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.

3.Symptoms and Causes of Aneurysms

Causes of Aneurysms:

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.

Symptoms of Aneurysms:

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:

• Internal bleeding
• Severe pain in the chest, back or head
• Increase in heart rate
• Angina
• Dizziness
• Vomiting and nausea
• Vision changes
• Stiff, painful neck

Some brain aneurysms show symptoms when they grow large and exert pressure over the surrounding brain tissues. This can cause symptoms like:

• Severe headache
• Blurry vision
• Changes in speech
• Neck pain
• Numbness of Leg and Arm

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.

4.Diagnosis and Treatment of Aneurysms

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.

• CT Scan: A CT scan is an imaging test. Using x-rays, detailed pictures are taken of the brain or heart and the blood vessels inside. Computers combine these images to create a 3-D picture that will help your doctor detect abnormalities.
• Angiogram: In this test, a catheter is inserted into a blood vessel through your arm, neck, or groin. A catheter is a thin, long, flexible tube. This catheter is then threaded to your heart. A dye is then injected into the catheter. The dye travels to the heart or brain (site of the aneurysm). Your doctor will then take X-rays of that area. The dye allows the doctor to view the arteries clearly and check for anomalies.
• Lumbar Puncture: A lumbar puncture or spinal tap is done to extract and examine a small amount of cerebrospinal fluid (CSF) to check for the presence of blood. CSF is a clear, colourless fluid and the presence of blood in it indicates a leaking or ruptured aneurysm.
• MRI: Magnetic Resonance Imaging is a test where magnets, radio waves, and computers are used to obtain detailed pictures of your brain or heart. This will help your doctor check if you have any abnormalities in the blood vessels.
• Vascular Ultrasound: This test uses sound waves to detect anomalies like blood clots and blockages in your blood vessels.
• Electrocardiogram / Electroencephalogram: An ECG or EEG measures the electrical activity of the heart and brain respectively. This can let your doctor determine if there are any irregularities in the heart or brain activity.
• Echocardiography: In this test, sound waves are used to create moving images of your heart. This helps the doctor see if the heart’s valves and chambers are working properly.
• Stress Test: A cardiac stress test checks if your heart works well when you are under physical stress. You either exercise or take medicine to get your heart rate pumping. During this test, your blood pressure and an ECG will be measured. This can help your doctor figure out if there are any issues in the circulatory system.
• Chest X-ray: An X-ray takes pictures of the structure and organs inside, like the lungs, heart, and blood vessels. You doctor can figure out if there are abnormalities in your blood vessels or heart using the X-ray images.

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:

• Bleeding around the area of the graft
• Pre and post-surgical bleeding
• Kidney failure
• Nerve damage that causes numbness
• Decreased blood supply to the kidneys, legs or other organs
• Erectile dysfunction
• Stent blockage
• Slipping of the stent
• Unsuccessful surgery that then requires another surgery

Brain aneurysm surgery carries the following risks:

• Infection
• Seizures
• Confusion and memory problems
• Vision and speech issues
• Swelling in the brain
• Blood clots
• Changes in behaviour due to brain injury
• Stroke
• Problems with coordination
• Numbness in arms or face

6.Road to Recovery and Aftercare

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:

• Fatigue
• Problems with vision, balance, and coordination
• Confusion, memory loss
• Stress
• Pain
• Bleeding around the incision

Aftercare steps include:

• Keep your BP in control. Take your prescribed medication, including medicines, for preventing a seizure.
• Avoid smoking, alcohol, and drugs
• Avoid bright lights for a few days
• Abstain from sexual activity until your doctor gives you the go-ahead.
• Do not climb stairs or do heavy physical activities like exercise, yard work, or playing sports.
• Avoid driving until your doctor says it is alright.
• Do not take a bath or go swimming for 1 week.
• Do not take any medication without checking with your doctor first. Avoid flights for 2 weeks.

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.

7.Aneurysm FAQs: All your concerns addressed

Am I at risk for an aneurysm?

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.

When should I get checked for aneurysms?

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.

Do I need surgery?

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.

How long will the surgery take?

A clipping or a craniotomy will take 3-5 hours. A coiling surgery can take upto 2 hours.

How long will it take for me to recover?

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.

When to call a doctor after I have been discharged?

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.

What sizes of aneurysms require surgical treatment?

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.

What size aneurysms have a high risk of rupt

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.

Can stress cause aneurysms?

Stress causes high blood pressure, which will weaken the arteries and increase the risk of developing aneurysms.

What does a headache caused by an aneurysm feel like?

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.

Where do aneurysms occur?

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:

• major artery from the heart (aortic aneurysm)
• the brain (cerebral aneurysm)
• part of the leg behind the knee (popliteal artery aneurysm)
• the intestine (mesenteric artery aneurysm)
• an artery in the spleen (splenic artery aneurysm)

How do I know if I have an aneurysm in my leg?

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:

• Cramping in the legs with exercise or claudication
• Pain in the arms or legs even during rest
• Numbness or pain radiating in the leg or arm
• A throbbing lump that can be felt in the neck, arm, leg or groin
• Sore fingers or toes that don’t heal
• Gangrene or tissue death

Can you live a normal life with an aortic aneurysm?

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.

Can an aneurysm heal itself?

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.

What are the complications that can develop when an aneurysm ruptures?

Some of the complications that can result from an aneurysm rupture are:

• Re-bleeding: A ruptured or leaking aneurysm is likely to bleed again causing further damage to brain cells.
• Vasospasm: Rupturing of a brain aneurysm can lead to narrowing of the blood vessels in the brain, a condition called vasospasm. This can limit blood flow to the brain cells and damage them.
• Hydrocephalus: Hydrocephalus is caused when an excess of cerebrospinal fluid exerts pressure on the brain and damages the tissues. This condition occurs when an aneurysm ruptures and bleeds in the space between the brain and surrounding tissues (subarachnoid haemorrhage).
• Hyponatremia: Subarachnoid haemorrhage caused due to a ruptured brain aneurysm may disrupt sodium balance in the blood resulting in hyponatremia. This can swell up the brain cells leading to permanent damage.

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