Every year in India, around 76,000 to 200,000 cases of cerebral aneurysms are reported to have occurred. The medical attention that patients receive depends significantly on their access to adequate, affordable healthcare and their awareness about this condition. Read on to know what aneurysms are, their causes and symptoms, types, frequently asked questions, and how to diagnose and treat them.
An aneurysm is a condition where there is a ballooning or weakening of the inside wall of an artery. Arteries are blood vessels that transport nutrient-rich oxygenated blood from the heart to the rest of the body. When an area on the inner wall of an artery weakens, it bulges out and can burst or rupture due to the pressure of the blood flow. Rupture of an aneurysm causes profuse internal bleeding, strokes, and even death.
Aneurysms can happen in any artery of your body. However, it is most common in the aorta, brain, spleen, and legs. Here are the types of aneurysms:
Aortic aneurysms: The aorta is the largest blood vessel in your body. It starts on the left side of the heart and runs down the chest to the abdomen, where it then splits into two and goes down each of your legs. This blood vessel is a common site for aneurysms. When it occurs in the chest region, it is called a thoracic aortic aneurysm. When it occurs in the abdomen, it is called an abdominal aortic aneurysm. This is the most commonly occurring form in this type of aneurysms.
Cerebral or Brain aneurysms: These occur inside the blood vessels that supply oxygen and nutrients to your brain. They can be of any size and show no signs or symptoms. You may not even know that you have one if it is in a blood vessel that is deep inside your brain. This type of aneurysm can cause bleeding in some of the affected cases.
Peripheral Aneurysms: You can also get aneurysms in other parts of your body, such as your knee, spleen, groin, intestines, thighs, neck, or kidneys. The chances of these rupturing is less compared to aortic aneurysms. Popliteal aneurysm, which happens in the knee is the most common type of peripheral aneurysms.
Cirsoid Aneurysms: This is a condition where a group of blood vessels is dilated because of a birth defect or congenital malformation. Here, an abnormal connection occurs between a vein and an artery, called arterio-venous shunting. This can cause a dangerous mixing of oxygenated and deoxygenated blood. This type of aneurysm occurs commonly in the head and neck, and they look like nodules.
The precise cause of aneurysms is not yet clear, and a lot more research needs to be done to determine that. However, there are several factors that contribute to the development of an aneurysm. These include:
High Blood Pressure: Hypertension or high BP can weaken the arterial wall over time and cause it to bulge or balloon out.
Atherosclerosis: This is a condition where a deposit called plaque builds up inside the artery walls over time. Plaque is a combination of cholesterol, calcium, fat, and other substances present in your blood. Plaque slowly hardens and narrows the artery. This causes the walls to weaken and results in high BP and aneurysms.
Trauma and Tumours: Physical trauma and injuries, like those caused in a vehicular accident, can damage your arterial walls, resulting in aortic aneurysms. Tumours can also weaken arterial walls by exerting pressure on them and cause the formation of aneurysms.
Heredity: Some kinds of aneurysms are hereditary and run in the family. For example, abdominal aneurysms are hereditary, and research has shown that it occurs in two or more closely-related family members.
Abnormal Blood flow at Arterial Junctions: Arterial junctions or bifurcations are especially vulnerable to aneurysms, as the junctions are exposed to the highest stress from blood flow. They can weaken after a while, resulting in aneurysms.
Alcohol and Drug Abuse: Research shows that alcohol and drug abuse can increase blood pressure and inflame blood vessels. This weakens the artery walls and causes aneurysms.
Smoking: Smoking breaks down the lining of your arteries and causes irreparable damage to the walls. This causes weak spots in the walls of your arteries, resulting in the formation of multiple aneurysms.
Unhealthy Diet: Eating unhealthy food can increase blood pressure and plaque formation in your blood vessels and weakening their walls, contributing to aneurysm formation.
Obesity: Being overweight or obese exerts a lot of pressure on the artery walls and your heart, thus heightening the risk of developing an aneurysm.
