Cerebral aneurysm (brain artery dilation)

Description An abnormal widenin...

Description

An abnormal widening or ballooning of an artery in the brain. Most are congenital and do not cause symptoms until they leak blood or burst and bleed profusely. Rarely the dilation of the vessel can be large enough to cause symptoms before they leak by pressing on surrounding brain. The most common initial symptom is a sudden severe headache.

Symptoms

The symptoms depend on the amount of bleeding. A small amount of bleeding (sentinel bleed) causes a sudden severe headache (thunder clap headache), and vomiting. More significant bleeding can cause: confusion, fainting, weakness, seizures, coma and death. If the aneurysm has not bled but is large enough to cause symptoms then one may see: progressively worse headache, vomiting, confusion, change in behavior, weakness, visual problems, seizures.

Tests

Common tests used for diagnosis and treatment

Workup:
A history and physical exam will be performed. If the doctor suspects an aneurysm a head CT or brain MRI will be done. The addition of contrast may help identify the disorder (CT angiogram or MR angiogram). Sometimes a lumbar puncture is performed to identify the blood in the cerebrospinal fluid when an imaging study has been negative and the suspicion is still high for a ruptured aneurysm.

Tests:
Complete blood count (CBC), CT Scan, Magnetic resonance imaging (MRI)

Other Specific Tests: Lumbar puncture, CTA, MRA

Specialists:
Neurosurgery, Pediatric Neurosurgery

Treatment

Therapy depends on the amount of bleeding. Severe bleeding may require: insertion of a breathing tube, anti-seizure medication, blood pressure medication, and/or surgery. The goal of unruptured aneurysms that don't cause symptoms depends on the size and location. Observation and periodic repeat imaging may be advised. Or treatment to prevent rupture or reduce symptoms may include: surgical clipping or endovascular embolization.