September is National Brain Aneurysm Awareness Month – What should you be aware of? The term “brain aneurysm” can stoke intense fear, but do you know what a brain aneurysm is exactly or what to do about one? Exploring the answers to these 7 questions will make you more aneurysm-aware.

1) What is a brain aneurysm and why can it be problematic?

Any aneurysm is an out-pouching or abnormal expansion in the wall of a blood vessel – typically accompanied by a weakening of that blood vessel wall. This can happen anywhere in the body. A brain aneurysm is an abnormal expansion of one of the arteries inside the head that carry blood to the brain or retinas.

Most brain aneurysms are small and harmless. Many people – probably about 2% of people – have a brain aneurysm and don’t know it. The majority of these people live normal lives and die of something unrelated to their aneurysm.

Rarely aneurysms rupture and cause severe bleeding inside the head. The results can be devastating. Nearly half of people whose aneurysms rupture will die, and many of those who survive will be left with permanent neurological symptoms.

Prior to the development of and increasingly widespread use of advanced brain and blood vessel imaging technologies, almost nobody knew they had a brain aneurysm unless they were unlucky enough to have it rupture – causing neurologic symptoms and medical evaluation.

Now, it’s increasingly common for people to get advanced imaging (CT, MRI, CTA, MRA, etc) studies of their brains for a variety of symptoms such as headaches, vertigo, hearing loss, facial pain, etc. Thus, since about 2% of people have brain aneurysms, many people now find out they have one when it is unruptured and unlikely to ever rupture. This is a source of a lot of anxiety for patients who can be left feeling like they have a “ticking time bomb” inside their head.

2) What’s the difference between an aneurysm and rupture of an aneurysm?

One of the most helpful things to be aware of is the difference between an aneurysm (an out-pouching or expansion of a blood vessel wall) and an aneurysm rupture (a sudden bleeding event causing symptoms and often damage to the brain). A quick internet search of news stories shows that headlines often misuse the term “brain aneurysm” to mean the rupture of a brain aneurysm.

3) What are the symptoms of brain aneurysm rupture? What should I do if I suspect this?

The most common reported symptom is sudden onset of severe headache – often the “worst headache [in one’s] life.” There may be loss of consciousness, neck stiffness, vision changes, numbness, or weakness.
Anyone experiencing or witnessing the sudden onset of brain symptoms such as these should call 911 for emergency neurologic evaluation.

This could be an aneurysm rupture or another kind of stroke. This is an emergency.

Headaches that start gradually and build up are unlikely to be related to aneurysm.

4) Do unruptured aneurysms cause symptoms?

Not usually, but sometimes, if an aneurysm is in the right spot, it can put pressure on a nerve and cause one dilated pupil or double vision. Occasionally aneurysms can case a whooshing sound or headache behind one eye, but both of these symptoms are most often benign.

Anyone with new pupil enlargement or double vision should be seen by a doctor soon but does not necessarily need to go straight to the emergency room.

5) What should I do if I find out I have an aneurysm?

Discovering one has a brain aneurysm is not a medical emergency. It is something that should be discussed with your doctor, and depending on the individual circumstances (most importantly the size), perhaps should be discussed with a neurologist or neurosurgeon who specializes in aneurysms.

Sometimes it does make sense to intervene on incidentally discovered brain aneurysms either by doing brain surgery or by using catheters inside the blood vessels to deploy coils into the aneurysm and causing it to clot off. These procedures are done to reduce the risk of a rupture. How to weigh the risks and benefits of whether it makes sense to do anything about a given incidentally discovered brain aneurysm depends on each person’s individual situation. Often the wisest choice is to monitor the aneurysm periodically with repeat images or to simply ignore it.

6) Should I get a brain scan to see if I have an aneurysm?

If you’re having symptoms that might be caused by an aneurysm, yes. This is a decision to make with your healthcare provider in clinic or in the emergency room.

Current guidelines don’t recommend screening most patients for brain aneurysms.

Since brain aneurysms can run in some families, if you have more than one close relative (parent, sibling, or child) with a brain aneurysm, or if you have one close relative with a brain aneurysm and a family history of polycystic kidney disease, Ehlers-Danlos syndrome, or another connective tissue disorder, then you should be screened.

7) Is there anything I can do to reduce my risk of getting a brain aneurysm or having one rupture?

Yes! Quit smoking if you’re a smoker, and don’t start smoking if you’re a non-smoker. Maintain a healthy blood pressure. Know what your blood pressure is, and take medication if you need to in order to achieve healthier blood pressures. Also talk to your health care provider about lifestyle changes that can help maintain a healthy blood pressure.

If you’re interested, lots more information on brain aneurysms can be found at www.bafound.org.

Thanks for reading along!
I hope you feel more aneurysm-aware, and I hope you have a great September!

David B. Sommer, MD MPH
Neurology

Dr. Sommer is accepting new patients, to learn more and book an appointment visit his profile here.