Overview

Every year, around 76,000 to 200,000 cases of cerebral aneurysms are reported in India. Patients' medical attention depends significantly on their access to adequate, affordable healthcare and their awareness of this condition. Read on to learn about aneurysms, their causes and symptoms, types, frequently asked questions, and how to diagnose and treat them.

What is an Aneurysm?

An aneurysm is characterised by ballooning or weakening an artery's inside wall. 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 blood flow pressure. The rupture of an aneurysm causes profuse internal bleeding, strokes, and even death.

Types of Aneurysms (Aorta, Brain, Other Areas)

Aneurysms can happen in any body artery. 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 happens in the abdomen, it is called an abdominal aortic aneurysm. It is the most commonly occurring form of this type of aneurysm.

Aneurysm

Cerebral or Brain aneurysms: It occur inside the blood vessels that supply oxygen and nutrients to the brain. They can be of any size and show no signs or symptoms. You may not even know you have one if it is in a blood vessel deep inside your brain. This type of aneurysm can cause bleeding in some affected cases.
Peripheral Aneurysms: Aneurysms can also occur in other body parts, such as the knee, spleen, groin, intestines, thighs, neck, or kidneys. The chances of these ruptures are less than those of aortic aneurysms. Popliteal aneurysms, which happen in the knee, are the most common type of peripheral aneurysms.
Cirsoid Aneurysms: These are conditions in which a group of blood vessels is dilated because of a birth defect or congenital malformation. 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 it looks like nodules.

Causes and Symptoms of Aneurysm

The precise cause of aneurysms is not yet clear, and much more research must be done to determine that. However, several factors contribute to the development of an aneurysm. These include

High Blood Pressure: Hypertension, or high BP, which can weaken the arterial wall over time and cause it to bulge or balloon out.
Atherosclerosis is a condition in which plaque deposits build up inside the artery walls over time. Plaque combines cholesterol, calcium, fat, and other substances in your blood. It slowly hardens and narrows the artery, weakening the walls and resulting in high blood pressure 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 they occur 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. It weakens the artery walls and causes aneurysms.
Smoking: Smoking breaks down the lining of your arteries and causes irreparable damage to the walls. It 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 weaken 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 increase your aneurysm risk.
Infection: In rare cases, bacterial infections in the heart can cause mycotic aneurysms. In these, the bacteria infect the artery wall and cause it to dilate. This occurs in people with 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 haemorrhages as Caucasians.

Symptoms Of Aneurysms

Aneurysms do not show 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 one is 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 on the surrounding brain tissues. It 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), hydrocephalus (increased pressure on the brain that damages tissues), coma, brain damage, tears in the aorta wall, etc.

Diagnosis and Treatment of Aneurysms

Aneurysm Diagnosis: Diagnosing an aneurysm or damaged arteries depends on the location of the problem. 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. Aortic and peripheral aneurysms are diagnosed 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. Detailed pictures of the brain or heart and the blood vessels inside are taken using X-rays. Computers combine these images to create a 3-D picture to help your doctor detect abnormalities.
Angiogram: In this test, a thin, long, flexible tube called a catheter is inserted into a blood vessel through your arm, neck, or groin. The 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 lets the doctor 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 with blood, indicating a leaking or ruptured aneurysm.
MRI: Magnetic Resonance Imaging is a test in which magnets, radio waves, and computers obtain detailed pictures of your brain or heart. This will help your doctor determine whether you have any abnormalities in the blood vessels.
Vascular Ultrasound: This test uses sound waves to detect anomalies in blood vessels, such as blood clots and blockages.
Electrocardiogram / Electroencephalogram: An ECG or EEG measures the electrical activity of the heart and brain, respectively. It can help your doctor determine if there are any irregularities in these activities.
Echocardiography: In this test, sound waves create moving images of your heart. It helps the doctor see if the heart’s valves and chambers work correctly.
Stress Test: A cardiac stress test checks if your heart works well 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. It can help your doctor determine if there are any issues in the circulatory system.
Chest X-ray: An X-ray takes pictures of the structure and organs inside the body, such as the lungs, heart, and blood vessels. Your doctor can use the images to determine abnormalities in your blood vessels or heart.
Aneurysm Treatment: Treatments for aneurysms vary according to the type of aneurysm, keeping in mind the health and age of the patient. For unruptured aneurysms, there is not always a need for 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, endovascular stent graft surgery is used. This minimally invasive surgery involves reinforcing and repairing damaged blood vessels.

For brain aneurysms that show symptoms, clipping and coiling are the two treatment options. Both require 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 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.

