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Brain Aneurysm

A brain aneurysm, also called a cerebral aneurysm, is a weak spot along a blood vessel in the brain that bulges outward. Often described as balloon-like in appearance, they may burst and bleed into the brain (hemorrhage, or hemorrhagic stroke). This can potentially cause life-threatening complications.

Even if a brain aneurysm does not burst, it can cause other problems by putting pressure on nearby nerves or tissue. Most cerebral aneurysms occur along a ring of interconnected arteries at the base of the brain known as the circle of Willis.

Although some risk factors can increase your risk, the precise cause of brain aneurysm formation is not always known. There is a genetic component, but the specific gene(s) that are involved are still under investigation.

The unique anatomy of an individual can also come into play, that is the way that the arteries in your brain bend and turn. Excessive curves in the arteries can cause hemodynamic stress on the arterial wall, which can degrade the tissue and cause it to weaken, bulge, and bleed.

Anatomy of the Cerebrovascular System

The cerebrovascular system is the network of blood vessels that supply your brain with oxygen and nutrients. The system includes the internal carotid arteries, vertebral arteries, and their branches, which bring blood into the brain, and the veins that carry blood back to the heart.

The carotid arteries are located in the neck and provide blood to the front part of the brain (known as the anterior circulation). The vertebral arteries are located at the back of the neck and provide blood to the back part of the brain (the posterior circulation). These arteries branch off into smaller blood vessels, which in turn supply different areas. Aneurysms can form on any of these arteries, though they are more common in the larger arteries at the base of the brain.

Within the brain, the smallest blood vessels are called capillaries, which have thin walls that allow for the exchange of oxygen and nutrients with brain cells. The capillaries then join together to form larger blood vessels called veins, which carry the blood back to the heart to be reoxygenated via the internal jugular veins.

The cerebrovascular system is essential for the proper functioning of the brain. Any disruption of blood flow can cause serious health problems, such as stroke or cognitive impairment. Therefore, maintaining a healthy lifestyle and managing risk factors such as high blood pressure or diabetes is important for maintaining the health of the cerebrovascular system.

Brain Aneurysm Symptoms

Cerebral aneurysms usually do not cause symptoms until they either become very large or burst. Most are found when they burst and bleed into the space between the skull and the brain. This is a serious condition called subarachnoid hemorrhage, or hemorrhagic stroke.

Symptoms of an aneurysm pressing on nearby tissue and nerves may include:

• Some growing aneurysms cause nerve compression. For instance, a posterior communicating artery aneurysm that is compressing the oculomotor nerve might cause double vision. This is a classic presentation, but also rare. Similarly, an one that is near the optic apparatus, either on the carotid artery or the anterior communicating artery, can compress the optic nerve and cause a blind spot.
• Some aneurysms that are in the basilar circulation or posterior circulation can compress the brainstem and cause symptoms such as weakness in the arms and legs, double vision, or swallowing difficulties.
• Other symptoms stemming from nerve compression can include:
  • Pain above and behind the eye
  • Numbness, weakness, or paralysis on one side of the face
  • Dilated pupils
  • Vision changes

Symptoms of a ruptured aneurysm may include:

• A sudden, severe, and explosive, or ‘thunderclap’ headache. These headaches come on in an instant and are usually described by patients as being the “worst headache of my life”, or an 11 out of 10 on the pain scale. This headache is caused by an aneurysm that has burst and started bleeding into the surrounding subarachnoid space and is a medical emergency. The subarachnoid space describes the area between the pia mater—the delicate, innermost covering of the brain—and the arachnoid mater. This space contains cerebrospinal fluid and the major blood vessels of the brain.
• Other symptoms of a ruptured aneurysm can include:
  • Double vision
  • Drooping eyelid
  • Nausea
  • Vomiting
  • Stiff neck
  • Sensitivity to light
  • Loss of consciousness, including coma
  • Seizures

Subarachnoid hemorrhage can cause serious complications, including:

• Hydrocephalus is an abnormal buildup of cerebrospinal fluid in the skull that puts pressure on brain tissue.
• Vasospasm is a narrowing of blood vessels. It reduces the amount of blood flow to the brain and can cause stroke or tissue damage.

If you are experiencing these symptoms, contact a medical professional.

Prognosis for a Ruptured Brain Aneurysm

The survival rate of a ruptured brain aneurysm used to be about 50 percent. Over time, these numbers have improved to about a 30-40% mortality rate (60-70% survival rate) as a result of advances in neurocritical care over the last 20 years.

