A brain aneurysm is an abnormal bulge in a brain artery. If left untreated, it can burst, causing a dangerous brain hemorrhage.
What is a brain aneurysm?
A brain aneurysm (sometimes called a cerebral aneurysm) is an abnormal bulge or bubble in an artery in your brain. This bulge can happen when a blood vessel wall becomes weak or thin. Many aneurysms cause no symptoms until they begin to bleed or they grow large enough that they push on a nerve or the surrounding brain.
A ruptured brain aneurysm, also known as a brain bleed or subarachnoid hemorrhage, is a critical medical emergency demanding immediate care. Prompt treatment is vital due to the severe and life-threatening complications that can arise. When an aneurysm ruptures, it causes bleeding into the brain, rapidly increasing pressure, damaging brain cells, and disrupting vital blood flow.
Aneurysms are treated by specialized stroke care teams because they are classified as cerebrovascular disorders. AHN’s dedicated Stroke Centers and the team of experts there understand the urgency needed to treat aneurysms and have the experience and skill in providing this level of care.
AHN Stroke Centers
AHN Stroke Centers are specially equipped to treat strokes and other cerebrovascular diseases that affect blood flow to the brain. Our certified centers are located throughout western Pennsylvania and Erie. This provides you with advanced treatment that is close to home from specialized providers who are experienced in treating neurological health conditions.
Why choose AHN for brain aneurysm treatment?
At the AHN Neuroscience Institute, you’ll get prompt, expert care. Our experienced neurosurgeons and neurointerventionalists (a doctor who specializes in brain conditions using minimally invasive techniques) collaborate to use effective therapies to treat ruptured and unruptured brain aneurysms. Our Stroke Centers are staffed by board-certified neurologists, neurosurgeons, and specialists who work together to deliver the most effective stroke treatment for each patient.
This effective care is recognized by The Joint Commission, which is an outside, independent organization that accredits and recognizes health care organizations that focus on patient safety and care quality. Several AHN Stroke Centers have received advanced stroke center certifications by the Commission, which recognizes the top-level care we provide for even the most complex stroke conditions.
Brain aneurysm symptoms and signs
An unruptured brain aneurysm may cause no symptoms at all. However, because a ruptured brain aneurysm can be life-threatening, it is critical to seek immediate medical care if you believe you or a loved one are experiencing symptoms of a ruptured (or burst) brain aneurysm. These symptoms include sudden:
- Severe headache or neck pain
- Nausea
- Vomiting
- Problems seeing, speaking, or thinking clearly
- Loss of consciousness
Causes and risk factors
Doctors don't always know the exact reason why someone gets a brain aneurysm. It's usually a mix of things you're born with and things that happen during your life, like a head injury or certain infections, that make the blood vessel walls weak over time. Being aware of these causes and risk factors can help you and your care team stay on top of appropriate testing that may lead to a quicker diagnosis.
Risk factors you can’t control
There are certain risk factors that are beyond your control. However, knowing what they are and having regular checkups and appointments with your AHN neurological team are important factors for reducing the risk of a brain aneurysm. Risk factors include:
- Age: As you get older, especially after age 40, the risk of an aneurysm forming and possibly bursting goes up.
- Gender: Those assigned female at birth tend to get brain aneurysms more often than men, especially after they go through menopause.
- Family history: If your mom, dad, or a brother or sister has had a brain aneurysm, especially one that burst, your risk is higher. This means it can sometimes run in families.
- Race: Black and Hispanic individuals often have a higher risk of brain aneurysm rupture.
Risk factors you may control
There are some habits or health issues that you might be able to change or manage to lower your risk include:
- High blood pressure: When your blood pressure is high for a long time, it puts a lot of stress on your blood vessel walls, making them weak and more likely to form or burst an aneurysm.
- Smoking: Chemicals in cigarettes damage blood vessel walls, making them weaker and increasing the risk of an aneurysm forming and bursting.
- Drug abuse: Drugs like cocaine and amphetamines can cause a sudden, very high spike in blood pressure, which can make an aneurysm burst. They can also hurt blood vessels directly.
- Drinking too much alcohol: Heavy drinking has been linked to a higher risk of aneurysms.
- Untreated high cholesterol: While not as strong a link as high blood pressure or smoking, high cholesterol can still contribute to overall blood vessel problems.
It's important to remember that having one or more of these risk factors doesn't mean you will definitely get an aneurysm. Many people with aneurysms don't have any of these known risk factors. So, while high blood pressure, smoking, age, gender, and family history are the main things doctors look at, other factors can also be important in certain situations.
Brain aneurysm screening and diagnosis
For certain groups with elevated risk, brain aneurysm screening is important in determining an early diagnosis. Doctors usually suggest screening for patients born with rare conditions or for someone who has already been treated for an aneurysm. If an aneurysm is suspected, doctors can use these tests to confirm it:
- MRI angiography (MRA): This uses strong magnets and radio waves to create detailed pictures of the blood vessels in your brain. It's a good choice for screening because it doesn't use X-rays.
