Brain aneurysm rupture: Causes, types and more

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Overview

A Brain aneurysm rupture 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 often a ruptured brain aneurysm occurs in the space between the brain and the thin tissues covering the brain. This type of hemorrhagic stroke is called a subarachnoid hemorrhage.

Brain aneurysm rupture is a balloon-like bulge of an artery wall. As brain aneurysm grows it puts pressure on nearby structures and may eventually rupture. A ruptured aneurysm releases blood into the subarachnoid space around the brain. A subarachnoid hemorrhage (SAH) is a life-threatening type of stroke. Treatment focuses on stopping the bleeding and repairing the aneurysm with clipping, coiling, or bypass.

Brain aneurysm rupture
What You Should Know About Brain aneurysm rupture

What is a Brain aneurysm rupture?

A brain aneurysm rupture is a balloon-like bulge or weakening of an artery wall. (Similar to a balloon on the side of a garden hose.) As the bulge grows it becomes thinner and weaker. It can become so thin that the blood pressure within can cause it to leak or burst open. Aneurysms usually occur on larger blood vessels at the fork where an artery branches off. Types of aneurysms include:

  • Saccular – (most common, also called “berry”) the aneurysm rupture bulges from one side of the artery and has a distinct neck at its base.
  • Fusiform – the aneurysm rupture bulges in all directions and has no distinct neck.
  • Dissecting – a tear in the inner wall of the artery allows blood to split the layers and pool; often caused by a traumatic injury.

When Brain aneurysm rupture occurs, it releases blood into the spaces between the brain and the skull. This space is filled with cerebrospinal fluid (CSF) that bathes and cushions the brain. As blood spreads and clots it irritates the lining of the brain and damages brain cells. At the same time, the area of brain that previously received oxygen-rich blood from the affected artery is now deprived of blood, resulting in a stroke. A subarachnoid hemorrhage (SAH) is life threatening with a 40% risk of death.

Enclosed within the rigid skull, clotted blood and fluid buildup increases pressure that can crush the brain against the bone or cause it to shift and herniate. Blockage of the normal CSF circulation can enlarge the ventricles (hydrocephalus) causing confusion, lethargy, and loss of consciousness.

A complication that occurs 5 to 10 days after a brain aneurysm rupture is vasospasm. Irritating blood byproducts cause the walls of an artery to spasm and narrow, reducing blood flow to that region of the brain and causing a secondary stroke.

Symptoms of Brain aneurysm rupture

A sudden, severe headache is the key symptom of a brain ruptured aneurysm. This headache is often described as the “worst headache” ever experienced.

Common signs and symptoms of a brain aneurysm rupture include:

  • Sudden, extremely severe headache
  • Nausea and vomiting
  • Stiff neck
  • Blurred or double vision
  • Sensitivity to light
  • Seizure
  • A drooping eyelid
  • Loss of consciousness
  • Confusion

What are the causes of Brain aneurysm rupture?

Risk factors for brain aneurysm rupture include:

  • smoking
  • high blood pressure
  • drug or alcohol abuse
  • genetic (family inherited)
  • atherosclerosis and
  • lifestyle habits.

Who is affected?

About 2 to 5% of Americans may have or develop an aneurysm; of those, 15% have multiple aneurysms. Unruptured aneurysms are more common than ruptured. However, 85% of aneurysms are not diagnosed until after they bleed. Aneurysms are usually diagnosed between ages 35 to 60 and are more common in women.

Brain aneurysm rupture diagnosis

When a person is brought to the emergency room with a suspected brain aneurysm rupture, doctors will learn as much as possible about his or her symptoms, current and previous medical problems, medications, and family history. The person’s condition is assessed quickly. Diagnostic tests will help determine the source of the bleeding.

  • Computed Tomography (CT) scan is a noninvasive X-ray to view the anatomical structures within the brain and to detect blood in or around the brain (Fig 3). A CT angiography (CTA) involves the injection of contrast into the blood stream to view the arteries of the brain.
  • Lumbar puncture is an invasive procedure in which a hollow needle is inserted in the low back to collect cerebrospinal fluid (CSF) from the spinal canal. The CSF is examined to detect blood from a suspected hemorrhage.
  • Angiogram is an invasive procedure in which a catheter is inserted into an artery and passed through the blood vessels to the brain. Once the catheter is in place, contrast dye is injected into the bloodstream and x-rays are taken.
  • Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a magnetic field and radio-frequency waves to give a detailed view of the soft tissues of the brain. An MRA (Magnetic Resonance Angiogram) involves the injection of contrast into the blood stream to examine the blood vessels in addition to structures of the brain.