However, roughly 25% of people who survive a ruptured brain aneurysm have cognitive deficits or discrete neurologic deficits like difficulty speaking, weakness, and other symptoms stemming from permanent brain damage.

Brain Aneurysm Treatment

Not all aneurysms bleed. Small lesions may be watched for growth and symptom onset. When deciding whether or not to treat an unruptured brain aneurysm, your doctor will consider many factors. These include the type, size, and location of the aneurysm; your health, age, and medical history; and the risks associated with treatment.

There are three kinds of treatments for brain aneurysms:

• Aneurysm clipping
• Occlusion and bypass
• Endovascular embolization

Aneurysm Clipping

Aneurysm clipping, also called microvascular clipping, is a surgical procedure that involves cutting off blood flow to the brain aneurysm. Your neurosurgeon will open up part of your skull and place a clip on the neck of the aneurysm to halt its blood supply.

Bypass and Occlusion

Occlusion is a procedure where your neurosurgeon clamps off the entire artery leading to the brain aneurysm. This surgery is often performed when an aneurysm has damaged an artery. It may be accompanied by a bypass, in which a small blood vessel is surgically grafted to the artery. This reroutes blood flow away from the damaged section of the vessel.

Endovascular Embolization

Endovascular embolization is a minimally-invasive treatment where a catheter is inserted into a major artery in the wrist or groin and threaded through the blood vessels to the site of the brain aneurysm. Coils are passed through the catheter and then released into the aneurysm.

The coils then fill the aneurysm, preventing blood from flowing through it and causing it to clot. This decreases the chances of rupture. Alternatively, an aneurysm can be treated by placing a special stent called a flow diverting stent across the base of an aneurysm. This leads to clotting and shrinkage of the aneurysm, eventually blocking it off from the main artery.

Recovery after Aneurysm Clipping or a Ruptured Brain Aneurysm

Routine, elective clipping typically requires just one night in the hospital. However, the length of stay depends on the size of the aneurysm, its location, your age, and other medical conditions you may have. Generally speaking, elective surgery requires a two-to-four week recovery time of rest and slow reintegration into your normal activities.

Recovery from an aneurysmal bleed takes much longer. It takes two weeks of in-hospital care to treat the after effects of a subarachnoid hemorrhage, which may include:

• Cerebral edema or swelling
• Increased intracranial pressure
• Vasospasm, or narrowing of the blood vessels
• Hydrocephalus
• Management of cerebrospinal fluid

Intensive care for vasospasm may include induced hypertension, angioplasty, and intra-arterial vasodilators. Patients with neurological injuries may require neuro-rehabilitation. Time to complete recovery varies greatly and depends on the severity of the hemorrhage, up to a year.

Safety of MRI after Treatment with Clips or Coils

It is safe to get an MRI after treatment with clipping or coiling. The metals used for clips or coils are MRI safe. They can, however, produce imaging artifact, or shadows, which degrade the quality of the MRI images.

Can a brain aneurysm be cured?

A cure can be achieved by excluding the aneurysm from the circulation in the brain. Indeed, the goal of surgery is always a complete cure. Clipping provides a durable cure, with recurrence rates of less than 2% over 10 years.

Endovascular therapies, such as coiling, are also intended to be curative, but have a higher recurrence rate and require retreatment in 10-15% of cases.

Brain Aneurysm Prevention

These lesions can occur in anyone at any age, but they are more common in adults than in children and slightly more common in women than in men. They also occur more often in people with certain genetic diseases and blood vessel disorders.

The only way to avoid a bleed is to control your risk factors, which include:

• Cigarette smoking
• High blood pressure
• High cholesterol
• Poor diet
• Lack of exercise
• Stimulant drugs like cocaine or methamphetamines
• Declining estrogen levels and menopause

You can modify these risk factors to decrease the risk of occurrence, but these measures do not prevent rupture.

The best way to prevent a bleed is early detection. If you have a family history of aneurysm, meaning that your parents or siblings have been diagnosed with a brain aneurysm or experienced a ruptured brain aneurysm, you can undergo screening using medical imaging.

How common are brain aneurysms and ruptured brain aneurysm?

About five percent of the population has at least one cerebral aneurysm. One-third of those people have more than one. Each year, these lesions bleed in 10 to 20 per 100,000 people.