- CT angiography (CTA): This uses X-rays and a special dye that's put into your vein to make the blood vessels show up clearly. It's quicker than MRA but uses a little bit of radiation.
- Cerebral angiography (DSA): A tiny tube is put into an artery (usually in your leg) and gently moved up to your brain's blood vessels. A dye is injected, and X-ray pictures are taken. This test shows the aneurysm's exact size, shape, and location, which is very important for planning treatment. However, it's a small procedure and has a tiny risk of problems.
Your doctor will decide which test to use based on your symptoms and screening results.
Diagnosing a burst aneurysm
When an aneurysm bursts, it causes a very serious emergency called a subarachnoid hemorrhage (SAH). People often describe it as the most severe headache ever experienced, along with a stiff neck, sickness, throwing up, or even passing out. In this emergency situation, doctors usually do these tests right away:
- CT scan of the head (without dye): This is usually the first test. It can quickly show if there's blood in the space around the brain, which is the key sign of a burst aneurysm.
- Lumbar puncture (spinal tap): If the CT scan doesn't show blood but doctors still strongly suspect a burst aneurysm, they might do a spinal tap. They take a small sample of fluid from your spine. If there's blood in this fluid, it confirms a burst aneurysm.
- CTA or cerebral angiography: Once a burst aneurysm is confirmed (or strongly suspected), doctors do one of these tests right away to find exactly where the bleeding is coming from so they can treat it quickly.
It's crucial to remember that the decision to undergo screening is a complex one and should always be made in consultation with your neurological team. They will consider your individual risk factors, medical history, and the potential benefits and risks of screening.
Size and types of brain aneurysm
Brain aneurysms are mainly grouped by their shape and measurements. The size of an unruptured aneurysm is very important for figuring out how likely it is to burst and what treatment might be best. Generally, aneurysm sizes can fit into four categories:
- Small aneurysms: Less than 5 millimeters (about the size of a pencil eraser). These usually have a lower chance of bursting.
- Medium aneurysms: 5 to 12 millimeters.
- Large aneurysms: 13 to 24 millimeters.
- Giant aneurysms: 25 millimeters (about an inch) or bigger. These have a much higher chance of bursting and can also cause problems by pushing on parts of the brain.
Types of brain aneurysms
Brain aneurysms don't all look alike. They come in different shapes, and knowing the shape helps doctors understand them better.
Saccular aneurysms (berry aneurysms)
Saccular aneurysms, or berry aneurysms, are the most common type. They look like a small berry hanging on a stem and out from one side of a blood vessel. They often form where blood vessels split or fork, especially at the bottom of the brain. These are the most likely type to burst.
Fusiform aneurysms
These types of aneurysms are less common. Instead of a berry shape, the whole blood vessel widens or balloons out, like a bulging tube. They're often linked to hardening of the arteries. They can burst, but they also often cause other problems because of their size and how they affect blood flow.
Dissecting aneurysms
These happen when the inner lining of a blood vessel tears. Blood then flows between the layers of the vessel wall. This can make the outer layer bulge like an aneurysm, or it can narrow the vessel, blocking blood flow. They are often caused by an injury or certain problems with body tissues. They can burst or cause a stroke due to blood flow problems.
Mycotic aneurysms
Often caused by an infection that makes the blood vessel wall weak, mycotic aneurysms travel through the blood from another part of the body (like from a heart infection). They are often very weak but have a high chance of bursting.
Pseudoaneurysms (false aneurysms)
Unlike true aneurysms where all parts of the blood vessel wall are weak, a false aneurysm means there's a tear in the inner layers. Blood leaks out but is held in by the outer layer or nearby tissues. Often caused by an injury or by something that happened during a medical procedure.
No matter the type of aneurysm, the AHN neurological team’s advanced training and expertise is standing by, ready to treat you with tailored, precise care.
Renowned neurosurgeons focused on you.
Available at The AHN Neuroscience Institute.
Brain aneurysm treatment
At AHN, physicians consider multiple factors, including the location and characteristics of an aneurysm, before developing a personalized treatment plan for you. Learn more about AHN’s system of cerebrovascular and stroke care.
The right treatment for a brain aneurysm also depends on what risk the aneurysm poses. If an aneurysm is unlikely to burst and causes no symptoms, physicians may decide to monitor you before recommending treatment.
Surgery or embolization can treat ruptured aneurysms or unruptured aneurysms that doctors deem a danger to your health. Before determining the right treatment for you, we consider the specifics of the condition as well as your overall health and circumstances.
Our neurosurgeons and neurointerventionalists have years of experience performing the latest procedures to treat many different types of brain aneurysms. These treatments include:
- Microsurgical clipping: Physicians perform a craniotomy, a specialized surgery where doctors remove part of the skull to access the brain. We use tiny tools to clip an aneurysm off from the blood vessel, preventing it from rupturing.
