Can you survive a brain aneurysm?

What is a brain aneurysm?

A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. It often looks like a berry hanging on a stem. A brain aneurysm can leak or rupture, causing bleeding into the brain (hemorrhagic stroke). Most brain aneurysms produce no symptoms until they become large, begin to leak blood, or rupture.

What causes a brain aneurysm?

Most brain aneurysms are congenital – meaning you are born with them. Other risk factors include:

• Older age – Most aneurysms develop after age 40
• Hypertension
• Current smoking
• Heavy alcohol consumption
• Drug abuse, particularly the use of cocaine
• Head trauma
• Infection
• Heredity – Having a first-degree relative, such as a parent or sibling, who has an aneurysm increases your risk of developing one

What are the symptoms of a brain aneurysm?

Most small aneurysms do not rupture or cause any symptoms. When they do cause symptoms, brain aneurysms can cause:

• A sudden, severe headache that feels different from past headaches
• Nausea and vomiting
• Stiff neck
• Blurred or double vision
• Pain above and behind an eye
• Dilated pupils
• Sensitivity to light
• Loss of sensation
• Loss of balance
• Weakness or paralysis on one side of the face or body
• Seizure
• Drooping eyelid
• Confusion
• Loss of consciousness

Symptoms that develop suddenly or rapidly often signal an emergency situation. Seek immediate medical attention if you experience:

• A sudden, severe headache
• Stiff neck
• Drowsiness
• Nausea and vomiting
• Confusion
• Seizures
• Loss of balance
• Weakness or paralysis on one side of the body

How is a brain aneurysm diagnosed?

If a brain aneurysm is suspected, your doctor will likely recommend imaging tests to confirm the diagnosis. These may include:

• CT scan – This test uses X-rays and a computer to create detailed images of the brain that can reveal bleeding in the brain.
• Cerebral angiogram – During this X-ray test, a catheter is inserted into an artery, usually in the groin, and threaded through the blood vessels to the brain. Contrast dye is injected into the bloodstream. The dye highlights the arteries and reveals the shape, size and location of any aneurysms.
• MRI – Magnetic resonance imaging uses a magnetic field and radio waves to create cross-sectional images of the head and body. An MRI may reveal signs of bleeding.
• CTA scan – A CT angiogram involves both a CT scan and intravenous injection of contrast material to produce images of blood vessels and tissues in the brain.
• MRA scan – A magnetic resonance angiogram is a noninvasive way to evaluate blood vessels in the brain.

What are the treatment options for brain aneurysms?

Watchful waiting

If an unruptured aneurysm is small (less than 5 to 7 millimeters), your doctor may recommend periodic monitoring with CT scans or MRIs to observe the aneurysm and check for growth.

Medication

Medications may be used to treat symptoms caused by a ruptured aneurysm and to prevent further rupture. Examples include:

• Pain relievers to treat headache
• Anti-seizure drugs to prevent seizures
• Calcium channel blockers and antispasmodic agents to prevent narrowing of blood vessels (vasospasm)
• Sedatives to induce coma and decrease risk of brain injury after rupture

Surgery

• Surgical clipping – This procedure involves placing a tiny metal clip at the base of the aneurysm to stop blood flow into it. This technique requires open brain surgery.
• Endovascular coiling – Soft platinum coils and stents are inserted through a catheter and guided to the aneurysm. The coils fill the aneurysm, block blood flow and cause a clot to form. This is a minimally invasive procedure.
• Flow diverter stent – Densely braided stent implants are placed inside the parent artery across the aneurysm neck. This reduces blood flow into the aneurysm so that it stabilizes and clots off.
• EC-IC bypass – This surgery involves rerouting blood flow from a surface artery in the skull to a deeper artery beyond the aneurysm. It may be done along with clipping or coiling.

The best treatment option will depend on the size, location and shape of your aneurysm, your symptoms, your age and overall health. Your doctor will discuss the pros and cons of each approach.

Emergency treatment for a ruptured aneurysm

A ruptured aneurysm is life-threatening and requires emergency treatment. Bleeding in the brain can cause brain damage, coma and death if it’s not stopped.

Emergency steps may include:

• Controlling blood pressure – High blood pressure after rupture raises the risk of further bleeding and stroke. Medications will be given to lower your blood pressure.
• Pain relievers – To relieve severe headache after rupture.
• Sedatives – To induce coma and prevent re-bleeding while preparing for surgery.
• Ventriculostomy – This procedure relieves pressure on the brain by draining excess cerebrospinal fluid.
• Surgical clipping or coiling – Once you are stabilized, surgery will be done to stop the aneurysm from bleeding further. This is usually done within 24 hours.

Recovery, complications and outlook after a brain aneurysm

Recovery after aneurysm rupture

Recovery after a ruptured brain aneurysm may take weeks or months. It depends on the complications you experienced and how quickly treatment was received. Rehabilitation can help regain skills, such as:

• Speech therapy after stroke
• Occupational therapy to relearn daily activities
• Physical therapy to improve movement and balance

Be patient with yourself during recovery. Healing and adjustment to disability take time. Joining a support group may help you cope and share tips with others experiencing similar challenges.

Complications

Complications of ruptured aneurysms may include:

• Re-bleeding – Risk is highest in the first 24 hours after initial rupture.
• Vasospasm – Up to 30% of patients develop this narrowing of blood vessels that can lead to stroke.
• Seizures
• Hydrocephalus – Buildup of cerebrospinal fluid in the brain.
• Hyponatremia – Low sodium levels in blood.
• Intra-cerebral and subarachnoid hemorrhage – Bleeding within and surrounding the brain.
• Increased intracranial pressure – Pressure inside the skull.

Complications increase the risk of permanent brain damage or death. Aggressive monitoring and preventive treatment are needed.

Long-term outlook

The outlook depends on factors like:

• Age – Older adults have a higher mortality rate.
• Size of aneurysm – Larger ones are more prone to rupture.
• Timeliness of treatment – Faster treatment can prevent complications.
• Location in the brain – Aneurysms near the brain stem are riskier.
• Pre-existing health problems – High blood pressure raises risk of stroke.

Overall, about a third of aneurysm cases lead to death. With treatment, over half of surviving patients can live relatively normal lives again. Early diagnosis, careful monitoring and rapid emergency care improve your prognosis.

Conclusion

Brain aneurysms develop in an estimated 1 in 50 people. Most cause no symptoms unless they grow larger or rupture. A ruptured aneurysm requires emergency care to stop bleeding and prevent permanent brain damage. Prognosis after rupture depends on multiple factors. With proper treatment, many patients survive ruptured aneurysms and recover to resume normal activities. Periodic screening in high-risk individuals allows early detection and monitoring of aneurysms before they rupture. Prompt care for sudden, severe headaches and related symptoms can be lifesaving.