A cerebral (brain) aneurysm is a bulging or ballooning out of a part of a blood vessel wall due to a weak point in the latter’s wall. As the aneurysm grows, the vessel wall becomes thinner and weaker. It can become so thin that it spontaneously leaks or ruptures, releasing blood into the space around the brain called the subarachnoid space. This results in a subarachnoid haemorrhage (SAH). Blood can also leak into the cerebrospinal fluid (brain fluid) or into the brain substance itself, resulting in an intracerebral haematoma (blood clot). This blood can irritate, damage or destroy nearby brain cells. In more serious cases, the bleeding may cause brain damage, paralysis, coma or even death.
Most people with brain aneurysms do not experience any symptoms prior to the onset of the rupture. The rupture occurs suddenly. Up to 40% of the people experience ‘sentinel headaches’ days to weeks before the rupture and these are thought to be ‘warning leak symptoms’. At the time of aneurysm rupture, the following may occur:
(Any of these symptoms are very serious, and emergency medical attention should be sought immediately.)
To lessen the risk of rupture and prevent development of brain aneurysm, avoid consuming any substance or doing any activity that may lead to a sudden increase in blood pressure – for example, smoking, intake of caffeine or stimulant drugs or straining exercise (e.g. weight lifting).
Aneurysms can occur in all age groups, with the peak age of presentation of a ruptured aneurysm between 50-60 years. Women have a higher incidence of this occurrence than men.
The exact mechanisms by which aneurysms develop are still not fully understood. Previously thought to be congenital defects in the vessel wall, there is little evidence for such inherited weakness. It is now thought to be a degenerative condition with a number of contributory factors.
In the management of a patient with a ruptured aneurysm, the immediate goal is to prevent a second bleed as re-bleeding has a 60-80% risk of death and severe disability. The risk of a re-bleed is approximately 1.5% per day, reaching a cumulative risk of 20% at the end of the first 2 weeks, and 50-60% at the end of 6 months.
The best treatment option is often individualised, depending on the site, shape and location of the aneurysm. The patient’s age and clinical condition are also factors to consider.
The complications or ill-effects of a subarachnoid haemorrhage include:
The recovery process following a ruptured aneurysm is different with every patient. It often depends on the amount of damage in the initial rupture. If the patient has severe damage from the beginning, prognosis is often guarded. On the other hand, if the initial damage is limited and the aneurysm is successfully secured, the chance of a good recovery is much higher. The recovery process, however, may take many months to a year or more. A younger and fitter individual will have a better chance of a good recovery as compared to an elderly and weaker individual.
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