Sedentary Lifestyle: Lack of exercise can contribute to obesity and high blood pressure, all of which increases your aneurysm risk.
Infection: In some rare cases, bacterial infections in the heart can cause a condition called mycotic aneurysm. Here, the bacteria infects the artery wall and causes it to dilate. This occurs in people who have diseases like vasculitis, endocarditis, and syphilis.
Other risk factors for aneurysms include gender and race. Statistics show that women are much more likely than men to get a brain aneurysm or subarachnoid haemorrhage. Research also shows that race plays a part in determining the risk of an aneurysm – African Americans were found to have twice the number of subarachnoid hemorrhage as Caucasians.
Aneurysms do not show any symptoms until they rupture or exert pressure on surrounding tissues. The aneurysms that develop near the surface of your body could cause pain and swelling. You may also notice a large mass under your skin if there is one close to the surface. When an aneurysm ruptures, the symptoms will vary based on its location and type. Such symptoms include:
Some brain aneurysms show symptoms when they grow large and exert pressure over the surrounding brain tissues. This can cause symptoms like:
Aneurysm complications include internal bleeding, vasospasm (narrowing of arteries after rupture), stroke, hyponatremia (low sodium levels), and hydrocephalus (increased pressure on the brain that damages tissues), coma, brain damage, tears in the aorta wall, etc.
Aneurysm Diagnosis: The diagnosis of an aneurysm or damaged arteries depends on where the problem is located. If your doctor suspects that you may have an aneurysm based on your symptoms, she may recommend several diagnostic tests to confirm this.
For brain aneurysms, diagnosis is done using CT scans, angiogram, EEG, or lumbar puncture. For aortic and peripheral aneurysms, diagnosis is done using chest MRI, vascular ultrasound, and heart diagnostic tests like echocardiography, ECG, CT scan, cardiac stress test, coronary angiogram, and chest X-ray.
Aneurysm Treatment: Treatments for aneurysms vary according to the type of aneurysms and keeping in mind the health and age of the patient. For unruptured aneurysms, there is not always a need of constant treatment. Treatments could include medicines to reduce high BP and cholesterol. If the aneurysm ruptures, then the patient would require emergency surgery.
For weak blood vessels in the chest and abdomen area, a surgery called endovascular stent graft is used. This surgery is minimally invasive and involves reinforcing and repairing damaged blood vessels.
For brain aneurysms that show symptoms, clipping and coiling are the two treatment options. Both require you to be under general anaesthesia. Clipping is when a neurosurgeon operates on the brain, and puts a clip over the leaking aneurysm. Coiling is when a neurologist threads a tube through your brain’s arteries, finds the aneurysm, and fills it up with platinum or latex wire coils.
Endovascular surgery that is done to repair aortic aneurysms has the following risks:
Brain aneurysm surgery carries the following risks:
Although it is not possible to prevent all aneurysms, you can try to minimise your risk of developing them by the following methods:
You can live with an unruptured aneurysm and never know about it if it does not show symptoms. Aneurysms that rupture and leak are very serious and can cause disability or even death. Post treatment, you need to focus on your rehabilitation to get healthy again. The road to recovery after an aneurysm is a long and arduous one.
In the case of brain aneurysm treatment, you will feel very tired post-surgery. You might have issues with concentration or headaches for 1-2 weeks. It may take around 8 weeks to completely recover. If you had bleeding, the recovery could take longer. If you had a stroke, you could have permanent issues like problems with thinking or speech, numbness, etc.
In the case of brain aneurysm treatment, you will feel very tired post-surgery. You might have issues with concentration or headaches for 1-2 weeks. It may take around 8 weeks to completely recover. If you had bleeding, the recovery could take longer. If you had a stroke, you could have permanent issues like problems with thinking or speech, numbness, etc.
