cordina011.JPGA cerebral aneurysm is a ballooning in a blood vessel in the brain that can leak or rupture, causing bleeding into the brain. 

Dr. Steve Cordina, associate professor of neurology and an interventional neurologist with USA Physicians Group, said a ruptured (bleeding) aneurysm quickly becomes life-threatening and requires prompt medical treatment.

About 3 to 5 million people in the U.S. have cerebral aneurysms, but most do not produce any symptoms. Brain aneurysms are often detected after they've ruptured and become medical emergencies. However, aneurysms are also found incidentally or on screening, such as when you’ve undergone imaging tests for another condition.

Dr. Cordina, who is an interventional neurologist, said only a small percentage of aneurysms rupture. Many factors determine whether an aneurysm is likely to bleed, including the size, shape and location of the aneurysm. Smaller aneurysms that are uniform in size may be less likely to bleed than larger, irregularly shaped ones.

According to Dr. Cordina, most cerebral aneurysms are asymptomatic unless they rupture. “If ruptured, the headache that results is typically described as the ‘worst headache of my life,’ he said. “Other symptoms of a ruptured aneurysm include visual acuity loss, double vision, and facial pain.”

Dr. Cordina said everyone should be aware of risk factors for aneurysms. Risk factors that are present at birth include connective tissue disease (e.g. Ehlers-Danlos syndrome), autosomal dominant polycystic kidney disease, familial hyperaldosteronism Type 1, and Moyamoya syndrome. In addition, family members of patients with cerebral aneurysms are at increased risk of having an aneurysm, even in the absence of a known hereditary syndrome.

Risk factors that develop over time include cigarette smoking (the risk is increased with the number of cigarettes smoked) and hypertension, or high blood pressure. Those who both smoke and have hypertension have an almost 15-fold increase in risk of bleeding.

Several things can cause an aneurysm to rupture, including prior bleeding, family history, and aneurysm morphology (how the aneurysm looks). Dr. Cordina said emotionally stressful life events have not been convincingly shown to be a trigger for aneurysm rupture.

If an aneurysm ruptures, it leaks blood into the space around the brain. This bleeding may damage the brain and cause stroke symptoms. Once an aneurysm bleeds and brain damage occurs, treating the aneurysm will not reverse the damage. Treatment is aimed at preventing additional bleeding.

If you have a sudden, severe headache or other symptoms possibly related to a ruptured aneurysm, imaging tests can determine if you have had bleeding into the space between your brain and surrounding tissues. Symptomatic aneurysms of all sizes should be considered for treatment with urgency.

Small, unruptured aneurysms that aren’t creating any symptoms may not need treatment unless they grow, trigger symptoms or rupture. If an aneurysm has ruptured, repair will be recommended.

To prevent aneurysms from rupturing, Dr. Cordina strongly recommends avoiding the following: smoking, heavy alcohol consumption, stimulant medications and illicit drugs, and excessive straining.

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