Brain Aneurysm Diagnosis

Most cerebral aneurysms go unnoticed until they bleed or are found by imaging tests done for other reasons.

The following tests may be used for diagnosis:

• Angiography
• CT scan
• MRI scan
• Lumbar puncture (spinal tap)

Can stress increase my risk?

Stress probably does not cause brain aneurysm formation, but stress can lead to a bleed. There are case reports of aneurysms that ruptured during sexual intercourse or episodes of high blood pressure.

Can exercise cause a ruptured brain aneurysm?

Strenuous exercise generally raises your heart rate and your circulation rather than your blood pressure. Some exercises that involve a lot of straining, like weightlifting, can potentially stress aneurysms.

Can you feel an aneurysm in your head?

Aneurysms can only be felt if they bleed and cause subarachnoid hemorrhage, or if they compress an adjacent nerve.

Do I need to get checked for a brain aneurysm?

You should only undergo screening for a brain aneurysm if you have a positive family history. A positive family history means that one or more of your parents or siblings have been diagnosed with a brain aneurysm.

What is the difference between a brain aneurysm and stroke?

A brain aneurysm is the anatomical sac that forms on the artery wall. If that sac bursts and bleeds into the surrounding tissue, it is known as a hemorrhagic stroke. However, hemorrhagic strokes can also be caused by high blood pressure, malformations of the arteries and veins, and aging of arteries, among other causes.

Ischemic strokes, which account for roughly 85% of all strokes, are caused by blockage of blood flow, depriving brain tissue downstream of oxygenated blood. These classic strokes result in damage or death of brain tissue.

Can a brain aneurysm change your personality?

It is unlikely for a brain aneurysm to cause personality change. Those that grow to a giant size and compress parts of the brain may affect personality, but this is exceptionally rare. Changes in personality can occur when a bleed damages parts of the brain.

Can you exercise with a brain aneurysm?

Patients with aneurysms can and should exercise. A sedentary lifestyle can contribute to poor cerebrovascular health. Many brain aneurysms are small in size (less than seven millimeters) and normal activity and exercise is encouraged for these people.

How much does it cost?

The cost for a second opinion from a top neurosurgeon at Barrow Neurological Institute is a flat $100, and it is non-refundable. Payment must be made by credit card at the time of submission. We do not offer other payment options at this time.

How does it work?

1. Once you click the link, you’ll be directed to our Dignity Health hello humankindness secure portal where you will create your account.
2. You will answer an electronic questionnaire to give our physicians an understanding of your medical history and the condition you would like an opinion for.
3. After filling out our questionnaire, we’ll direct you to a secure page where you can upload your MRI and/or CT images.
4. Payment will be requested.
5. Once payment is received, your case will be sent to a coordinator who will review all of your information. The coordinator may contact you for additional information.
6. After the coordinator confirms that all of the information the neurosurgeon will need to review your case has been met, your case will be routed to the neurosurgeon most appropriate for your condition.
7. Within 7 to-10 business days, you’ll receive a notification through email that your second opinion is available in the portal. (Please note 7 to 10 business days cannot be guaranteed for submissions from June through August, peak summer months, and submissions during the peak U.S. holiday months of November and December; To ensure that our physicians have the most up-to-date information about your case, Barrow Second Opinion requires that your most recent imaging tests be performed within the last six months. We get it: Imaging scans are inconvenient and sometimes uncomfortable. But the more current your imaging is, the more meaningful your second opinion will be!)

You may download, keep, and share your second opinion with whomever you like.

Why should I get a second opinion from Barrow Neurological Institute?

Barrow Neurological Institute is one of the leading neurosurgical teaching hospitals in the world and has been designated as a top neurosurgery hospital by Newsweek. Patients and healthcare providers come from across the globe to receive care and learn from us. We acknowledge that many areas do not have the expertise we do and understand cost can be a large barrier to care. Our Second Opinion Program can help connect you digitally to a top neurosurgeon even if they aren’t any practicing in your immediate area.

Do I need to travel to Barrow Neurological Institute for treatment?

There is no obligation for you to come to Barrow Neurological Institute for treatment, and your second opinion is yours to keep and share.

What if I decide to come to Barrow Neurological Institute for treatment?

If your second opinion recommends neurosurgery and you decide to come to Barrow Neurological Institute for treatment, you will be treated by the neurosurgeon who reviewed your case. If you decide to come to Barrow, simply let our Second Opinion Program coordinators know. Our coordinators will assist you with appointment scheduling, travel resources, insurance verification, and financial concerns.

