Aneurysm: Summary and Overview

An aneurysm is a balloon-like bulge in an artery or vein. It can be defined as dilatation of the aorta greater than 150% of its normal diameter for a given segment. Aneurysms can occur in the brain (cerebral), thorax (chest) or abdomen. They are serious health conditions and if they rupture can cause internal hemorrhaging. If an aneurysm in the brain ruptures, it releases blood into the brain and causes a stroke. The health effects are serious and can be fatal. 

Aneurysm: Causes

A person might have an inherited tendency to form aneurysms. Or they may develop because of hardening of the arteries (atherosclerosis). The risk also markedly increases with age: most people develop them over the risk of 40. Risk factors also include high blood pressure and smoking. 

In the brain, most or about 85 percent of aneurysms occur in the Circle of Willis, a ring of arteries at the base of the brain. Cerebral aneurysms are sometimes called “berry aneurysms” because they look like a berry hanging from a stem. 

Aneurysms: Symptoms

Often aneurysms have no symptoms, and so they are only detected when visiting the doctor and having other, unrelated body scans. Even large aneurysms often have no symptoms. The most likely way you will notice an aneurysm is if it grows big enough to press against nerve-bearing tissue, causing pain. Unfortunately, this means the aneurysm has grown recently, so the warning comes late. Fast-growing aneurysms are the ones most likely to rupture. 

Symptoms of thoracic aneurysms are rare but include chest pain, upper back pain, or both, coughing up of blood, difficulty swallowing, hoarseness, drooping eyelid, absence of sweating on one side of the face and wheezing. 

Most abdominal aortic aneurysms produce no symptoms. When they produce symptoms, the most common symptom is pain. The pain typically has a deep quality as if it is boring into the person. It is felt most prominently in the middle of the abdomen and can radiate to the back. The pain is usually steady but may be relieved by changing position. The person may also feel prominent abdominal pulsation.

Brain aneurysms are more symptomatic. They can cause problems by pressing on areas in the brain. When this happens, a sudden, severe headache is the key symptom. Some people with a ruptured aneurysm will suffer a warning headache several days or weeks before the rupture. This is commonly referred to as a “sentinel headache.” Other symptoms of a brain aneurysm include blurred vision, changes in speech, neck pain, nausea and vomiting, confusion, seizure, a drooping eyelid, and sensitivity to light. If a cerebral aneurysm ruptures, it can cause paralysis or even death. 

Aneurysms:  Diagnostic Tests

As aneurysms often have no symptoms, they may show up when having other diagnostic tests, such as computerized tomography (CT), magnetic resonance imaging (MRI), echocardiography, computerized tomography (CT), lumbar puncture (spinal tap), angiogram and others.

Once detected, your doctor will likely do further tests to determine their location and size of the aneurysm. The type of diagnostic test will depend on the location of the aneurysm. For example, CT scans are the most common way of imaging the brain to detect a cerebral aneurysm and the necessity of surgical or other treatment. 

Aneurysms:  Treatment Options

The treatment of an aneurysm depends on its size, location and how likely to rupture. Autopsy studies have revealed that 3-6% of adults in the United States have aneurysms inside their brains. Fortunately, many of these aneurysms are small and not at risk to break. The risks of brain surgery may outweigh the risk of rupture. It’s important for you to talk to your doctor about all your treatment options. 

Watchful waiting means that you won’t receive immediate surgery, but you’ll be given regular check-ups so that your aneurysm can be carefully monitored. This usually involves having a diagnostic study every three or six months. Hypertension is a risk factor for aneurysm breakage, and so during this time, you may try to reduce the risk by taking measures to lower your blood pressure.

There are two common treatment options. Surgical clipping is when surgeons place a tiny metal clip on the neck of the aneurysm to stop blood flow to it. Endovascular coiling is where the surgeon inserts a hollow plastic tube (catheter) into an artery, usually in your groin, and threads it through your body to the aneurysm. He or she then inserts a platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow, causing it to clot. This clotting essentially seals off the aneurysm from the artery. Endovascular coiling is less invasive, although the known risks of the procedure may still outweigh the potential benefit. 

Aneurysm: Prevention

Smoking markedly increases risk for aneurysm. The risk is directly related to number of years smoking and decreases in the years following smoking cessation. 

Blood “thinners” (such as Warfarin), some medications and prescription drugs, (including diet pills that act as stimulants such as ephedrine and amphetamines), and harmful drugs like cocaine can cause aneurysms to rupture and bleed.

Other risk factors include hardening of the arteries (arteriosclerosis), certain blood infections and high blood pressure. A healthy diet and exercise will reduce your risk of high blood pressure and arteriosclerosis, lowering your overall risk and improving general health. 

Aneurysm: Conclusion

Aneurysms can occur in the brain (cerebral), thorax (chest) or abdomen. They are serious health conditions. If they rupture, they can cause internal bleeding, paralysis or even death. Aneurysms have a number of risk factors, including arteriosclerosis and hypertension. A healthy, balanced diet, quitting smoking and regular exercise will help reduce your chances of developing an aneurysm.