Brain Aneurysm

Brain aneurysms, also known as cerebral aneurysms, have been surfacing as new headlines following a recent young Malaysian artiste, Queenzy Cheng, who collapsed and succumbed at a work site due to a ruptured brain aneurysm.

Slightly closer to home and heart, within the same month, one of our blog authors' friends (also a young adult) collapsed from a similar medical condition and had a haemorrhagic stroke. The friend survived but with significant neurological complications and is currently undergoing intense rehabilitation in the hospital. 

A brain aneurysm is a medical condition that, in its wake, causes a catastrophic event to patients and their surrounding family and friends. Brain aneurysms tend to have a high mortality rate (approximately 50%), and even if an individual survives a rupture, they may have to live with profound long-term neurological disability.  This is a condition that nobody wishes to happen to themselves or their loved ones.

This article is written to serve as a general information guide to patients and families on brain aneurysms to promote awareness of this serious medical condition. 

What is a brain aneurysm?

Aneurysm is a medical condition where there is a 'weakened point' [1] on the wall of a blood vessel. Over time, this weakened area may herniate or ‘bulge’ externally. An aneurysm can occur in any blood vessel – it can occur in the abdomen (abdominal aneurysm) and in the brain (brain aneurysm).

The thinning of the blood vessel wall can be due to a disease, trauma, injury, or a malformation at birth. If the aneurysm/thinning becomes significant, it runs a risk [2] of rupturing and bursting. If this occurs in the brain, the blood will spill over to the surrounding brain tissue, leading to brain inflammation, swelling, and irreversible brain tissue damage. A ruptured brain aneurysm can potentially lead to a disastrous event of a stroke, irreversible nerve paralysis, or even death.

What are the symptoms of a brain aneurysm?

A brain aneurysm that has ruptured can cause catastrophic symptoms [3] or even death. Patients with brain aneurysms are usually asymptomatic; however, when the aneurysm gets bigger, it may compress onto surrounding brain tissues or nerve cells, leading to neurological abnormal symptoms, such as:  

• Headache
• Pain in the eye area
• Vision blurriness or double vision
• Numbness or weakness of the face, arms and/or legs

At the onset of a ruptured aneurysm, one may present with:

• Acute, thunder-clapped severe headache
• Nausea, vomiting
• Loss of consciousness
• Neck pain

In the event of suspicion of a ruptured brain aneurysm, time is of the essence. Seek medical attention and go to the hospital immediately, as early neuro-surgical intervention can be life-saving. Delaying seeking medical assistance can result in death.

What is the cause of a brain aneurysm?

In most patients, the cause of brain aneurysm remains unknown. 

However, one may be predisposed to brain aneurysm if there are hereditary [4] conditions such as connective tissue disease, blood vessel malformations, or polycystic kidney disease. 

Environmental factors such as head injury, uncontrolled high blood pressure, smoking, recreational drug usage, infection, or even high cholesterol leading to atherosclerosis can also put a person at risk of developing a brain aneurysm.

What happens if the brain aneurysm ruptures?

As the brain aneurysm extends over time, the arterial wall of the aneurysm can ‘thin out’ and may eventually rupture. Once the aneurysm is ruptured, the blood will spill into the brain space known as the subarachnoid region. This is an area that is usually filled with cerebrospinal fluid that cushions the brain. The bleeding blood causes inflammation and swelling over the surrounding brain tissue. Simultaneously, the brain region that is supposed to receive blood supply from the aneurysm is deprived of blood supply, leading to a stroke.

To make things worse, the massive outpour of blood from the aneurysm, brain inflammation and swelling will lead to fluid and pressure build-ups in the enclosed brain area. This can crush the brain tissue against the solid skull or force the brain to shift or herniate.

One can become terminally ill very quickly with confusion, coma, paralysis, stroke symptoms, or even death.

The role of Diagnostic Imaging in screening for brain aneurysm

A Brain Magnetic Resonance Imaging (MRI) is safe, pain-free, and reliable to screen for brain aneurysm(s). It allows one to understand the brain structures, including the arteries and the veins in the brain. An MRI can visualise succinctly the size, location, character of the aneurysm (if any), and potential progression or effect from the aneurysm.

Sometimes, your doctor may recommend a brain MRI with contrast dye to facilitate the structure of the blood vessels in the brain. 

A brain MRI can serve as a way of detecting aneurysms in high-risk asymptomatic individuals or symptomatic patients. This may be beneficial in facilitating the physician (usually a neurologist or neurosurgical specialist) to decide the patient's future management. This includes monitoring the progression of the aneurysm closely or taking a proactive approach to surgically repairing the aneurysm. 

In the case of an acute rupture of a brain aneurysm, a computed tomography (CT) scan and brain MRI serves as a diagnostic life-saving imaging option to confirm the diagnosis, assess the extent and severity of the effect, thereafter allowing the physician to plan the immediate next best course of action for the patient.

What can I do if I have a brain aneurysm?

You are advised to follow up with your neurologist or neurosurgical specialist regularly to monitor the progression of the brain aneurysm.

In terms of lifestyle:

• YCultivate good healthy living habits — with regular exercises and healthy eating to manage and lower your blood pressure, if required
• Consider long-term blood pressure medication to reduce and control your blood pressure (if persistently elevated)
• Avoid or stop smoking
• Avoid illicit drug use, such as cocaine and amphetamines

Health is our biggest wealth… Without health, nothing is important

If you have any modifiable risk factors above, you should speak to your doctor about lifestyle alternatives to lower your risk of developing a brain aneurysm. If you have concerns about family history and personal history of potential undiagnosed brain aneurysms, discuss with your doctor for appropriate medical screening tests and follow-up.

References:

1. Jersey AM, Foster DM. Cerebral Aneurysm. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507902/
2. Ellegala, Dilantha B, MD; Day, Arthur L, MD.  Ruptured Cerebral Aneurysms. The New England Journal of Medicine; Boston Vol. 352, Iss. 2,  (Jan 13, 2005): 121-4.
3. Novitzke J. The basics of brain aneurysms: a guide for patients. J Vasc Interv Neurol. 2008 Jul;1(3):89-90. PMID: 22518230; PMCID: PMC3317292.
4. “Cerebral Aneurysms,” National Institute of Neurological Disorders and Stroke, 2024, https://www.ninds.nih.gov/health-information/disorders/cerebral-aneurysms.