- Coil embolization: Using a minimally invasive approach, physicians insert small platinum coils to seal off an aneurysm. A catheter delivers the coils to the precise location, so there is no head incision.
- Flow diverters and stents: Physicians use a specialized stent to cover the aneurysm and redirect blood flow away from the aneurysm. A catheter delivers this stent through a small incision in the groin.
Brain aneurysm FAQs
A brain aneurysm can be a frightening diagnosis, and for many, it remains a condition that brings uncertainty. To help provide clarity on this complex condition, we’ve included some of our patients’ frequently asked questions. From understanding the warning signs and survival possibilities to knowing what steps to take if you're diagnosed, you can get background information to help you feel more informed. Of course, your AHN care team is ready to answer any and all questions you have, but this can help set those conversations up.
Is it possible to survive a brain aneurysm?
Yes, it is possible to survive a brain aneurysm, especially if it is detected before it ruptures or if medical attention is sought immediately after a rupture. The outcome depends on various factors, including the aneurysm's size and location, whether it ruptured, the severity of the bleed, and the patient's overall health and the promptness of treatment. Many people who experience a ruptured aneurysm can survive, though some may face long-term neurological challenges. Unruptured aneurysms often have a very good prognosis when managed appropriately.
Can a brain aneurysm develop suddenly?
While a brain aneurysm forms over time due to weakening of blood vessel walls, the detection or rupture of an aneurysm can indeed happen suddenly. Many aneurysms exist without any symptoms for years, and then either a routine scan reveals them, or they rupture without warning, leading to a sudden onset of severe symptoms. The weakening of the vessel wall itself is a gradual process, but the critical event of rupture can be very abrupt.
What should I do if I have a brain aneurysm?
If you have been diagnosed with a brain aneurysm, the most important step is to work closely with a neurosurgeon or a neurologist specializing in cerebrovascular conditions. They will assess your specific aneurysm (size, location, shape) and your overall health to determine the best course of action. This might involve:
- Watchful waiting: For small, unruptured aneurysms with low risk factors, regular monitoring with imaging scans might be recommended.
- Treatment: If the aneurysm is deemed high-risk, treatment options include surgical clipping (where a clip is placed at the base of the aneurysm) or endovascular coiling (where coils are inserted into the aneurysm to block blood flow).
- Lifestyle modifications: Managing blood pressure, quitting smoking, and avoiding excessive alcohol can help reduce the risk of rupture.
It is crucial to follow your doctor's recommendations precisely and attend all follow-up appointments.
What are the warning signs of a brain aneurysm?
Most unruptured brain aneurysms do not cause symptoms and are often discovered incidentally during imaging for another condition. However, a ruptured aneurysm typically presents with sudden, severe symptoms requiring immediate emergency medical attention. These warning signs include:
- Sudden, extremely severe headache (often described as the most severe headache experienced)
- Nausea and vomiting
- Stiff neck
- Blurred or double vision
- Sensitivity to light (photophobia)
- Seizure
- Drooping eyelid
- Dilated pupil
- Weakness or numbness on one side of the body
- Difficulty speaking
- Loss of consciousness
In some cases, an unruptured aneurysm, if it is large enough, can press on nearby nerves or brain tissue, causing symptoms like localized headache, vision changes, a drooping eyelid, or numbness/weakness. These are less common but indicate a need for medical evaluation.
Can you have a brain aneurysm and not know it?
Yes, this is very common. Many brain aneurysms are silent or asymptomatic, meaning they do not cause any symptoms. They can exist for many years, even decades, without the individual being aware of their presence. Often, these unruptured aneurysms are discovered incidentally when a person undergoes a CT scan or MRI of the brain for an unrelated reason (e.g., headaches, dizziness, or following a minor head injury).
What happens when you have a brain aneurysm?
Having a brain aneurysm" refers to the presence of a weakened, bulging spot on the wall of a brain artery. What happens next depends on whether it ruptures. If it does not rupture (unruptured aneurysm):
- Many unruptured aneurysms remain stable and never cause problems.
- Larger unruptured aneurysms might press on nearby nerves or brain tissue, causing symptoms like headache, vision changes, or facial pain/numbness.
- They can be monitored, and if deemed high-risk for rupture, they may be treated with surgical clipping or endovascular coiling to prevent a future rupture.
If it does rupture (ruptured aneurysm):
- Blood spills into the space around the brain (subarachnoid hemorrhage), leading to a sudden, severe headache and other neurological symptoms mentioned above (nausea, stiff neck, etc.).
- The bleeding can cause increased pressure within the skull, damaging brain cells, and potentially leading to stroke, coma, or even death.
- Immediate emergency medical and surgical intervention is required to stop the bleeding, secure the aneurysm, and manage complications.
Contact us
To schedule an appointment or learn more about AHN neuroscience services, call 412-359-6200 or 814-452-7575 in Erie
If you're an existing patient, you can also call (412) DOCTORS 412-362-8677 in Pittsburgh or 814-CONNECT in Erie make an appointment with AHN Neuroscience.