Brain Aneurysm

A brain aneurysm is a bulge or ballooning in a weakened section of an artery wall in the brain. Most aneurysms never cause problems and are found incidentally on scans done for other reasons. When an aneurysm ruptures, though, it causes a haemorrhagic stroke — usually a subarachnoid haemorrhage — which is a life-threatening emergency.

Symptoms

Unruptured aneurysms usually cause no symptoms. Larger ones may press on nearby brain structures and cause:

• Persistent headaches or pain behind one eye
• A dilated pupil or drooping eyelid on one side
• Double vision
• Numbness or weakness on one side of the face

Ruptured aneurysm — medical emergency. Dial 112 immediately. Classic signs:

• Sudden, extremely severe headache — often described as "the worst headache of my life"
• Stiff neck
• Nausea, vomiting
• Blurred or double vision, sensitivity to light
• Loss of consciousness
• Seizures
• Confusion

Risk factors

• High blood pressure — the biggest modifiable risk
• Smoking
• Family history of brain aneurysm (first-degree relative)
• Age — more common over 40
• Female sex — more common in women
• Some inherited conditions — polycystic kidney disease, Ehlers-Danlos, Marfan syndrome
• Drug use — cocaine, amphetamines
• Head injury
• Heavy alcohol use

Diagnosis

• CT scan — detects bleeding after rupture
• CT angiography, MR angiography, or catheter cerebral angiography — to visualise the aneurysm
• Lumbar puncture in some cases if CT is normal but rupture suspected

Treatment

Depends on whether the aneurysm has ruptured, its size, location, and shape:

• Ruptured aneurysm — emergency treatment to stop the bleeding and prevent rebleeding: either surgical clipping (open surgery) or endovascular coiling (a catheter-based procedure). Intensive care management follows. Highly specialised care — available at neurosurgical centres in major Indian cities.
• Unruptured aneurysm — some are monitored without treatment, particularly small ones with low rupture risk; others are treated preventively if risk is judged high. Decisions involve neurologists / neurosurgeons / interventional neuroradiologists and individual factors.
• Risk-factor control — strict blood pressure control, not smoking, avoiding stimulant drugs

If you have a known aneurysm, follow-up with a specialist is essential. If you have risk factors and sudden new severe headache, especially the worst you've had, go to hospital — don't wait.