In some cases, an aneurysm might leak a slight amount of blood. This leaking (sentinel bleed) can cause:
Sudden, extremely severe headaches
A more severe rupture
An unruptured brain aneurysm may produce no symptoms, particularly if it's small. However a larger unruptured aneurysm may press on brain tissues and nerves possibly causing:
Pain above and behind the eye
A dilated pupil
Change in vision or double vision
Numbness on one side of the face
If you experience a sudden, severe headache or other symptoms possibly related to a ruptured aneurysm, you’ll be given a test or a series of tests to determine whether you’ve started bleeding into the space between your brain and surrounding tissues (subarachnoid hemorrhage) or if it is another type of stroke.
If bleeding has occurred, your emergency care team will determine whether the cause is a ruptured aneurysm.
If you show symptoms of an unruptured brain aneurysm — such as pain behind the eye, changes in vision or double vision — you will have to undergo tests to identify the offending aneurysm.
Diagnostic tests include:
Computerized tomography (CT). A CT scan, a specialized X-ray exam, is usually the first test used to determine if you are bleeding in the brain. The test produces images that are 2-D "slices" of the brain. For this test, you may also receive an injection of a dye that makes it easier to observe blood flow in the brain and indicate the presence of an aneurysm. This variation of the test is called CT angiography.
Cerebrospinal fluid test. If you've had a subarachnoid hemorrhage, there will most likely be red blood cells in the fluid surrounding your brain and spine (cerebrospinal fluid). Your doctor will order a test for the cerebrospinal fluid if you have symptoms of a ruptured aneurysm but CT scans don’t show evidence of bleeding. The procedure to draw cerebrospinal fluid from your back with a needle is called a lumbar puncture (spinal tap).
Magnetic resonance imaging (MRI). An MRI uses a magnetic field and radio waves to create detailed images of the brain, which can be either 2-D slices or 3-D images. The type of MRI which assesses arteries in detail (MRI angiography) can detect the presence of an aneurysm.
Cerebral angiogram. During this procedure, also called a cerebral arteriogram, your doctor inserts a thin, flexible tube (catheter) into a large artery — usually in your groin — and threads it past your heart to the arteries in your brain. A special dye injected into the catheter travels to arteries across your brain.
A series of X-ray images can then reveal details about the conditions of your arteries and detect aneurysms. This test is more invasive than others and is usually used when other diagnostic tests fail to provide enough information.
Screening for brain aneurysms
The use of imaging tests to screen for unruptured brain aneurysms is generally not recommended. However, you may want to discuss the potential benefits of a screening test with your doctor if you have:
A parent or sibling who has had a brain aneurysm, particularly if you have two such first-degree family members with brain aneurysms
A congenital disorder that increases your risk of a brain aneurysm
There are two common treatment options for a ruptured brain aneurysm.
Surgical clipping clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then he or she places a tiny metal clip on the neck of the aneurysm to stop blood flow to it.
Endovascular coiling is a less invasive procedure than surgical clipping. 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 uses a guide wire to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and essentially seals off the aneurysm from the artery.
Brain aneurysm surgery
There are two common treatment options for a ruptured brain aneurysm. Both procedures pose potential risks, particularly bleeding in the brain or loss of blood flow to the brain.
The endovascular coil is less invasive and may be initially safer, but it has a slightly higher risk of needing a repeat procedure in the future, due to reopening of the aneurysm.
Newer treatments available for brain aneurysm include flow diverters, which are tubular stent-like implants that work by diverting blood flow away from an aneurysm sac. The diversion stops blood movement within the aneurysm and stimulates the body to heal the site, encouraging reconstruction of the parent artery. Flow diverters may be particularly useful for larger aneurysms that can’t be safely treated with other options.
Your neurosurgeon or interventional neuroradiologist, in collaboration with your neurologist, will make a recommendation based on the size, location and overall appearance of the brain aneurysm in addition to your ability to undergo the procedure, and other health factors.
Other treatments (ruptured aneurysms)
Other treatments for ruptured brain aneurysms are aimed at relieving symptoms and managing complications.
Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.
Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These medications can lessen erratic narrowing of blood vessels (vasospasm), which may be a complication of a ruptured aneurysm. One of these medications, nimodipine (Nymalize, Nimotop), has been shown to reduce risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage from a ruptured aneurysm.
Interventions to prevent stroke from insufficient blood flow include intravenous injections of a medication called a vasopressor, which elevates blood pressure to overcome the resistance of narrowed blood vessels. An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain. A drug known as a vasodilator may then be used to expand blood vessels in the affected area.
Anti-seizure medications may be used to treat seizures related to ruptured aneurysms. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid (Depakene) and others. Their use has been debated by several experts, and is generally subject to caregiver discretion and on basis of medical needs of the patient.
Ventricular or lumbar drainage catheters and shunt surgery can lessen pressure on the brain caused by excess cerebrospinal fluid (hydrocephalus), normally associated with a ruptured aneurysm. A catheter is placed in the spaces filled with fluid inside of the brain (ventricles) or surrounding your brain & spinal cord to drain excess fluid into an external bag. Sometimes it may become necessary to introduce a shunt system — which consists of a flexible silicone rubber tube (shunt) and a valve — to create a drainage channel starting in your brain and ending in your abdominal cavity.