cerebral aneurysm as a congenital abnormality.

Diagnosing Brain Aneurysm
An imaging test is generally ordered by a neurosurgery doctor to diagnose a case of a brain aneurysm. The size, form and location of the aneurysm are revealed by tests such as magnetic resonance imaging, computed tomography, diagnostic cerebral angiogram, magnetic resonance angiography and computed tomography angiography. Sometimes, the initial test may not detect a ruptured aneurysm. Your doctor might suggest a lumbar puncture if your symptoms suggest a ruptured aneurysm (spinal tap). This examination reveals whether or not there is blood present in the cerebrospinal fluid.

Surviving a Brain Aneurysm
Unruptured brain aneurysms can remain undetected for the entirety of a person's life. The risk of their rupture relies on a number of variables, including the aneurysm's size, placement and other elements. A hemorrhagic stroke is brought on if an aneurysm ruptures, leaking blood into the area around your brain and occasionally into the brain tissue itself.

Emergency medical care is required for a ruptured brain aneurysm. The risk of death or disability increases as time goes on with a ruptured aneurysm. With a ruptured brain aneurysm, about 75% of patients survive for more than 24 hours. However, one-fourth of the survivors could experience fatal consequences within six months. If you believe you are experiencing signs of a burst or ruptured brain aneurysm, dial 108 or visit an emergency room. Your chances of survival are higher depending on how early you can receive medical care.

Complications
Blood rushes into or surrounds the brain when the aneurysm ruptures or leaks. The irritated brain tissue caused by the blood pooling might cause swelling of the brain, which can result in permanent brain injury, stroke or further issues like:

• Due to sudden intracranial pressure blood flow to the brain may stop, causing the patient to become unconscious or even die.
• Vasospasm is a condition in which the blood vessels constrict and the oxygen supply to the brain is limited
• A condition known as hydrocephalus, or "water on the brain", is a buildup of spinal fluid surrounding the brain that causes pressure
• Coma, wherein you are unconscious for numerous days to weeks
• Hyponatremia is a condition where the sodium level in the blood fluctuates and can harm the brain by enlarging brain cells
• Muscle convulsions, often known as seizures, can exacerbate existing brain injury.

Treatment
An Aneurysm in the brain that has ruptured can be treated in one of two ways:

• An Aneurysm is closed through surgery using a technique called clipping. Your skull is partially removed by the neurosurgeon in order to reach the Aneurysm. The blood vessel feeding the Aneurysm is then identified. The neurosurgeon will then put a tiny metal clip on the Aneurysm's neck in order to stop blood flow into it
• In the Endovascular technique, the surgeon places a catheter into an artery, commonly in your wrist or groin, and threads it through your body to the aneurysm. A flow diverter, an intraluminal flow disruptor, a stent, coils or different combinations of these devices is then used to block the aneurysm
• Both treatments are effective & can be safely done. Though endovascular appears less invasive.

Managing Brain Aneurysm
It is improbable that an Aneurysm will go away on its own after being discovered. However, leading a healthy lifestyle can lower the chance of aneurysm growth, change, rupture or the formation of a new Aneurysm.

Steps that could be taken are as follows:

• Giving up smoking
• Regular exercise without overly strenuous lifting
• Consuming a healthy diet
• Avoiding cocaine or any other stimulant substances and seeking help if you have an alcohol or drug use disorder.

Dr. Dhananjaya I Bhat, Consultant – Neurosurgery, Aster RV Hospital