Brain Aneurysm

Brain Aneurysm (Cerebral or Intracranial aneurysm) is the weak area of an artery in the brain which causes a localized blood filled balloon, like bulge, in the wall of blood vessel. Aneurysm is caused from wear and tear of the arteries, injury, infection and inherited tendency. It can occur to all age groups but incidence increases gradually after the age of 25. Most affected age group is 50 to 60 and women have more tendency of prevalence.
Large unruptured aneurysms lead to symptoms based on the pressure on the brain tissue, nerves and surrounding structures. Symptoms include weakness or paralysis on one side of the face, pain above and behind the eye, numbness, enlarged pupil or changes in vision. Unruptured Aneurysms require different assessment and treatment. When cerebral aneurysms rupture, bleeding is usually caused in to the brain and surrounding space known as “subarachnoid space”. Approximately 2% – 3% of people with brain aneurysm suffer from bleeding. It is an emergency situation and stiff neck, blurred vision, nausea and vomiting and loss of sensations are usual symptoms.

Diagnosis
Ruptured aneurysms are diagnosed by finding signs of subarachnoid hemorrhage via CT scan (Computerized Tomography). Cerebral Angiogram, a test, is performed by neuro-interventional expert to determine the exact size, location and shape of an aneurysm. Cerebral angiography is a medical procedure when dye is injected in to the arterial system through a catheter. MRA (Magnetic Resonance Angiography) and CTA (Computed Tomographic Angiography) are non-invasive alternative procedures to the traditional methods. Contrast dye injected in to the vein which travels to the brain arteries and images are created using CT scan. These images show how blood flows in to the brain arteries.

Treatment
There are two type treatment options available for brain aneurysm.
1. Aneurysm Clipping
2. Aneurysm Coiling

Aneurysm Coiling
Objective of Aneurysm Coiling is to isolate an aneurysm from the normal circulation without blocking off nearby arteries or contracting main vessel.
Microcatheter is inserted through initial catheter and the coil is attached with the microcatheter. Once the microcatheter reaches the aneurysm and gets inserted in to it, coil is separated from catheter with the use of electric current. This coil will cap the opening of the aneurysm and it is placed permanently in aneurysm. More than one coil may be needed depending upon the size of aneurysm. Coils used in this procedure are spring shaped and made of soft platinum metal. These coils are very thin and small, ranging from less than the width of human hair to twice to the width of a single hair. Fluoroscopy supports the whole procedure of Endovascular Coiling. It is a special type of X-ray movie. Physicians use Fluoroscopy in order to locate the aneurysm and guide catheter for all movements.
Patient can return to home spending one night in Intensive Care Unit after surgery and may be expected to resume normal life activities within 2 days. Exact details regarding procedure and discharge for a particular case could be obtained from the physician.

By

Umair Rashid Chaudhry
(Neuroradilogist)