How is brain aneurysm diagnosed?
Most brain aneurysms may be undetected until they rupture. They can also be detected incidentally by brain imaging that is performed for another condition.
Computed Tomography (CT)
Brain CT scan of the head is a fast, painless, non-invasive diagnostic tool that can detect blood in the brain (subarachnoid hemorrhage) when one has the symptoms mentioned above. This is often the first diagnostic procedure for detecting aneurysm rupture.
Cerebral angiography is an invasive procedure that involves the use of contrast dye to provide a series of pictures of the blood vessels in the head and neck with access through the groin. It is the gold standard to determine the exact location, size and shape of the aneurysm.
Computed Tomography Angiography (CTA)
This is a non-invasive method whereby a contrast dye is injected into the arm vein with CT scanning to produce detailed images of blood flow in the brain arteries. Although the gold-standard for detecting a brain aneurysm remains cerebral angiography, CTA is frequently performed as it is less invasive.
Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA)
MRI is another imaging technology to view the brain by using a strong magnetic field. It is able to provide a more detailed image of the brain than CT. MRA utilises MR technology to produce imaging of blood vessels of the brain. Both MRI and MRA take a longer time to perform compared to a CT scan.
Cerebrospinal Fluid Analysis
A cerebrospinal fluid analysis may be ordered if a ruptured brain aneurysm is highly suspected despite a normal CT brain. Following application of a local anesthetic, a small amount of brain fluid is removed from the back by a spinal needle. The fluid is tested for presence of blood.
What are the dangers of brain aneurysms?
Brain aneurysms may rupture and bleed, causing serious complications including stroke, coma or death. After initial rupture, the aneurysm may rupture and re-bleed again. Re-bleeding has a 60-80% risk of death and severe disability. The risk of re-bleed is approximately 1.5% per day, reaching a cumulative risk of 20% at the end of first 2 weeks, and 50-60% at the end of 6 months.
The type of bleeding after an aneurysm rupture is commonly or technically known as subarachnoid hemorrhage.
Hydrocephalus – Blood from a ruptured brain aneurysm can block the fluid circulation in the brain. This causes an excessive accumulation of fluid within the brain cavity (ventricles). This condition is known as hydrocephalus. Pressure in the brain rises and death can occur if left untreated. To treat this condition, a temporary external drain is usually inserted via an operation.
Cerebral vasospasm – Usually at 7-10 days after the aneurysm rupture, blood vessels in the brain may spontaneous contract and limit blood flow to vital areas of the brain resulting in stroke. Cerebral vasospasm is monitored by a combination of close neurological examination and Transcranial Doppler (TCTCD) ultrasound. To prevent vasospasm, a drug called Nimodipine is usually given for duration of 21 days. After the aneurysm is treated, patient is kept well hydrated and blood pressure may be kept slightly higher to prevent vasospasm. An angiographic procedure may be performed to inject nimodipine directly injected into the affected arteries if the vasospasm is severe.
Other possible common complications following brain aneurysm rupture may include brain swelling, seizure, electrolyte imbalance and infection.
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