Cerebral aneurysm - Patient guide

This guide is aimed at all people who want to know about this disease, which affects a portion of the population and, in the vast majority of cases, patients have the disease, but do not know. In this way, it is important to know the symptoms that can represent this disease so that the person can seek medical help as soon as possible. The text is structured in questions and answers, in order to facilitate understanding.

WHAT IS CEREBRAL ANEURYSM?

Aneurysms are abnormal dilatations of blood vessels, usually due to fragility in their wall. Most of the time, it affects the arteries (vessels that carry blood from the heart to the organs of the body). When these changes involve the arteries of the brain, they are called cerebral aneurysms.

The figure shows the two main types of brain aneurysm

ARE BRAIN ANEURYSMS COMMON?

Statistics show that up to 5% of the population has a brain aneurysm, and a small portion of these people may experience bleeding from a ruptured aneurysm.

WHAT ARE THE CAUSES OF CEREBRAL ANEURYSM?

In the vast majority of cases, the person develops a brain aneurysm, not born with the problem. The weakening of the artery wall occurs by the natural aging process and by the hardening (atherosclerosis) of the blood vessel added to several risk factors that can accentuate the problem. In the region where the artery wall becomes fragile, the blood pressure on this site causes abnormal dilation.

WHAT ARE THE RISK FACTORS?

The risk factors below can increase a person's chances of developing a brain aneurysm:

• Arterial hypertension

• Smoking – smoking is one of the main risk factors for developing a brain aneurysm

• Women are more likely to develop aneurysms

• People between 40 and 50 years old

• Family history of brain aneurysm – people who have relatives with a brain aneurysm are more likely to develop this problem

• Personal history of aneurysm – people who have had a brain aneurysm are more likely to develop another

• Use of illicit drugs

WHAT ARE THE SYMPTOMS?

Often, brain aneurysm causes no symptoms, being diagnosed when the patient undergoes a CT scan or MRI scan for another reason. The onset of symptoms occurs by compression of nearby brain structures or by rupture. The clinical manifestations are very variable and depend on the location of the aneurysm, some examples are given below:

• Headache

• Neck ache

• Eye pain

• Double vision

• Visual loss

• Malaise and vomiting

• Mental confusion

The main symptoms of cerebral aneurysm rupture are:

• Very severe headache, referred to as the worst headache the patient has ever felt

• Excessive sleepiness

• Neck stiffness (difficulty putting chin to chest)

• Muscle weakness (difficulty moving the arm and leg on one side of the body)

• Numbness

• Convulsion

WHAT HAPPENS WHEN THE ANEURYSM RUPTURES?

When the aneurysm ruptures, blood leaks out of the blood vessel and causes irreversible damage to surrounding neurons. In addition, there is an increase in pressure inside the skull, impairing oxygenation and irrigation of all neurons. This can cause permanent sequelae, in addition to increasing the risk of death. Other complications that can occur after an aneurysm ruptures are:

• Vasospasm – involuntary contraction of cerebral vessels due to irritation of the vessel wall by the presence of extravasated blood

• Hydrocephalus – accumulation of cerebrospinal fluid (nervous system fluid) within the brain

• Hyponatremia – a drop in the level of sodium (mineral) in the blood

• Coma

Representation of the rupture of a brain aneurysm

WHEN TO SEEK MEDICAL ATTENTION?

It is recommended to look for the Neurosurgeon if a person has some of the symptoms shown in the previous topic. During the medical consultation, several questions will be asked about life habits (sedentary lifestyle, smoking, use of alcohol and illicit drugs) and previous history of personal and family illnesses. However, if the patient has a very strong and sudden headache, with nausea and vomiting, in addition to neck stiffness and difficulty in arm and leg movements, the nearest emergency service should be sought immediately, in order to expedite the procedure. all diagnostic investigation of possible suspicion of cerebral aneurysm rupture.

HOW DO I DIAGNOSE BRAIN ANEURSYM?

The following tests may be performed to diagnose a brain aneurysm:

• CT scan of the skull – useful when aneurysm rupture is suspected as it can identify bleeding most of the time

• CT angiography of the skull – more detailed study of the cerebral vessels, as it combines tomography with the injection of venous contrast

• Magnetic resonance angiography of the skull – also allows for detail of the cerebral vessels, using magnetic fields and use of contrast

• Cerebral angiography - it is the most invasive exam, but it has better detail of the cerebral vessels and characteristics of the aneurysm

IS THERE A TREATMENT?

Yup. And each patient should receive an individualized treatment, based on their clinical condition, risk factors, characteristics of the aneurysm and the presence or absence of rupture. All these parameters must be taken into account by the Neurosurgeon to define the best treatment for the patient. Not all brain aneurysms need immediate treatment once they are diagnosed. In some cases, periodic follow-up with imaging tests can be done to determine whether the aneurysm has grown. On the other hand, some patients may need early treatment due to the risk of rupture. This decision is made by the neurosurgeon, the patient and their family, in a shared way. In aneurysms that have not ruptured, the therapeutic planning is done in an elective, programmed way. When rupture occurs, it is a medical emergency and treatment is carried out as soon as possible.

WHAT ARE THE TREATMENT FOR CEREBRAL ANEURYSM?

There is no drug that reduces or eliminates the cerebral aneurysm, therefore, the treatment must be surgical. When used, the remedy serves to relieve headache and prevent seizures. Traditional surgical treatment involves surgical clipping, in which a bone window is made in the skull and a surgical clip is placed in the aneurysm in order to eliminate it from the bloodstream. The hospital stay is 4 to 10 days and full recovery takes about two weeks.

Representation of a surgical clipping of a brain aneurysm

The other form of treatment is known as an endovascular procedure, in which a catheter is inserted into the brain's blood vessels and a device is placed inside the aneurysm.

Representation of endovascular treatment for cerebral aneurysm

Each type of treatment has risks, which should be discussed with your Neurosurgeon.

AFTER THE TREATMENT, IS ANY TYPE OF FOLLOW-UP NECESSARY?

Yup. After treatment, the patient needs periodic consultations and imaging tests to confirm the absence of aneurysm and other complications.