Signs and Symptoms

Aneurysms usually do not cause any symptoms until they burst. In most cases, it will then seal itself off on its own, but blood will remain around the crevices of the brain, causing what it is known as a subarachnoid hemorrhage. However, some aneurysms do not repair themselves on their own; in these cases, death may occur.

The hallmark symptom of a ruptured aneurysm is a sudden and severe headache. Other symptoms of the condition may differ for each child, depending on the location of the aneurysm and how much blood has seeped into the brain. Symptoms may include:

• Vomiting
• Stiff neck
• Photophobia, a condition in which eyes are sensitive to the light
• Weakness
• Seizures
• Coma or loss of consciousness
• Eye movement problems

Diagnosis

Because ruptured aneurysms are very serious and in some cases can be fatal, a quick and accurate diagnosis is essential for your child's recovery. Symptoms of aneurysms also can mimic those of other conditions, such as meningitis. Therefore, it is important that a definite diagnosis is made so that an effective treatment plan can be started with your child. 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 uses a strong magnetic field to show the arteries in the neck and brain.

• 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 aneurysms need to be treated. The ultimate goal of treatment is to prevent future bleeding while preserving the artery from which the aneurysm originated. At UCSF Children's Hospital, a team of experts specializing in aneurysms that affect blood vessels in the brain works together with you and your family to develop the best possible treatment plan for your child. This team includes a neurologist, neurosurgeon, and neuroradiologist.

In most cases, aneurysms can be successfully treated. A child's prognosis depends on how much bleeding occurred and how their function and consciousness was initially affected by the ruptured aneurysm.

After a child's aneurysm has been treated, future complications can occur. This includes a condition known as vasospasm, in which the blood vessels around the site of the aneurysm clamp down. This can cause a decrease in blood supply to part of the brain, resulting in stroke.

Currently there are two major treatments for brain aneurysms, including:

• Surgery -- Surgery involves placing small, metal clips at the base of the aneurysm at the point where is arises from the artery, while maintaining this artery so that a stroke does not occur. This technique, known as microsurgical clipping, has an excellent success rate. However, some aneurysms cannot be safely clipped and require other surgical procedures, such as 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.

• Endovascular Therapy -- A fairly new alternative to surgery is endovascular treatment of brain aneurysms. This procedure involves placing small, metal coils inside the aneurysm, which helps to prevent further bleeding. It is important to note that although this therapy appears to be safe and effective, there is less experience with this therapy in children.