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Brain Aneurysm

Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju
Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju

Arterial cerebral aneurysms are one of the common causes of life-threatening intracranial hemorrhages. Arterial aneurysms are a limited or diffuse expansion of the lumen of an artery or protrusion of its wall. Most often, saccular aneurysms are found, which look like a small thin-walled sac in which the bottom, middle part, and neck can be distinguished. More rare forms are spherical, fusiform (fusiform), or S-shaped.

The wall of the brain aneurysm is a plate of cicatricial connective tissue of varying thickness. In the cavity of the aneurysm, there may be blood clots of various ages.

The cause of arterial brain aneurysm formation is established only in a small number of patients. About 4-5% of aneurysms develop in connection with the ingress of infected emboli into the arteries of the brain. These are the so-called mycotic aneurysms. Atherosclerosis plays an undoubted role in the origin of large spherical and S-shaped aneurysms. The occurrence of saccular aneurysms is associated with congenital inferiority of the arterial system of the brain. Atherosclerosis and hypertension, as well as trauma, play a significant role. Aneurysms can be single or multiple.

Clinical manifestations of the cerebral brain aneurysm

Clinical manifestations of the cerebral brain aneurysm

Almost all vascular diseases of the brain have common symptoms – a cerebral aneurysm is no exception.

The appearance of neurological symptoms is associated with the squeezing of various nerve formations by the aneurysm: cranial nerves, parts of the brain, nearby blood vessels. The most common complaint of people with intracranial vascular anomalies is headache (cephalalgia). It can be of a different nature, location and intensity. Migraine-like pains that extend the half of the head, occiput pain, neck, or eyeball are possible. Localization of discomfort depends on the location of the aneurysm. In case of impaired CSF flow, the hydrocephalic syndrome may develop due to increased intracranial pressure, accompanied by a diffuse headache with a feeling of pressure on the eyeballs and nausea.

Cephalalgia can be combined with signs of compression of certain cranial nerves or parts of the brain aneurysm :

  • double vision (diplopia) in the horizontal plane with impaired abduction of the eyeball outward with damage to the abducens nerve by an aneurysm in the cavernous sinus;
  • oculomotor disorders, combined with ptosis, unilateral constriction of the pupil, and a decrease in its response to light, occur when the oculomotor nerve is damaged by a large aneurysm at the junction of the internal carotid and anterior communicating arteries or aneurysm of the superior choroidal artery;
  • loss of visual fields due to compression of the optic nerve or the outer part of the chiasm by the supracliniform aneurysm of the internal carotid artery or aneurysm in the area of ​​the bifurcation of this vessel;
  • peripheral paresis of the facial nerve (with drooping of the lower eyelid, impaired tear production, and pronounced asymmetry of the face) due to the pressure of the brain aneurysm of the main artery;
  • unilateral facial pain with loss of sensitivity when the trigeminal nerve is compressed by an aneurysm located within the cavernous sinus;
  • hemiparesis or hemiplegia with unilateral pyramidal symptoms, impaired sensitivity, and a decrease in the possibility of voluntary movements with intracerebral hematoma or stealing syndrome of the motor cortex;
  • bulbar syndrome with an aneurysm located in the posterior cranial fossa;
  • various forms of aphasia (speech disorders) and other disorders of cortical functions;
  • emotional lability, emotional volitional disturbances with decreased drive control or apathy, mnestic decrease, pseudobulbar syndrome with damage to the frontal lobes and hypothalamus with aneurysms of the anterior cerebral or anterior communicating artery, including intracerebral localization.

Causes and types of ruptured cerebral aneurysm

Causes of ruptured cerebral aneurysm

The reason for the development of an intracranial cerebral aneurysm cannot always be accurately determined. According to statistics, a certain role is assigned to predisposition at the genetic level.

In addition to heredity, the following factors affect:

  • high blood pressure;
  • atherosclerosis (vascular calcification);
  • head trauma;
  • age 50 and older;
  • alcohol and drug abuse;
  • diseases of the circulatory system;
  • low estrogen levels after menopause;
  • smoking (promotes atherosclerosis, increases blood pressure).

Disease types

The classification of pathology is based on its form:

  1. Saccular brain aneurysm. It occurs most often among cases of aneurysms in the brain area.
  2. Exfoliating aneurysm. The formation has an elongated shape and is located between the layers of the vessel wall. It is often found on the aorta due to the appearance of an intimal defect. Blood begins to gradually penetrate, stratifying the walls and provoking the formation of a cavity. In the blood vessels of the brain, pathology is much less common than in the aorta.
  3. Vertebral aneurysm. Also rarely found in the blood vessels of the brain, it develops mainly on the wall of the aorta. Formation of a cylindrical shape, the vascular wall expands evenly.
  4. At the initial stage of formation, the aneurysm does not manifest itself in any way. As the pathology develops, the symptoms become pronounced. This is due to the pressure of the formation on the surrounding tissue or rupture and ingress of blood into the brain tissue.

