Brain Aneurysm Basics

A Q & A with Dr. Christopher Ogilvy and Deidre Buckley, RN, NP

Brain aneurysm — sounds scary, doesn’t it? We asked Christopher Ogilvy, MD, Director of the Brain Aneurysm Institute at Beth Israel Deaconess Medical Center, and Deidre Buckley, RN, NP, to give us their expert point of view. about brain aneurysms to get a better understanding of the condition.

What is a brain aneurysm?

A brain aneurysm is a weak spot in the wall of an artery (carries blood to the brain, that causes a bulging or ballooning of the weak area. An aneurysm can affect any artery in the body, but the ones in the brain may cause serious medical conditions, like a stroke, when they rupture.

What causes a brain aneurysm?

Some aneurysms are associated with genetics — such as those related to tissue disorders or circulatory disorders. Also, risk factors such as high blood pressure, smoking, and family history of brain aneurysms.

How is a brain aneurysm diagnosed?

Most of the time, aneurysms go unnoticed until they rupture. Other times, they are discovered during an MRI/ MRA done for other reasons.

Are there any signs or symptoms of a brain aneurysm?

Unruptured brain aneurysms typically don’t come with any symptoms. These aneurysms are small in size, usually less than one half inch in diameter. However, large unruptured aneurysms can press on the brain or the cranial nerves of the brain, which is when we see symptoms like:

•Localized headache
•Dilated pupils
•Blurred or double vision
•Pain above and behind eye
•Weakness and numbness
•Difficulty speaking

When should one seek medical attention?

If you experience some or all of these symptoms, you should immediately get medical attention:

•Sudden severe headache, the worst headache of your life
•Loss of consciousness
•Nausea/vomiting
•Stiff neck
•Sudden blurred or double vision
•Sudden pain above/behind the eye or difficulty seeing
•Sudden change in mental status/awareness
•Sudden trouble walking or dizziness
•Sudden weakness and numbness
•Sensitivity to light (photophobia)
•Seizure
•Drooping eyelid

How are aneurysms treated?

The treatment depends on many factors, and whether the aneurysm is unruptured or ruptured.

There are many considerations when evaluating a patient with an unruptured aneurysm. For example, is there a risk of hemorrhage? What is the size and location of the aneurysm? We consider family history, age and health of the patient. We also consider all risks before recommending treatment.

Observation: For small, unruptured aneurysms that are asymptomatic, we may observe them with scans (MRA) at various intervals to monitor for growth.

Clipping: Clipping is one way to treat ruptured and unruptured aneurysms. In this procedure, an opening is made in the skull and a small clip is placed across the neck of the aneurysm so that it blocks the blood flow from entering the aneurysm. The clip remains permanently.

Coiling: In this procedure, a catheter is inserted, usually in the groin, and the clinician guides the catheter through the artery in the thigh to the aneurysm. The wire guided through the catheter coils up inside the aneurysm, disrupts the blood flow and causes the blood to clot. This clotting seals off the aneurysm from the artery.

Artery occlusion and bypass: If clipping or coiling is not an option due to aneurysm size, location, or perforating vessels, a bypass may be done and the aneurysm safely blocked. In a bypass, blood flow can be redirected (bypassed) around the blocked artery. With the advent of newer endovascular techniques, this is seldom needed.

New devices provide greater options to treat challenging aneurysms. There are stents (metal mesh in the shape of a tube that can be placed inside a blood vessel), which can treat wide-neck aneurysms. They can be used in addition to the coils.

A Pipeline Embolization Device (PED) is a new device approved in 2011. It is a flexible, tube-shaped piece of mesh that is placed inside the artery to block the neck of the aneurysm.

Facts you should know:

•Approximately 6 million people in the U.S. have an unruptured brain aneurysm, or 1 in 50 people
•Approximately 30,000 people in the U.S. suffer a ruptured brain aneurysm a year
•Brain aneurysms are fatal in about 40 percent of all cases
•Of the survivors, approximately 66 percent will have some permanent disability
•Ruptured brain aneurysms account for three to five percent of all first-time strokes