Cerebral Aneurysm

What Is a Cerebral Aneurysm?

A cerebral aneurysm, also called a brain aneurysm, is a weakened area in the wall of a blood vessel in the brain that bulges or balloons outward. If it ruptures, it can cause bleeding in the brain (a hemorrhagic stroke), which is a medical emergency.

Not all aneurysms rupture. Some remain small and stable, never causing symptoms. However, a ruptured aneurysm can lead to severe brain damage or death if not treated quickly.

Who Is Affected?

Cerebral aneurysms can affect people of any age, but they are most commonly found in adults between 30 and 60 years old. Many aneurysms are discovered incidentally during imaging for other health issues.

What Causes a Cerebral Aneurysm?

Aneurysms develop when the wall of a brain artery weakens over time. This weakening may be due to genetics, health conditions, or lifestyle factors. Some people are born with blood vessel abnormalities that increase their risk.

Risk Factors

Not Controllable

• Age (over 40)
• Family history of aneurysms or hemorrhagic stroke
• Gender (higher risk in women)
• Certain genetic conditions (e.g., Ehlers-Danlos syndrome, polycystic kidney disease)
• Previous aneurysm

Controllable

• High blood pressure
• Smoking
• Heavy alcohol consumption
• Recreational drug use (especially cocaine or amphetamines)
• Poorly controlled cholesterol or diabetes

Who Is Most at Risk?

People with a family history of brain aneurysms, uncontrolled high blood pressure, or a history of smoking are at highest risk. Risk increases with age and is slightly higher among women.

How to Reduce Your Risk

• Stop smoking
• Control your blood pressure
• Limit alcohol use
• Eat a heart-healthy diet
• Exercise regularly
• Avoid illicit drugs

Routine screening may be recommended if you have a strong family history or genetic predisposition.

Unruptured Aneurysm

Most unruptured aneurysms cause no symptoms and are found incidentally. However, larger aneurysms may press on brain tissue or nerves and cause:

• Headaches
• Vision problems
• Pain above or behind one eye
• Difficulty speaking or concentrating

Ruptured Aneurysm

A ruptured cerebral aneurysm leads to a subarachnoid hemorrhage (bleeding into the space around the brain). Symptoms may include:

• Sudden, severe headache ("worst headache of your life")
• Nausea or vomiting
• Stiff neck
• Loss of consciousness
• Seizures
• Sensitivity to light
• Confusion or disorientation

How Is a Brain Aneurysm Diagnosed?

If a brain aneurysm is suspected, either due to symptoms or family history,your doctor may order imaging tests to examine the blood vessels in the brain.

Common Diagnostic Tests

• CT scan: Quickly detects bleeding in the brain after rupture.
• CT angiography (CTA): Uses contrast dye to visualize blood vessels.
• MRI or MRA (Magnetic Resonance Angiography): Shows detailed brain structures and blood flow.
• Cerebral angiogram: A catheter-based test offering the most detailed images of brain arteries.

Blood tests may also be ordered to check for infection or other conditions if symptoms are unclear.

How Is a Cerebral Aneurysm Treated?

Treatment depends on the size, location, and whether the aneurysm has ruptured. Unruptured aneurysms may be monitored or treated, while ruptured aneurysms need emergency treatment.

Lifestyle Changes

• Manage blood pressure
• Quit smoking
• Reduce stress
• Adopt a low-sodium, heart-healthy diet

Medical

• Blood pressure medication
• Pain relief and seizure prevention in ruptured aneurysms
• Monitoring of small, unruptured aneurysms with regular imaging

Surgical

• Neurovascular (endovascular) coiling: A catheter inserts coils into the aneurysm to block blood flow and prevent rupture.
• Neurovascular placement of flow diverting stents (Pipeline Embolization): Stent-like devices that divert blood away from the aneurysm, allowing it to heal.
• Neurovascular placement of intrasaccular devices (Woven EndoBridge or WEB): A catheter is used to place a mesh like implant within the sac inside the aneurysm to slow the blood flow, allowing a clot to form.
• Surgical clipping: A neurosurgeon places a tiny clip at the base of the aneurysm to stop blood flow.
• Bypass or vessel reconstruction: Used in complex or large aneurysms.

Your neurovascular team will carefully evaluate the risks versus benefits to recommend the best course of action.

When to Call Your Doctor

• If you have symptoms of an unruptured cerebral aneurysm such as headaches, vision problems or pain above or behind one eye, make an appointment to see your doctor.
• If you have been told that you have a cerebral aneurysm that has not ruptured, ask your physician to refer you to Riverside Neurovascular Specialists for further diagnosis and management.  They will create an appropriate care plan based on the individual situation.

When to Seek Emergency Medical Care

If you show any signs of a ruptured cerebral aneurysm or stroke, you should call 911 immediately. Seek immediate assistance even if symptoms seem to get better.

To remember stroke symptoms, just remember to BE FAST:

• BALANCE: If there is a sudden loss of balance or coordination
• EYES: If there is a sudden loss of vision in one or both eyes or if vision becomes blurry
• FACIAL DROOPING: If there is a sudden weakness in the face – especially on only one side
• ARM WEAKNESS: If there is sudden weakness in an arm or leg
• SPEECH: If there is a sudden difficulty speaking or slurring of speech
• TIME TO CALL 911

Other symptoms may include:

• Sudden severe headache with no known cause (common complaint with a ruptured aneurysm)

Even if symptoms go away, it is still a medical emergency, and you need to call 911.

Time is brain - you need emergency evaluation to prevent a larger, potentially deadly stroke.

• Seek care for any emergent symptoms by calling 911.
• Talk to your doctor if you have symptoms of an unruptured aneurysm such as headaches, vision problems or pain behind one eye so you can be further evaluated.
• If an aneurysm is found incidentally after imaging tests for another issue, seek care with a neurovascular specialists to get a clearer picture of the problem and to create an appropriate care plan so it can be managed prior to a rupture.