Steps to Prevent Aneurysms

Although it is not possible to prevent all aneurysms, you can try to minimise your risk of developing them by the following methods:

Eat healthy: A healthy diet that includes a lot of fresh fruits, vegetables, low-fat dairy, nuts, and lean meat helps prevent aneurysms from forming.
Quit smoking: Quitting smoking decreases the risk of aneurysms and high BP and prevents arterial damage.
Stay away from alcohol and drugs: Avoid alcohol and drugs to prevent high BP and inflammation of blood vessels.
Exercise every day: Regular exercise, particularly cardio, keeps your heart and circulatory system healthy, reducing your risk of having an aneurysm.
Remain stress-free: Stress causes high BP and increases your risk of aneurysms. So try yoga, hobbies, breathing techniques, etc., to remain calm and stress-free.
Get Regular Health Check-ups: It is important to check your health properly at least once a year. Go for an annual full-body check-up. It will help your doctor monitor the health and functioning of your heart and circulatory system and detect any anomalies if present.

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 exhausted post-surgery. You might have issues with concentration or headaches for 1-2 weeks. It may take around eight weeks to recover completely. 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, to prevent 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 sports.
Avoid driving until your doctor says it is all right.
Do not take a bath or go swimming for one week.
Do not take any medication without first checking with your doctor. Avoid flights for two 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.

Frequently Asked Questions

Q1. Am I at risk for an aneurysm?
A1. 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.

Q2. When should I get checked for aneurysms?
A2. 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.

Q3. Do I need surgery?
A3. Your doctor will decide whether you need surgical treatment for an aneurysm. Abdominal aneurysms require endovascular stent surgery, while unruptured brain aneurysms may not need surgery and may require only regular monitoring. A ruptured aneurysm will require emergency surgery to stop the bleeding and relieve pressure on the brain.

Q4. How long will the surgery take?
A4. A clipping or a craniotomy will take 3-5 hours. A coiling surgery can take up to 2 hours.

Q5. How long will it take for me to recover?
A5. 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.

Q6. When should I call a doctor after I have been discharged?
A6. 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.

Q7. What sizes of aneurysms require surgical treatment?
A7. Surgical treatment is needed if aneurysms are greater than 5 to 5.5 cm in diameter. Your doctor will discuss this with you and help you make the right decision.

Q8. What size aneurysms have a high risk of rupture
A8. A rupture is most likely if an aneurysm is more than 5.5 cm in diameter. It is also expected if the aneurysm has grown more than 1 cm within a year.

Q9. Can stress cause aneurysms?
A9. Stress causes high blood pressure, weakening the arteries and increasing the risk of developing aneurysms.

Q10. What does a headache caused by an aneurysm feel like?
A10. Patients have reported that an aneurysm headache feels incredibly painful like being hit on the back of the head with a hammer. Other symptoms like vomiting, nausea, blurred vision, sensitivity to light, and dizziness usually accompany it.

Q11. Where do aneurysms occur?
A11. An aneurysm may occur when a part of an artery wall weakens, causing it to widen or balloon out abnormally. It can happen 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)

Q12. How do I know if I have an aneurysm in my leg?
A12. Peripheral aneurysms usually develop in the popliteal artery that runs down the lower part of the thigh and knee. Although they don’t occur as commonly as the other types of aneurysms, they can also develop in the arteries that supply blood to the kidneys or bowels and in the 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

Q13. Can you live an everyday life with an aortic aneurysm?
A13. 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 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, the risk of rupture increases. If 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 after the surgery unless the individual has an unusual disease that causes aneurysms in the body.

Q14. Can an aneurysm heal itself?
A14. An aortic aneurysm is treated to prevent the risk of dissection or rupture, which increases with its size. Once an aneurysm forms along the aorta, it doesn’t heal by itself or decrease in size. Sometimes, small aneurysms may remain stable for years, but others will increase over time. Generally, an aneurysm will grow at less than one-fourth of an inch annually. However, that varies substantially between aneurysms.

The doctor may prescribe certain medications to keep blood pressure in check and suggest you wait and watch the condition. These medications can slow down the growth of an aneurysm, but they cannot cure it. So, most aortic aneurysms must be repaired eventually to prevent them from rupturing.\

Q15. What are the complications that can develop when an aneurysm ruptures?
A15. 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 the narrowing of the blood vessels in the brain, a condition called vasospasm. It 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 by a ruptured brain aneurysm may disrupt sodium balance in the blood, resulting in hyponatremia. It can swell up the brain cells, leading to permanent damage.