Cerebral Aneurysm: Causes, Symptoms & Treatment

A cerebral aneurysm is a bulge in the wall of a blood vessel in the brain. Such changes in the vessels have disease value. Basically, cerebral aneurysms belong to the so-called cerebral angiodysplasias. This category also includes cavernomas and angiomas. In numerous cases, cerebral aneurysm occurs in areas where the main arteries in the brain branch.

What is a cerebral aneurysm?

In principle, aneurysms represent bulges in blood vessels. They develop primarily at such sites where blood vessels divide. A distinction is made between different types of aneurysms, depending on their shape. There are sac-shaped aneurysms and irregularly shaped aneurysms. Aneurysms also differ considerably in terms of size. The extent varies from a few millimeters to aneurysms in the centimeter range. If the aneurysm is larger than two centimeters, it is a so-called giant aneurysm. Rupture of cerebral aneurysms is particularly dangerous. Such ruptures occur with a probability of approximately 10:100,000 cases per year. It has been shown that female patients suffer a rupture more often than men. The structure of aneurysms is divided into a neck and a sac area. In the majority of cases, a rupture occurs at the thinnest point within the sac. In numerous individuals, the rupture does not announce itself by prior signs, so it usually happens suddenly and expectedly. Sometimes, however, the rupture is favored by physical exertion or pushing. Bag-shaped aneurysms often occur at the base of the brain. This is because the four major arteries of the brain connect in a circle there.

Causes

Several factors usually contribute to the development of a cerebral aneurysm. On the one hand, disturbances or damage to the walls of the blood vessels are a possible development factor. To some extent, genetic predispositions also exist for the formation of aneurysms in the brain. In addition, some factors facilitate the development of cerebral aneurysms. These include, for example, weakness of the connective tissue, certain malformations in the arteriovenous area, and diseases of the kidney. Another decisive risk factor for the development of cerebral aneurysms is high blood pressure (medical term: hypertension). Smokers are also more at risk than non-smokers. Special mechanical forces act in the area where blood vessels divide in the brain. These are presumably involved in the formation of aneurysms. This explains why numerous cerebral aneurysms develop at branching points of vessels. In this process, the so-called tunica media is often thinned. In the majority of cases, cerebral aneurysms form during life. The smaller proportion of aneurysms are congenital or inherited.

Symptoms, complaints, and signs

The possible symptoms of cerebral aneurysms vary. In many cases, however, an aneurysm does not cause any symptoms for a long time and for this reason remains undetected. In numerous cases, cerebral aneurysms are found and diagnosed by chance during other medical examinations. This is often possible, for example, in connection with MRI or computed tomography examinations. Furthermore, additional symptoms may occur. These are strongly related to where the cerebral aneurysm is located and how large it is. Particularly extensive vascular aneurysms occupy a certain amount of space in the brain, so that other tissue is displaced. This can be accompanied by neurological disorders such as cerebral nerve deficits. Some patients also suffer from seizures. In particularly severe cases, the cerebral aneurysm leads to compression of the brain stem. In the case of rupture of a cerebral aneurysm, a so-called subarachnoid hemorrhage occurs, which poses an acute threat to the patient’s life. The accompanying symptoms of the hemorrhage resemble those of a stroke.

Diagnosis and course of the disease

In principle, cerebral aneurysms can be diagnosed with the use of imaging examination techniques. Here, for example, a CT or an MRI examination come into question. Angiography also provides particularly accurate results. Since cerebral aneurysms remain asymptomatic in many cases, they are usually not discovered or are discovered only by chance.

Complications

The greatest danger with a cerebral aneurysm is that the dilated blood vessel will burst, leading to a condition called subarachnoid hemorrhage in the brain. A subarachnoid hemorrhage is a life-threatening condition that requires immediate medical attention. This is a hemorrhagic stroke that is fatal in 50 percent of cases. One third of patients die on the way to the hospital and another third cannot be saved or retain neurological damage despite treatment in the hospital. Often, those affected are permanently mentally retarded after surviving a subarachnoid hemorrhage. However, about one-third of patients also have a good to very good chance of recovery. Often, the cerebral aneurysm is an incidental finding because there are usually no symptoms. Sometimes, however, the finding is only made after a cerebral hemorrhage has already occurred. The hemorrhage is noticeable by sudden violent annihilation headache, drop in blood pressure, vomiting, difficulty breathing and loss of consciousness. Depending on the extent of the brain hemorrhage, death can sometimes occur suddenly from apparent full health. Even after immediate medical or surgical therapy, further complications are subsequently possible, such as secondary hemorrhage, vasospasm with the risk of ischemic stroke, CSF outflow obstruction due to blockage of the CSF pathways, cerebral edema, or cerebral seizures. Because surgical removal of cerebral aneurysms also carries risks, surgery is not recommended until the size exceeds seven millimeters.

