Brain Aneurysm

A brain aneurysm occurs when a blood vessel in the brain develops a weak spot, causing it to bulge or balloon outward. This weakened area may remain stable for years or rupture, releasing blood into the space around the brain. While many brain aneurysms do not cause symptoms, a ruptured aneurysm requires immediate medical attention, as it can lead to a stroke or brain damage.

Dr. Teo Kejia

Senior Consultant Neurosurgeon

MBBS (Singapore) | MRCS (Edinburgh) | FAMS (Neuro.Surg) | FRCS Ed (Neuro.Surg) | IFAANS

Symptoms causes diagnosis treatments prevention FAQ

Symptoms of Brain Aneurysm

Symptoms vary depending on whether the aneurysm has ruptured or remains intact. Key signs to watch for include:

Sudden, Severe Headache: A ruptured aneurysm typically causes an intense headache, often described as the worst headache ever experienced. The pain develops suddenly and is unlike regular headaches.
Nausea and Vomiting: The increased pressure in the brain from a ruptured aneurysm triggers severe nausea and repeated vomiting episodes.
Neck Stiffness: Blood in the spinal fluid from a ruptured aneurysm causes the neck muscles to become rigid and resistant to movement.
Vision Changes: An expanding aneurysm can press on the optic nerves, leading to double vision, blurred vision, or sensitivity to light.
Drooping Eyelid: Pressure from an unruptured aneurysm on surrounding nerves may cause one eyelid to droop noticeably.
Seizures: The presence of blood in the brain or pressure from an aneurysm can trigger seizures ranging from mild to severe.
Loss of Consciousness: A ruptured aneurysm may cause fainting or a rapid decline in consciousness level.

Causes and Risk Factors

Several factors contribute to the development and rupture of brain aneurysms. These include:

High Blood Pressure

Sustained high blood pressure weakens blood vessel walls over time, making them more prone to aneurysm formation.
Smoking

Tobacco use damages blood vessels and raises blood pressure, contributing to aneurysm development.
Family History

People with first-degree relatives who have experienced brain aneurysms face a higher risk of developing them.
Age

Brain aneurysms occur more frequently in adults between 40 and 60 years old, with a higher occurrence in women.
Previous Aneurysm

Having one brain aneurysm increases the likelihood of developing additional aneurysms.
Genetic Conditions

Certain inherited disorders affecting connective tissue, such as Ehlers-Danlos syndrome, can lead to aneurysm formation.

Diagnostic Methods

Computed Tomography (CT) Scan: A CT scan uses X-rays and computer processing to produce detailed brain images. When performed immediately after symptom onset, it detects 95% of ruptured aneurysms. It also reveals bleeding patterns and helps locate the aneurysm.
CT Angiogram (CTA): A CTA is an enhanced CT scan that involves injecting contrast dye into the bloodstream. The dye highlights blood vessels, creating detailed 3D images of the aneurysm. This scan helps determine the aneurysm’s size and shape.
Magnetic Resonance Imaging (MRI): MRI scans use magnetic fields and radio waves to generate detailed brain images. This method effectively detects unruptured aneurysms and reveals changes in brain tissue. It also helps assess blood flow patterns and nearby structures.
Digital Subtraction Angiography (DSA): DSA involves inserting a catheter through an artery in the groin and guiding it to the brain’s blood vessels. A contrast dye is then injected to produce real-time X-ray images of blood flow. This technique provides highly detailed views of blood vessels and remains the standard for diagnosing aneurysms.

Treatment Options

Brain aneurysm treatment varies based on factors such as size, location, patient age, and overall health. Some aneurysms require only monitoring, while others may need surgical intervention to prevent rupture.

Non-Surgical Treatment

Observation

Small, unruptured aneurysms (less than 7mm) may be monitored through regular imaging. This approach includes scheduled scans to track changes in size or shape. Patients undergo risk factor modification and blood pressure control.

Risk Factor Management

This involves controlling blood pressure, stopping smoking, and reducing cholesterol levels. Regular monitoring ensures these modifications effectively lower rupture risk. Lifestyle changes form part of long-term management.

Surgical Treatment

Microsurgical Clipping

Our neurosurgeon places a tiny metal clip across the aneurysm neck during open brain surgery. The clip prevents blood from entering the aneurysm while maintaining normal blood flow in the artery. This procedure is most suitable for accessible aneurysms.

Endovascular Coiling

This minimally invasive procedure involves inserting tiny platinum coils into the aneurysm through a catheter. The coils cause clot formation within the aneurysm, sealing it from circulation. Recovery time is generally shorter than traditional surgery.

Flow Diversion

Special stents redirect blood flow away from the aneurysm. This promotes clotting within the aneurysm and reconstruction of the parent vessel. This approach is effective for treating large, complex, or giant aneurysms.

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Prevention and Management

Managing blood pressure is key to brain aneurysm care. Consistent monitoring, medication adherence, regular exercise, and a low-sodium diet help maintain vessel health. Quitting smoking reduces strain on blood vessels.

Individuals with diagnosed aneurysms should avoid activities that cause sudden blood pressure spikes, such as heavy lifting. Routine medical check-ups help track aneurysm status and adjust treatment plans as needed. Those with a family history of aneurysms may benefit from periodic screening.

Frequently Asked Questions (FAQ)

How long does recovery take after aneurysm treatment?

Recovery time depends on the treatment type and individual healing rates. Endovascular coiling typically allows a return to normal activities within 2–4 weeks. Microsurgical clipping generally requires 6–8 weeks for initial recovery, with full activity resumption possible after 3–6 months.

What follow-up care is needed after treatment?

Post-treatment monitoring involves regular imaging to assess treatment effectiveness. Follow-up schedules vary based on the procedure and individual risk factors, but most patients have annual check-ups with periodic imaging studies.

How does age influence treatment decisions?

Younger patients often receive more aggressive treatment due to a longer lifetime risk of rupture. In older patients or those with other medical conditions, observation may be considered if the aneurysm poses a lower immediate risk.

Dr. Teo Kejia

Senior Consultant Neurosurgeon

MBBS (Singapore)|MRCS (Edinburgh)|FAMS (Neuro.Surg)|FRCS Ed (Neuro.Surg)|IFAANS

Dr. Teo’s expertise lies in complex brain tumour surgeries employing advanced techniques like brain mapping and awake brain surgery. He also manages neurovascular conditions, traumatic head injuries and spinal disorders.

Dr. Teo graduated from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery in 2006. He completed his general surgery training and advanced neurosurgery training at the National University Hospital Singapore. He furthered his education in the United Kingdom, obtaining advanced certifications and completing specialist training in various neurosurgical disciplines.
Dr. Teo’s AMDA award facilitated his training at Queen’s Hospital in London, where he specialized in functional neurosurgery, neuro-oncology, neurovascular, skull base, and spinal surgery. He also underwent fellowship training in brain mapping and awake brain surgery at renowned institutions in Italy and France, working with leading experts in the field.

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