Your loved one may be unable to make decisions about treatment. So you may need to decide what’s best for him or her. The doctors may refer to the Hunt-Hess SAH scale as an indicator of the patient’s condition.

Hunt-Hess scale grades:

  • Alert, no symptoms, mild headache or neck stiffness
  • Aware of surroundings, moderate to severe headache, stiff neck, no neurologic defect except cranial nerve palsy
  • Drowsy, weakness or partial or severe paralysis on one side of the body
  • Dazed, total paralysis on one side of the body
  • Comatose, with abnormal posture

Treatment for Brain aneurysm rupture

There are two common treatment options for a brain aneurysm rupture.

  • Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then he or she places a tiny metal clip on the neck of the aneurysm to stop blood flow to it.
  • Endovascular coiling is a less invasive procedure than surgical clipping. The surgeon inserts a hollow plastic tube (catheter) into an artery, usually in your groin, and threads it through your body to the aneurysm.He or she then uses a guide wire to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and essentially seals off the aneurysm from the artery.

Both procedures pose potential risks, particularly bleeding in the brain or loss of blood flow to the brain. The endovascular coil is less invasive and may be initially safer, but it may have a slightly higher risk of need for a repeat procedure in the future due to reopening of the aneurysm.

Flow diverters

Newer treatments available for brain aneurysm rupture include flow diverters, tubular stent-like implants that work by diverting blood flow away from an aneurysm sac. The diversion stops blood movement within the aneurysm and so stimulates the body to heal the site, encouraging reconstruction of the parent artery. Flow diverters may be particularly useful in larger aneurysms that can’t be safely treated with other options.

Your neurosurgeon or interventional neuroradiologist, in collaboration with your neurologist, will make a recommendation based on the size, location and overall appearance of the brain aneurysm, your ability to undergo a procedure, and other factors.

treatments for Brain aneurysm rupture
Surgical and endovascular treatments for cerebral aneurysm

Other treatments (Brain aneurysm rupture)

Other treatments for brain aneurysm rupture are aimed at relieving symptoms and managing complications.

  • Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.
  • Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These medications may lessen the erratic narrowing of blood vessels (vasospasm) that may be a complication of a ruptured aneurysm.One of these medications, nimodipine (Nymalize, Nimotop), has been shown to reduce the risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage from aneurysm rupture.
  • Interventions to prevent stroke from insufficient blood flow include intravenous injections of a drug called a vasopressor, which elevates blood pressure to overcome the resistance of narrowed blood vessels.An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain. A drug known as a vasodilator also may be used to expand blood vessels in the affected area.
  • Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid (Depakene) and others. Their use has been debated by several experts, and is generally subject to caregiver discretion, based on the medical needs of each patient.
  • Ventricular or lumbar draining catheters and shunt surgery can lessen pressure on the brain from excess cerebrospinal fluid (hydrocephalus) associated with a ruptured aneurysm. A catheter may be placed in the spaces filled with fluid inside of the brain (ventricles) or surrounding your brain and spinal cord to drain the excess fluid into an external bag.Sometimes it may then be necessary to introduce a shunt system — which consists of a flexible silicone rubber tube (shunt) and a valve — that creates a drainage channel starting in your brain and ending in your abdominal cavity.
  • Rehabilitative therapy. Damage to the brain from a subarachnoid hemorrhage may result in the need for physical, speech and occupational therapy to relearn skills.

Brain aneurysm rupture Recovery and prevention

The possibility of having a second bleed is 22% within the first 14 days after the first bleed. This is why neurosurgeons prefer to treat the aneurysm as soon as it is diagnosed, so that the risk of a re-bleed is lessened.

A brain aneurysm rupture patients may suffer short-term and/or long-term deficits as a result of a rupture or treatment. Some of these deficits may disappear over time with healing and therapy.

After a patient is discharged from the hospital, treatment may be continued at a facility that offers personalized rehabilitation therapies following a serious brain injury. A doctor who specializes in rehabilitation will oversee this care, which can include physical, occupational, and speech therapy. The recovery process is long and may take months or years to understand the deficits you incurred and regain function.

 

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