Brain (Cerebral) Aneurysm

A brain aneurysm is a weak spot on an artery at the base of the brain that balloons outwards, usually at a branching point. Around 2 to 3 adults in every hundred have one, and most never know.

The concern is rupture, which causes a subarachnoid haemorrhage. Most small aneurysms never rupture, so the task for an unruptured aneurysm is to weigh its individual risk against the risk of repairing it.

Symptome

• Usually none, with the aneurysm found on a scan for another reason
• A sudden, explosive headache reaching full intensity within a minute, if it ruptures
• Neck stiffness, vomiting, dislike of light or loss of consciousness after rupture
• A drooping eyelid, dilated pupil or double vision from pressure on a nerve
• Pain above or behind one eye

Ursachen und Risikofaktoren

Aneurysms develop over life where artery walls are under most stress. Smoking and high blood pressure are the strongest modifiable factors. Risk is higher in women, after the age of 40, in people with two or more first-degree relatives affected, and with polycystic kidney disease and some connective tissue disorders. Rupture risk depends mainly on size, site (higher at the back of the circulation and the communicating arteries), irregular shape, growth on repeat scans and previous haemorrhage from another aneurysm.

Wie es diagnostiziert wird

• CT scan and lumbar puncture: The emergency tests for suspected rupture.
• CT angiography or MR angiography: Non-invasive tests that find and measure most aneurysms. MR angiography without contrast suits follow-up and family screening.
• Catheter angiography with 3D reconstruction: Gives the detail of neck width and branches needed to plan repair.
• Risk scoring: Tools such as PHASES estimate five-year rupture risk from age, size, site and history.

Behandlungsmöglichkeiten

• Monitoring: Small, regular, low-risk aneurysms are re-imaged at intervals while blood pressure is controlled and smoking stopped.
• Endovascular coiling: Platinum coils placed through a catheter from the groin or wrist fill the aneurysm. Stents or balloons assist with wide necks.
• Flow diverter stent: A fine mesh tube redirects blood away from large or wide-necked aneurysms, which then close over months. It requires two antiplatelet drugs for a period.
• Surgical clipping: A small clip across the neck through an opening in the skull. It is durable and suits some locations, such as the middle cerebral artery, better than coiling.
• Treatment of rupture: Emergency securing of the aneurysm followed by two to three weeks of intensive monitoring.

Wenn es dringend ist

A thunderclap headache, the worst of your life and peaking within seconds to a minute, is an emergency even if it eases. So are collapse, a seizure, or a suddenly drooping eyelid with a large pupil. Call an ambulance. A ruptured aneurysm is always treated at the nearest neurosurgical centre.

Reisen nach Türkiye zur Behandlung

Planned repair of an unruptured aneurysm is a reasonable reason to travel. Coiling usually means one or two nights in hospital and about a week in Istanbul; clipping needs closer to two weeks. Start with a remote review of your angiography images, because watchful waiting is often the advice. Coiled and flow-diverted aneurysms need imaging at about 6 months and later, and antiplatelet tablets must be supervised at home.

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