Overview

A brain aneurysm is a weakened area in the wall of a blood vessel in the brain that balloons outward. While many brain aneurysms remain stable and never rupture, others can lead to life-threatening bleeding that requires immediate medical attention. Early diagnosis and specialist assessment are essential to determine whether monitoring or treatment is the most appropriate course of action.

At the Supreme Vascular and Interventional Clinic, Dr. Manish Taneja provides comprehensive evaluation and personalized treatment planning for patients with brain aneurysms. Using advanced diagnostic imaging and minimally invasive neurointerventional techniques where appropriate, treatment recommendations are tailored to each patient’s condition, symptoms, and overall health. In Singapore, brain aneurysms are present in 1 to 2% of population. The commonest age group affected is 40-60 years.

Understanding Brain Aneurysms: Where to Start

If you have been diagnosed with, or are concerned about, a brain aneurysm, it can help to approach the situation step by step. Most patients move through three key stages when understanding their condition and deciding what to do next.

1. Understanding Symptoms and Risk

Some brain aneurysms cause no symptoms, while others may present with warning signs depending on their size and location. Personal risk factors such as blood pressure, family history, and underlying conditions can also influence how an aneurysm behaves or how dangerous it is.

2. Confirming the Diagnosis

Imaging tests such as CT scans, MRI, and specialised vascular studies help doctors understand the size, shape, and location of an aneurysm. This information is essential in determining whether monitoring or treatment may be appropriate.

Learn more about brain aneurysm imaging.

3. Deciding on Monitoring or Treatment

Not all brain aneurysms require treatment. Some can be monitored over time, while others may benefit from minimally invasive procedures or, in certain cases, surgery. The decision depends on multiple individual factors and should be carefully assessed. If you’re unsure where to begin, you may explore our step-by-step guide to understanding your brain aneurysm journey.

Recognising Symptoms

Typically, you will experience symptoms once the blood vessel actually ruptures or becomes large enough to press up against surrounding structures in the brain.

Although the exact causes of a brain aneurysm aren’t always clear, several factors can contribute to the ballooning caused by the weakening of blood vessel walls. Many brain aneurysms do not cause symptoms until they grow larger or rupture. Brain aneurysms may remain silent for years, but certain symptoms can develop if the aneurysm enlarges, leaks, or ruptures. When symptoms do occur, they may vary depending on the situation.

Unruptured aneurysms may cause:

• Numbness or weakness on one side of the face
• A drooping eyelid
• Headache
• Blurred or double vision
• Dilated pupil of one eye
• Pain behind and above one eye

Ruptured aneurysms are a medical emergency and may present with:

• As in an unruptured brain aneurysm, blurred or double vision
• A severe, sudden headache, which patients often describe as the “worst headache of their life”
• Nausea and/or vomiting
• Stiffness in the neck
• Extreme sensitivity to light
• Seizures
• Loss of consciousness
• Altered mental state or confusion

Learn more about unruptured and ruptured warning signs and symptoms . Note: If you believe someone displays symptoms of a ruptured brain aneurysm, you must seek medical assistance immediately. Timely diagnosis and treatment can improve the chances of survival and reduce severe complications due to a debilitating stroke, for example. Brain aneurysms are considered a type of cerebrovascular condition involving weakened blood vessels within the brain. Certain headache patterns, especially sudden severe headaches accompanied by neurological symptoms, may require urgent evaluation for underlying neurovascular conditions.

Causes and Risk Factors

Brain aneurysms can develop due to a combination of factors that affect the strength and structure of blood vessel walls. These are not fully understood yet and may include long-term conditions such as high blood pressure, inherited or genetic influences, and lifestyle-related factors.

• Family history
• Smoking
• Age and gender of the patient
• High blood pressure, also known as hypertension
• Polycystic kidney disease (PKD)

Understanding these risks can help guide decisions about monitoring, screening, and prevention. Explore causes and risk factors.

How Is a Brain Aneurysm Diagnosed?

Diagnosis begins with a detailed medical history and neurological examination. If a brain aneurysm is suspected, imaging studies help confirm the diagnosis and guide treatment planning.

CT Scan

A CT scan is often the first investigation performed in emergency situations, particularly when bleeding is suspected.

CT Angiography (CTA)

CTA uses contrast dye to produce detailed images of blood vessels and is commonly used to identify aneurysms and assess their size and location.

MRI and MRA

MRI provides detailed images of the brain, while Magnetic Resonance Angiography (MRA) focuses specifically on blood vessels. These scans are often used for unruptured aneurysms and long-term monitoring.

Angiography

Cerebral angiography remains one of the most detailed imaging techniques for evaluating brain aneurysms. It provides precise information about the aneurysm’s anatomy and is frequently performed before endovascular treatment.

Brain Aneurysm Treatment Options

Brain aneurysm is a fully treatable and curable condition. The best time to treat a brain aneurysm is before it ruptures. Treatment for a brain aneurysm depends on several factors, including its size, location, and risk of rupture. In many cases, minimally invasive techniques can be used to treat aneurysms without open brain surgery.

Observation and Monitoring

Small aneurysms with a low estimated risk of rupture may be monitored with periodic imaging and regular specialist reviews.

Endovascular Coiling

Traditional treatment method of open surgery called clipping is largely replaced in majority of patients with minimally invasive endovascular technique called coiling.  Endovascular coiling is a minimally invasive procedure performed through a catheter inserted into a blood vessel. Tiny platinum coils are placed inside the aneurysm to reduce blood flow and lower the risk of rupture. This technique involves a 5 mm incision in the groin or wrist to get into a blood vessel. Through this, multiple small tubes called catheters and wires are advanced into the brain and the aneurysm is completely blocked from inside. No open surgery to skull is required with quicker treatment and recovery.

Flow Diversion

Flow diversion involves placing a specialized stent within the affected artery to redirect blood away from the aneurysm, allowing it to gradually heal over time. This option may be suitable for selected aneurysms based on their size and location.

Surgical Clipping

Surgical clipping involves placing a small metal clip across the neck of the aneurysm to prevent blood from entering it. This procedure is typically performed by a neurosurgeon and may be recommended for certain aneurysm types.

The most appropriate treatment depends on an individualized assessment rather than a one-size-fits-all approach. If you’ve been advised to undergo treatment or are exploring your options, a second opinion can help you better understand your condition and the most appropriate next step. Learn more about treatment options. 

Frequently Asked Questions