Can I submit anything I want?

No. There are a few rules:

1. You must have been diagnosed with one of the conditions outlined in the second frequently asked question.
2. Your imaging must be related to your condition, meet requested requirements, and have been taken in the past six months.
3. You must have already been diagnosed by a physician for the condition that has been submitted. We are unable to provide an initial diagnosis of your condition.

All records and information must be submitted in English, as Barrow Neurological Institute cannot translate these materials.

How old do I have to be?

You must be 18 years of age or older to submit your request for a neurosurgical second opinion.

May I submit a case for my child?

You may submit a case for a child as long as the child is 14 years of age or older. We may make some exceptions based on special situations; please email your inquiries to BarrowSecondOpinion@DignityHealth.org.

How long does this process take?

Once you have submitted the required documentation and imaging, your second opinion will be available in 7 to 10 business days. Please note that 7 to 10 business days cannot be guaranteed for submissions during November and December; peak U.S. holiday months, and the peak summer months of June through August.

Will you be contacting my doctor?

No. We will not contact your physician. We do recommend, however, that you share the recommendation with your doctor so that they are still involved in your care.

Can my doctor submit my case for me?

Yes. If your doctor submits the case on your behalf, there is no charge. To do this, please provide your doctor’s office with a link to our physician-to-physician Second Opinion portal. We will need to verify your doctor’s identity prior to processing your information.

Is the Second Opinion program covered by my insurance?

Although you may need to contact your insurance carrier for more information, we do not bill insurance companies for participating in our Second Opinion Program. You will be responsible for submitting any requests to your insurance company for reimbursement.

Please note that motor vehicle accident and workman’s compensation cases may not be able to be processed through our Second Opinion Program.

Does this make me a patient at Barrow Neurological Institute?

No. Receiving a neurosurgical second opinion does not make you a patient of Barrow Neurological Institute. In order to become a patient, you must make an appointment and be seen in our offices. If you’ve received a neurosurgical second opinion and would like to be seen at Barrow Neurological Institute, please call us at (602) 406-3396.

Get Your Second Opinion in 4 Steps

Getting a second opinion from one of the best neurosurgeons in the United States is fast, easy, and secure. It’s also affordable: we offer our neurosurgical second opinions for a flat, non-refundable fee of $100 paid upfront.

Here’s how it works:

1. Step 1: Tell us about yourself
   To get started, you’ll need to create an account with your contact information to use our secure Second Opinion Portal. Once your account is set up, we’ll ask you to tell us about your diagnosis, symptoms, and medical history in a brief questionnaire. Please remember, our doctors can only base your second opinion on the information and diagnostic imaging you provide. We’ll protect your personal health information like we would with any Barrow patient. Please note: Your Second Opinion Portal is operated through a Dignity Health hello humankindness account.
   
2. Step 2: Upload your medical images
   After filling out our questionnaire, we’ll direct you to a secure page where you can upload your MRI and/or CT images. Rest assured, we’ll only share these images with our neurosurgeons and clinical staff.
   
3. Step 3: Submit payment
   We require a payment of $100 to process a request. We accept Visa or Mastercard.
   
4. Step 4: Get your second opinion in 7-10 business days (or less)
   After we receive your request, we’ll assign your case to a neurosurgeon who specializes in your diagnosis.

What to Expect from The Barrow Second Opinion Program

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You can expect to receive your second opinion within 7 to 10 business days from the time we receive all required documentation and diagnostic imaging. We’ll contact you if any information is missing. (Please note that 7 to 10 business days cannot be guaranteed for submissions during November and December; peak U.S. holiday months, and the peak summer months of June through August.) Once our neurosurgeon makes a recommendation, we’ll notify you by e-mail that your second opinion is ready. You can log into your account and view the report in a PDF format. 

You’re not obligated to pursue our recommended course of treatment at Barrow or any other institution. However, if our neurosurgeon recommends surgery, we’ll provide their contact information so you can schedule a consultation if you choose.

Finally, our Second Opinion Program is not meant to replace an in-depth, face-to-face consultation with a physician.

I’m Still Unsure or Need More Help

If you have questions during any part of the process, please visit our FAQ page, or contact us at (602) 406-3396 or BarrowSecondOpinion@DignityHealth.org. We look forward to helping you, however we can.