Small (up to 11 mm), medium (up to 25 mm), and large (more than 25 mm) aneurysms are divided by size. Also, the disease can be congenital and acquired, with multiple and single formations.

Diagnostics of ruptured cerebral aneurysm

To identify an aneurysm and choose the right treatment tactics, it is necessary to carry out a complete diagnosis of the patient, including spiral computed tomography (CT), magnetic resonance imaging (MRI), and X-ray contrast angiography of the cerebral blood vessels. Accurate research results allow the neurologist and neuroangiosurgeon to choose the most appropriate treatment method.

  • CT and MRI – tomography can quickly identify a ruptured aneurysm. The results can be obtained a few minutes after the tomography, which can play an important role in saving the patient.
  • A referral to CT can also be prescribed if other pathologies are suspected during differential diagnostics. The MRI shows what exactly led to the development of changes in the structure of the blood vessels. This procedure is also performed after surgery. The picture clearly shows the consequences after the operation to remove the cerebral aneurysm.
  • Angiography – allows you to accurately determine the localization and degree of vascular lesions. With the help of angiography, it is possible to determine whether surgical removal of the aneurysm is necessary or whether conservative treatment can be dispensed with. The disadvantage of this type of research is the high complexity of the manipulation. With the introduction of contrast into the blood, allergic reactions are possible. The revealed aneurysm is a “time bomb”, which sooner or later, but will certainly lead to rupture of the vessel and subarachnoid or intracerebral hemorrhage (hemorrhagic stroke). If surgical treatment is not carried out on time, the consequences of an aneurysm can be catastrophic.
  • Coma after a ruptured aneurysm – occurs due to the ingress of blood into the subarachnoid space and mixing with cerebrospinal fluid
  • Death. About 75% of patients die at the preoperative stage. The probability of death after surgery is reduced to 15%. Sudden vascular angiospasm is the cause of stroke, death, or, with a successful outcome, the patient’s disability.

Treatment of ruptured cerebral aneurysm

reatment of ruptured cerebral aneurysm

Surgery is the only effective treatment for cerebral aneurysm therapy. After receiving the results of the patient’s examination, the surgeon decides on the appropriateness of the surgical operation. Since the consequences of a ruptured cerebral aneurysm are lethal, surgical intervention can save the patient’s life.

Previously, the surgeon, together with the patient, discusses the possible risks and outcomes of the disease and determines the appropriate treatment method. According to the indications, the following types of operation are prescribed:

  • Clipping aneurysm – the procedure is carried out as follows: a hole is cut in the skull through which a special metal clip is inserted and the wall of the damaged vessel is clamped. Life after clipping has many limitations; the patient is assigned a disability group. In addition, this type of surgery does not prevent the formation of a second aneurysm.
  • Embolization of an aneurysm is one of the most common methods of treating disease.

Intravascular spiral embolization is possible with a saccular brain aneurysm and a small lumen of the anastomosis. With a wide lumen, it is possible to simultaneously apply a stent (closure of the lumen) with subsequent spiral embolization of the aneurysm. The tactics are chosen by the neuroradiosurgeon after the angiography.

Embolization of an aneurysm results in the cessation of blood flow in the aneurysm (protrusion), maintaining normal blood flow through the cerebral artery. In the process of embolization, a catheter is inserted through convenient vascular access (usually inguinal) under radiological control and held up to the aneurysm. Then a thinner micro-catheter with a micro-wire coiled inside it is inserted into the catheter and inserted into the aneurysm cavity.

As soon as the tip of the microcatheter is in the aneurysm cavity, a micro coil is released from the microcatheter, which changes its shape, and in the form of a random coil of wire occupies the aneurysm cavity. For larger aneurysms, several coils may be needed. An aneurysm filled with a wire spiral is turned off from the bloodstream and gradually overgrows with connective tissue, that is, the possibility of its rupture is excluded.

In most cases, endovascular embolization is the least invasive method of treating cerebral aneurysms today. If it is impossible to carry out intravascular embolization or stenting, the usual neurosurgical operation of vessel stenting or aneurysm clearing can be performed.

Rehabilitation of ruptured cerebral aneurysm

Rehabilitation does not reverse the effects of a stroke. Stroke rehabilitation goals are to mobilize strength and power, to gain confidence to continue your normal daily activities, despite the consequences of your stroke.

