How to identify and treat a brain aneurysm

A cerebral aneurysm is a permanent dilation in one of the blood vessels that carry blood to the brain. When this happens, the dilated part usually has a thinner wall and, therefore, there is a high risk of the aneurysm rupture. When a cerebral aneurysm ruptures, it always causes bleeding that is more or less severe according to the size and amount of blood that seeps into the skull.

The most common symptom of a cerebral aneurysm arises when it ruptures, which is characterized as an extremely intense headache that can appear suddenly or that increases over time. The feeling that the head is hot and that there is a 'leak' and that it seems that the blood has spread also happens in some people.

Although genetic factors are involved in the causes of an aneurysm, uncontrolled high blood pressure greatly increases the risk of developing an aneurysm in the brain.

Cerebral aneurysm can be cured, depending on where it is. But generally, the doctor prefers to recommend a treatment that helps regulate blood pressure, for example, reducing the chances of breaking. Surgery, on the other hand, is used more frequently for cases of ruptured aneurysms, but can be indicated to treat specific aneurysms, depending on its location and size, and to prevent its rupture. The latter can be done through an endovascular procedure such as catheterization, where a stent is placed that protects the vessel, diverting blood flow from the aneurysm site, thus protecting the vessel from rupture.

Main symptoms

Usually, the aneurysm does not cause any symptoms, being accidentally identified in a diagnostic exam on the head, such as computed tomography. However, some people with aneurysms may experience signs such as constant pain behind the eye, dilated pupils, double vision or tingling in the face.

The most common is that the symptoms appear only when the aneurysm ruptures or is leaking. In these cases the symptoms are:

• Very intense and sudden headache, which worsens with time; Nausea and vomiting; Stiff neck; Double vision; Seizures; Fainting.

When these symptoms appear, and whenever an aneurysm rupture is suspected, it is very important to immediately call for medical help, by calling 192, or taking the person immediately to the hospital, to begin appropriate treatment.

There are also other problems that can cause similar symptoms, such as migraine, not necessarily an aneurysm. So if the headache is severe and appears very often, you should consult a general practitioner or a neurologist to identify the correct cause and start the most appropriate treatment.

How to confirm the diagnosis

Generally, to confirm the presence of a cerebral aneurysm, the doctor needs to order diagnostic tests to assess the structures of the brain and identify whether there is any dilation in the blood vessels. Some of the most used exams include computed tomography, magnetic resonance imaging or cerebral angiography, for example.

What causes aneurysm

The exact causes that lead to the development of an aneurysm in the brain are not yet known, however, some factors that seem to increase the risk include:

• Being a smoker; Having uncontrolled high blood pressure; Using drugs, especially cocaine; Drinking alcohol in excess; Having a family history of aneurysm.

In addition, some diseases that are present at birth can also increase the tendency to have an aneurysm, such as polycystic ovary disease, narrowing of the aorta or cerebral malformation.

How the treatment is done

The treatment of the aneurysm is quite variable, and may depend not only on the patient's history, but also on the size of the aneurysm and whether or not it is leaking. Thus, the most used treatments include:

1. Non-ruptured aneurysm

Most of the time, doctors choose not to treat non-ruptured aneurysms, as the risk of rupture during surgery is very high. Thus, it is normal to make a regular assessment of the size of the dilation to ensure that the aneurysm is not increasing in size.

In addition, remedies can also be prescribed to relieve some of the symptoms, such as Paracetamol, Dipyrone, Ibuprofen, to reduce headache or Levetiracetam, to control the onset of seizures, for example.

However, in some cases, the neurologist may choose to do endovascular surgery with stent placement, to prevent rupture, but because it is a very delicate procedure, due to the risk of rupture during the procedure, it needs to be very well evaluated and the risks must be well explained to the patient and family.

2. Ruptured aneurysm

When the aneurysm ruptures, it is a medical emergency and, therefore, one must immediately go to the hospital to start the appropriate treatment, which is usually done with surgery to close the bleeding vessel inside the brain. The sooner the treatment is done, the lower the chances of developing lifelong sequelae, since the smaller the area of ​​the brain affected will be.

When the aneurysm breaks, it causes symptoms similar to a hemorrhagic stroke. See what signs to watch out for.

Possible sequelae

A cerebral aneurysm can cause bleeding between the brain and the meninges that line it, in which case the hemorrhage is called a subarachnoid, or it can cause a hemorrhage called intracerebral, which is the bleeding that occurs in the middle of the brain.

After an aneurysm the person may not have any sequelae, but some may have neurological changes similar to that of a stroke, such as difficulty in raising an arm due to lack of strength, difficulty in speaking or slowness in thinking, for example. People who have already had an aneurysm have a higher risk of suffering a new event.

See other possible sequelae that can arise when there is a change in the brain.