After surgery, you may feel dizzy or confused for some time. In case of endovascular surgery, you will have pain in the groin area and bruising around the incision. Side-effects after surgery include:
Aftercare steps include:
Depending on how the aneurysm has affected your body, you may need physical therapy and speech therapy. You may also require occupational therapy to help you do better at work.
You are at risk for an aneurysm if you smoke, drink or do drugs, have high BP, or are obese. You are also at risk for aneurysms if you had a physical trauma that weakened your blood vessels or if aneurysms run in your family.
If you have symptoms like intensely-painful headaches, blurred vision, pain and swelling, dizziness, seizures, increased heart rate, stiff neck, etc. you should get checked for aneurysms.
Your doctor will take a call on whether you need surgical treatment for an aneurysm. Abdominal aneurysms need an endovascular stent surgery, while unruptured brain aneurysms may not need surgery. They may need only regular monitoring. A ruptured aneurysm will require emergency surgery to stop the bleeding and relieve pressure on the brain.
A clipping or a craniotomy will take 3-5 hours. A coiling surgery can take upto 2 hours.
It can take up to 12 weeks to completely recover after surgical treatment of an aneurysm. Talk to your doctor at length about precautions and aftercare.
Post-surgery, call your doctor immediately if you have a severe headache, eye pain, stiff neck, eye problems, behavioural changes, issues with thinking or understanding, a loss of consciousness, numbness in your arm, leg or face, speech problems, etc.
Surgical treatment is needed for aneurysms if they are greater than 5 to 5.5 cm in diameter. Your doctor will discuss this at length with you and help you make the right decision.
A rupture is most likely if an aneurysm is more than 5.5 cm in diameter. It is also likely if the aneurysm has grown more than 1 cm within a year.
Stress causes high blood pressure, which will weaken the arteries and increase the risk of developing aneurysms.
Patients have reported that an aneurysm headache feels incredibly painful, like being hit on the back of the head with a hammer. It is usually accompanied by other symptoms like vomiting, nausea, blurred vision, sensitivity to light, and dizziness.
An aneurysm may occur when a part of an artery wall weakens causing it to widen or balloon out abnormally. It can occur anywhere, but usually, the common areas are:
Peripheral aneurysms usually develop in the popliteal artery that runs down the lower part of the thigh and knee. Although it doesn’t occur as commonly as the other types of aneurysm, it can also develop in the arteries the supply blood to the kidneys or bowels, and in arteries of the arms or neck.
Unlike aortic aneurysms, peripheral aneurysms are not likely to rupture, but will often form blood clots that may block blood flow to the arms, legs or brain. Some of the warning signs to watch out for are:
Most aortic aneurysms develop and grow in size slowly over time. Eventually, they may cause the walls to stretch and enlarge like a balloon. A normal aorta is about as wide and as tough as a garden hose. So, if the aneurysm doesn’t grow much, the individual can live with it for years.
However, if the aneurysm grows in size, the risk of rupture increases. In case an emergency repair is carried out on a leaking or ruptured aneurysm, it may have complications and take a long time to recover. However, successful surgery for aortic aneurysm with complete recovery can be ensured if the aortic aneurysm has not ruptured. Generally, aneurysms are less likely to develop once the surgery is done, unless the individual has an unusual disease that causes aneurysms in the body.
An aortic aneurysm is treated with the goal to prevent the risk of dissection or rupture that increases with the size of the aneurysm. Once an aneurysm forms along the aorta, it doesn’t heal by itself or decrease in size. Sometimes, aneurysms that are small may remain stable in size for years, but others will increase in size over time. Generally, an aneurysm will grow in size at less than one-fourth of an inch per year. However, that varies substantially between aneurysms.
The doctor may prescribe certain medications to keep the blood pressure in check and suggest you to wait and watch the condition. These medications can slow down the growth of an aneurysm, but they cannot cure. So, most aortic aneurysms have to be repaired eventually to stop it from rupturing.
Some of the complications that can result from an aneurysm rupture are:
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