When should you see a doctor?

If there is a sudden rise in blood pressure, there is acute cause for concern. A doctor should be consulted or an ambulance should be alerted in acute cases. If the person’s health deteriorates to an immense extent within a short period of time, he or she requires urgent medical attention. In the event of seizures, signs of paralysis as well as a rapid decline in physical performance, a visit to the doctor is necessary. Disturbances of functional activity are warning signals of the organism. They should be presented to a doctor so that a diagnosis can be made and a treatment plan drawn up. In case of irregularities in respiratory activity, vomiting, nausea or dizziness, a medical examination is indicated. Because cerebral aneurysm can be fatal without treatment, a physician should be consulted immediately if you feel acutely unwell or very ill. Headaches, unsteadiness of gait, discoloration of the skin or disturbances in memory are the first signs of impaired health. They should be examined and treated by a doctor as soon as possible. A feeling of pressure inside the head, disturbances in blood circulation and a weakening of the connective tissue are considered to be warning signs of the organism. To avoid complications and secondary disorders, a medical clarification of the complaints should take place. If there is a tingling sensation in the organism or other sensitivity disorders on the skin, there is also a need for action.

Treatment and therapy

The treatment of cerebral aneurysms depends primarily on the individual case and, in this case, primarily on the location and the extent of the aneurysm. The shape of the vessel outpouching also plays a role in the choice of therapeutic methods. For example, if the aneurysm is smaller than seven millimeters and is located in the anterior circulation sphere, no treatment is usually necessary. This is especially true if the affected patient has not had a history of subarachnoid hemorrhage. If cerebral aneurysms larger than seven millimeters are involved, therapy should be considered. Here, the patient’s age, health status, and neurological factors are weighed to minimize the risk of complications. As long as the cerebral aneurysms do not cause any symptoms, possible therapeutic interventions should be thoroughly considered. Surgical intervention is used to separate the cerebral aneurysm from the blood flow with a clip.

Prevention

Although many cerebral aneurysms are acquired, prevention is difficult. Risk factors such as smoking should be avoided.

Aftercare

The actual treatment of the cerebral aneurysm is followed by the rehabilitation phase. This involves neurologic rehabilitation therapy. How much time this follow-up treatment takes depends on the extent of the disease. Especially for patients who are severely affected by the aneurysm, it is important to initiate the rehabilitation phase as early as possible. In the transitional phase, however, neurosurgical co-care of the patient must often take place. It is not uncommon for there to be close cooperation with various neurological specialist hospitals. Once the rehabilitation phase has been completed, further aftercare is considered useful. This includes, among other things, control examinations by angiography. The first examination is performed after one to six months. The next check-up takes place one year after the first examination, and another after three years. If the angiography reveals abnormalities that do not require immediate treatment, an annual check-up is recommended. If surgical closure has been performed, the time frame is similar…. In addition to imaging follow-up, follow-up care for a cerebral aneurysm also includes counseling the patient about his or her daily routines. The patient’s relatives can also obtain information from the physician. Due to modern therapy methods, the follow-up rate of a cerebral aneurysm could be reduced considerably. In addition to high-resolution vascular imaging, magnetic resonance imaging (MRI) is one of the most important procedures used in follow-up examinations.

What you can do yourself

In most cases, the person affected by this disease is no longer able to cope with everyday life himself, and in many cases depends on the help and support of caregivers. Here, especially the help from the own family has a very positive effect on the further course of the disease. Psychological help is also necessary to prevent depression and other psychological upsets. With the various paralyses, it is not uncommon for patients to be dependent on measures of physiotherapy or physiotherapy. Some of the exercises from these therapies can also be repeated in the patient’s own home, so that the symptoms continue to be alleviated. Cold hands and feet should be avoided as far as possible, and blood circulation in particular should be increased. Many of those affected by this disease also show reduced alertness and need special support in everyday life. This support cannot be provided exclusively by the patient’s own family; professional support is often very important to prevent psychological damage to the relatives. Since the risk of falls is significantly increased with this disease, the living situation must be adapted accordingly.