Brain aneurysms typically do not cause any symptoms until they rupture. The hallmark symptom of a ruptured aneurysm is a sudden and extremely severe headache that may occur with nausea, vomiting, stiff neck, impaired consciousness, seizures or coma.
Some brain aneurysms do not rupture, although they should still be promptly diagnosed and treated. People with unruptured aneurysms may not have any symptoms at all, although others may experience the following:
Cranial nerve palsy
Dilated pupils
Double vision
Localized headache
Pain above and behind the eye
Diagnosis
Because ruptured brain aneurysms are very serious and in some cases can be fatal, a quick and accurate diagnosis is essential for your recovery. Tests that are commonly used in the diagnosis of aneurysms include:
Angiography -- This test is commonly used in diagnosing aneurysms. During this procedure, a special dye that can be seen on X-rays is injected into an artery that supplies blood to the brain. The dye follows the path of the brain's blood flow and can show any obstructions or leaks.
Magnetic Resonance Angiography (MRA) -- This procedure is a magnetic resonance imaging (MRI) study of the blood vessels. Using a strong magnetic field, a MRI can generate a three-dimensional image of the brain that can be used to detect, diagnose and aid the treatment of various conditions. A MRA provides detailed images of blood vessels. The procedure is painless, and the magnetic field is not known to cause tissue damage of any kind.
Computed Tomography (CT) Scan -- With this test, X-ray beams are used to create a three-dimensional image of the brain. A CT scan can detect bleeding in the artery after the aneurysm has burst.
Treatment
Almost all brain aneurysms need to be treated. If the aneurysm has already ruptured, the ultimate goal of treatment is to prevent another rupture and future bleeding while preserving the artery from which the aneurysm originated. If the aneurysm has not yet ruptured, the goal is to prevent it from doing so.
After a ruptured aneurysm is diagnosed, the aneurysm is secured as quickly as possible using a variety of surgical or endovascular coiling techniques.
Surgery
Microsurgical Clipping -- The majority of aneurysms can be successfully treated using a surgical technique called microsurgical clipping. Aneurysms are located in the area outside the brain, called the subarachnoid spaces and fissures. During microsurgical clipping, the aneurysms are accessed by carefully opening these areas under the high magnification of operating microscopes. The surgeon then spreads the brain tissue apart and places small metal clips at the base of the aneurysm at the point where it arises from the artery, while maintaining this artery so that a stroke does not occur. After clipping the aneurysm, the bone is secured in its original place, and the wound is closed.
Skull Base Surgery -- This surgery is typically used for deep and complex aneurysms, which are accessed through the bone at the base of the skull.
Vascular Bypass Grafting -- Some aneurysms, such as those that are complex and very large, require vascular bypass grafting. During this procedure, a vein is taken from the leg and hooked up between an artery in the neck and an artery in the brain.
3-D Computer Modeling -- This novel technique, first performed by neurosurgeons at UCSF, is used for difficult to treat and rare aneurysms. It produces 3-D images of the aneurysm and blood flowing through the arteries to the aneurysm. First, dye is injected into patient arteries to track blood flow. A computer superimposes that information over brain scans to compose a 3-D model of the aneurysm. Then, on the computer, surgeons can test whether different surgical techniques would alter blood flow enough to ease hot spots of pressure inside the aneurysm.
Endovascular Therapy -- A fairly new and minimally invasive alternative to surgery is endovascular treatment of brain aneurysms, known as endovascular coiling. The procedure does not require making an incision in the head, is performed under general anesthesia or light sedation, and has a shorter recovery time and hospital stay compared to conventional surgery. However, it is important to note that endovascular therapy is not recommended for all patients.
The procedure involves placing small, metal coils inside the aneurysm using a catheter -- a long, flexible tube. The catheter is inserted into the femoral artery in your leg and navigated through the vascular system, into the head and aneurysm. Tiny metal coils are threaded through the catheter and placed in the aneurysm, blocking blood flow into the aneurysm and preventing rupture. The coils are made of platinum so that they can be visible on an X-ray and are flexible enough to conform to the aneurysm shape.
