Cerebral Aneurysm: The Silent Killer

• Learn how a cerebral aneurysm, defined as an abnormal bulging/ballooning of a blood vessel, can hemorrhage or cause increased intracranial pressure.
• Understand the genetic, lifestyle, and preexisting conditions such as head trauma that may contribute to an increased risk of cerebral aneurysms.
• Review diagnosis and treatment plans for cerebral aneurysms as clinical interventions have a higher chance of success when done early. 

Cerebral aneurysms are often referred to as the “silent killer” as they usually come with no symptoms or warning signs until it bursts causing bleeding around the brain and eventually death.

The bleeding can cause an increase in intracranial pressure which disrupts cerebral perfusion or the flow of oxygen and blood to the brain which can lead to comatose and eventually death. Roughly 1% to 2% of the population worldwide have brain aneurysms, which most of them are unaware of, and only a small percentage of that group will experience a rupture.

An aneurysm is defined as an abnormal bulging or ballooning of a blood vessel due to the weakening of the walls of the arteries which can lead to rupture, leaking of blood, and sudden death.

A bulging aneurysm puts pressure on the surrounding nerves or brain tissues, and a ruptured aneurysm can spill blood into the surrounding tissue which is called a hemorrhage. It can be compared to an old, weak bicycle tire that bulges or expands and then suddenly bursts.

Cerebral aneurysms can occur anywhere in the brain, but most of them form in the major arteries along the base of the skull. It does not choose any particular race, gender, or age and can happen to anyone at any age.

Risk Factors in Developing a Cerebral Aneurysm

The following risk factors can play a role in the development of a cerebral aneurysm and must be considered:

Genetics

• genetic connective tissue disorders that weaken artery walls
• arteriovenous malformations or snarled tangles of arteries and veins in the brain that disrupt blood flow – some develop sporadically or on their own
• history of aneurysm in a first-degree family member

Lifestyle

• untreated high blood pressure
• cigarette smoking
• drug abuse, especially cocaine or amphetamines, which raise blood pressure to dangerous levels
• IV drug abuse can cause infection in the arterial wall (mycotic aneurysm)
• high blood sugar and cholesterol
• stress

Other Risk Factors

• head trauma
• brain tumor

Risk Factors for Ruptured Aneurysm

• Smoking is linked to both the development and rupture of cerebral aneurysms. It may even cause multiple aneurysms to form in the brain.
• High blood pressure. High blood pressure damages and weakens arteries, making them more likely to form and rupture.
• The largest aneurysms are the ones most likely to rupture.
• Aneurysms located on the posterior communicating arteries (a pair of arteries in the back part of the brain) and possibly those on the anterior communicating artery (a single artery in the front of the brain) have a higher risk of rupturing than those at other locations in the brain.
• Aneurysms that grow, even if they are small, are at increased risk of rupture.
• Family history. A family history of aneurysm rupture suggests a higher risk of rupture for aneurysms detected in family members.

Diagnosis and Treatment

Brain aneurysms can be diagnosed by CT scan, MRI, cerebral angiography, and/or Cerebrospinal Fluid (CSF) analysis.

Quick treatment is vital. If the aneurysm has already ruptured and caused hemorrhage, a neurosurgeon will do an open surgery such as a craniotomy which creates an opening in the skull to evacuate the bleeding, or craniectomy which removes a portion of the skull to decompress and relieve the pressure in the brain. A neurosurgeon can also do clipping which cuts off the blood flow that feeds the aneurysm.

There are also less-invasive procedures such as sealing the ruptured artery from within the blood vessels with metal coils or stents.

The Bottom Line

A cerebral aneurysm can happen to anyone, and it has been observed that cerebral aneurysms are becoming more common among younger people as well.

Therefore, it is imperative to take care of yourself, be conscious of one’s health, and practice a healthy lifestyle. Moreover, we should learn to manage our stress, eat a healthy and balanced diet, exercise regularly, and avoid smoking and illicit drugs.

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