Aneurysm: Symptoms, Complaints, Signs

An aneurysm often does not cause any symptoms. The following symptoms and complaints may indicate an aneurysm of the vessels supplying the brain:

  • Headache
  • Cranial nerve failures (visual disturbances, hearing disturbances, dizziness, etc.)

Symptoms of acute rupture

  • Acute diffuse headache of unprecedented intensity.
  • Disturbance of consciousness
  • Meningismus (painful stiffness of the neck)
  • Nausea / vomiting

The following symptoms and complaints may indicate a thoracic aortic aneurysm:

  • Severe thoracic pain radiating to the back.
  • Dyspnea (shortness of breath)
  • Hoarseness

Symptoms of acute aortic dissection (synonym: aneurysm dissecans aortae).

  • Sudden chest pain (chest pain)/back pain (annihilation pain) + fear of death [here: acute aortic syndrome, AAS].
  • Syncope (momentary loss of consciousness).
  • Acute heart failure (cardiac insufficiency)
  • Myocardial infarction (heart attack)
  • Apoplexy (stroke)
  • Shock
  • Blood pressure difference between arms

Note: In severe chest pain (chest pain) often misinterpreted as myocardial infarction (heart attack). Further notes

  • A meta-analysis shows that three clinical signs are the strongest indicators of acute aortic dissection:
    • Focal motor or sensory neurologic deficits (sensitivity (percentage of diseased patients in whom disease is detected by use of the procedure, ie. a positive finding occurs) 18%, specificity (probability that actually healthy individuals who do not have the disease in question are also detected as healthy in the test) 95%, positive likelihood ratio [LR+: true positive/false positive] 4.3, negative likelihood ratio [indicates how many times more likely a negative test result occurs in sick individuals than in healthy individuals; LR-: false negative/false negative] 0.8).
    • Pulse deficit (difference between heart rate (measured by auscultation or ECG) and peripherally measurable pulse rate) (sensitivity 24%, specificity 92%, LR+: 2.5, LR-0.8).
    • Hypotension (low blood pressure) < 90 mmHg (sensitivity 10-22%, specificity 92-95%, LR+: 1.2-2.5, LR-: 0.8-1.0).

Classification of aortic dissection according to Stanford and DeBakey.

Stanford A = DeBakey type I/II (80%) Stanford B = DeBakey type III (20 %)
Localization Ascending aorta or aortic arch Descending aorta
Symptoms
  • Severe thoracic pain, wandering.
  • Radiation between shoulder blades, in back and abdomen.
Complications
  • Rupture (tear)
  • Aortic valve insufficiency (leakage of the aortic valve)
  • Pericardial tamponade (accumulation of fluid in the pericardium).
  • Ischemia; obstruction of the:
    • Coronary ostia/myocardial infarction (heart attack).
    • Head and neck vessels/apoplexy (stroke)
    • Spinal cord-supplying arteries
    • Intestinal and extremity arteries
  • Rupture (risk of rupture significantly lower than type A).
  • Mesenteric infarction, renal infarction, acute renal failure, leg ischemia.

The following symptoms and complaints may indicate abdominal aortic aneurysm (AAA):

Notice:

  • Most patients with a nonruptured AAA are asymptomatic.
  • If the AAA is pressure-dolent (painful on palpation), there is an increased risk of rupture → immediate further evaluation and surgery!
  • Acute onset of severe back or abdominal pain + symptoms of hypovolemia (volume deficiency) or hemorrhagic shock (hemorrhagic shock/volume deficiency shock) → (covered) ruptured AAA likely!

Symptoms of acute rupture

  • Annihilation pain + fear of death
  • Shock