Rehabilitation aims at gaining independence for a person who has suffered a stroke in many areas.

These include:

  • Self-help skills such as feeding, grooming, bathing, and dressing;
  • Mobility skills such as fine movement, walking, or driving self-propelled wheelchairs;
  • Communication skills;
  • Cognitive skills such as memory or problem solving;
  • Social skills for interacting with other people;

Specialists provide a treatment program specifically suited to each individual. The rehabilitation program that a person who has suffered a stroke will receive will depend on each specific case.

A rehabilitation program of a ruptured cerebral aneurysm may include:

  • Restoring feeding;
  • Kinesotherapy;
  • Physiotherapy;
  • Electroneurostimulation to restore lost motor functions;
  • Dynamic propriocorrection – wearing reflex-load suits, helps to restore motor functions;
  • Diagnostics and treatment of vertigo;
  • Balneotherapy – the effect of mineral waters – is used to treat, prevent and restore the body;
  • Stabilometry – a program aimed at restoring the vestibular apparatus;
  • Teaching methodology for free control of vertical posture based on biofeedback, in the form of dynamic exercises;
  • Vibration stimulation on the support zones of the feet;
  • It is possible both in normal walking mode and in the absence of the patient’s ability to move. This method stimulates nerve impulses that occur when walking and is effective for the prevention of thrombosis. Used after stroke and heart attack;
  • Speech therapy – the restoration of lost speech skills;
  • Studies of bioelectric potentials arising in human skeletal muscles upon excitation of muscle fibers. Allows you to identify the features of the functioning of muscles and nerve centers involved in the movement, as well as to trace their interaction;
  • Therapeutic and rehabilitation effects on various receptors;
  • Various types of hydrotherapy (hydromassage, swimming pool);
  • Color therapy – treatment with visual color images;
  • Special effect on auditory and visual analyzers, for the treatment of neurological disorders.

Methods for the prevention of brain aneurysm

Proper prophylaxis of the brain protects against the occurrence of pathologies in healthy people and alleviates the condition in sick people. Preventive measures are divided into primary and secondary. The first option is recommended to prevent vascular problems in a person who has no health problems or is at risk:

  • overweight;
  • abuses smoking and alcohol;
  • leads an inactive and sedentary lifestyle;
  • age over 30;
  • has a genetic predisposition;
  • suffers from diabetes and blood pressure;
  • experiences frequent emotional stress.

In this case, the prevention of vascular diseases of the brain consists in revising nutrition and in observing the basic principles of a healthy lifestyle:

  • give up foods high in cholesterol;
  • engage in moderate physical activity (gymnastics, hardening, and long walks);
  • consult a doctor for systematic headaches, fainting conditions, constant fatigue, and a sharp deterioration in vision.

Secondary prevention of the brain aneurysm involves improving health in the presence of vascular diseases. To avoid deterioration and complications, strengthen the blood vessels. To prevent atherosclerosis of the brain and other vascular diseases, control the possible risks. Perform the following manipulations:

  • If you tend to increase or drop in blood pressure, measure the pressure every day;
  • Get tested for cholesterol;
  • An ECG should be passed;
  • With diabetes, constantly check your blood sugar;
  • Get an MRI of the brain for prevention.

Methods of prevention brain aneurysm without medication

Non-drug prevention of diseases of the spinal cord and brain consists of lifestyle changes. At the same time, regular physical activity, herbal medicine, and water procedures are recommended.

Proper nutrition

Prevention of brain aging involves adhering to the principles of nutrition:

  • Replace animal fat with vegetable fat;
  • Reduce the number of animal fats – offal, fatty meats, and butter;
  • Consumption of marine fish such as cod, halibut, and mackerel are encouraged;
  • The menu should contain a significant amount of fruits, vegetables, herbs, and berries;
  • Choose low-fat fermented milk products from dairy products;
  • Eat fractionally about 4-5 times a day;
  • Boil the dishes, simmer and bake;
  • Drink plenty of clean water;
  • Add fruit drinks, compotes, and juices to the diet.

Prevention after a concussion also involves adhering to the principles of good nutrition.

Physical exercises

Exercise to prevent a brain aneurysm. To prevent the occurrence of cardiovascular pathologies, the following are useful:

  • walking;
  • running and cycling;
  • water procedures with a light hardening effect (contrast shower and swimming pool).

Regular exercise will improve the firmness and elasticity of blood vessels. The best prevention of a concussion is safety. Wear a helmet when riding a bicycle or motorcycle, and special protective equipment for contact sports.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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