Brain Aneurysm

Diagnosis of Brain Aneurysm

Screening and diagnosis involve imaging tests and procedures to detect aneurysms or bleeding in the brain.

• CT scan: A specialized X-ray producing 2D slices of the brain. A CT angiogram adds contrast dye to visualize blood flow and detect aneurysms.

• Lumbar puncture (spinal tap): Tests cerebrospinal fluid for red blood cells if a subarachnoid hemorrhage is suspected but CT is inconclusive.

• MRI: Uses magnetic fields and radio waves to create 2D or 3D images of the brain. MR angiography captures detailed images of brain arteries to detect aneurysm size, shape, and location.

• Cerebral angiogram: A catheter is inserted into an artery (usually groin or wrist), guided to brain arteries, and injected with dye. X-rays reveal aneurysm details and is used when other tests are inconclusive.

Screening for high-risk individuals is considered if there is:

• Family history of brain aneurysms or hemorrhagic stroke.

• Conditions that increase risk, such as polycystic kidney disease, coarctation of the aorta, or Ehlers-Danlos syndrome.

Prognosis factors include age, health, aneurysm size and location, bleeding severity, and timeliness of medical care. Roughly 25% of people with ruptured aneurysms die within 24 hours, and another 25% die within six months due to complications.

Treatment of Brain Aneurysm

Treatment depends on rupture status, aneurysm characteristics, and overall health.

Surgical Treatment

• Surgical clipping: A portion of the skull is removed to access the aneurysm. A metal clip is placed at the aneurysm neck to stop blood flow. Recovery: 4–6 weeks; hospital stay varies based on rupture status.

• Endovascular coiling: A catheter threads coils into the aneurysm to clot blood and prevent rupture. Stents may hold coils in place. Risks include bleeding, loss of blood flow, and possible aneurysm recurrence.

• Flow diversion: A stent diverts blood flow away from the aneurysm, reducing rupture risk and allowing healing. Often used for large or hard-to-treat aneurysms.

Other Procedures for Ruptured Aneurysms

• Angioplasty: Expands narrowed brain vessels caused by vasospasm, preventing stroke.

• Ventricular or lumbar draining catheters / shunt surgery: Reduce brain pressure from cerebrospinal fluid buildup.

Medicines

• Pain relievers: Such as acetaminophen for headache management.

• Calcium channel blockers: Reduce vasospasm risk; nimodipine helps prevent delayed brain injury after rupture.

• Vasodilators: Open narrowed blood vessels to maintain blood flow and prevent stroke.

• Anti-seizure medicines: Used if seizures occur post-rupture.

Rehabilitation

• Physical, speech, and occupational therapy may be needed to recover skills after brain damage from subarachnoid hemorrhage.

Treating Unruptured Brain Aneurysms

• Options include surgical clipping, endovascular coiling, or flow diversion.

• Decisions are based on aneurysm size, location, and rupture risk.

• Neurologists and neurosurgeons or interventional neuroradiologists collaborate to weigh risks versus benefits of treatment.