As a neurointerventionist, I often tell my patients that not all aneurysms are created equal. The shape and surface of an aneurysm whether smooth or irregular can significantly influence its risk of rupture. Irregular aneurysms, especially those with lobulations or blebs, tend to behave more unpredictably and warrant closer monitoring or intervention. Understanding these subtle differences helps tailor the most appropriate treatment plan for each individual.
Why The Shape of a Brain Aneurysm Matters: Understanding Irregular Intracranial Aneurysms and Rupture Risks
A brain (intracranial) aneurysm occurs when a blood vessel in the brain becomes weak and bulges (balloons) on one or more sides. While many brain aneurysms are small and not a cause for concern, others may swell and rupture, leading to a potentially deadly hemorrhage. This makes early detection and treatment critical, as medical intervention can greatly reduce the risk of hemorrhage and death.
Of course, this may lead you to wonder why an aneurysm might rupture. While many factors contribute to rupture risk, including the aneurysm's size and location, one of the biggest risk factors is its shape, as irregular aneurysms are much more likely to rupture. To learn why this is, take a look as we dive deeper into what irregular aneurysms are, their rupture risk, and what your treatment options are.
This article is part of our guide to brain aneurysm symptoms. For a complete overview, visit, Brain Aneurysm Symptoms: A Detailed Guide to Early Signs and Warning Symptoms.
What is An Irregular-Shaped Aneurysm?
So what exactly is an irregular-shaped aneurysm? As aneurysms grow, they tend to take on a round, domed look that might resemble a berry. However, not all aneurysms are perfectly shaped, and irregular-shaped aneurysms refer to aneurysms that are not round or oval, but instead may be mushroom-shaped, have multiple lobes, daughter sacs, blebs, or other irregular features. These irregularly shaped aneurysms come with a much higher risk of rupture than regular round ones.
Common Questions About Irregular-Shaped Brain Aneurysms
What is an irregular-shaped brain aneurysm?
An irregular-shaped brain aneurysm is a brain aneurysm that has an uneven outline, lobes, blebs or small outpouchings rather than a smooth, rounded appearance. The shape of an aneurysm is one of several factors specialists consider when assessing its behaviour and planning ongoing management.
Does an irregular-shaped aneurysm have a higher risk of rupture?
Research suggests that aneurysm shape may be associated with rupture risk, but shape alone does not determine whether treatment is required. Specialists also consider the aneurysm's size, location, growth over time, symptoms, your age, medical history and other individual risk factors before recommending observation or intervention.
How is the shape of a brain aneurysm assessed?
The shape of a brain aneurysm is evaluated using imaging studies such as CT angiography (CTA), MR angiography (MRA) or cerebral angiography. These scans allow specialists to examine the aneurysm in detail and determine whether additional monitoring or treatment should be considered.
Does an irregular-shaped aneurysm always require treatment?
No. Many irregular-shaped aneurysms can still be managed safely with regular surveillance if the overall risk of rupture is considered low. Treatment decisions are individualised and balance the potential risks of intervention against the natural history of the aneurysm.
What treatment options are available if an irregular-shaped aneurysm requires treatment?
Depending on the aneurysm's anatomy and clinical features, treatment may include minimally invasive endovascular techniques such as coiling, stent-assisted coiling or flow diversion. In some situations, microsurgical clipping may be recommended. Your specialist will explain which approach is most appropriate based on your individual circumstances.
Why Shape Matters: Link to Rupture Risk
The shape of an aneurysm, as well as its size, is a clear indicator of its rupture risk. In fact, an estimated 87% of ruptured aneurysms are irregularly shaped. Yet, why is this the case? There are several possible reasons why irregularly-shaped aneurysms are more likely to rupture, with one theory being that irregularly-shaped aneurysms have a larger surface area exposed to blood pressure, increasing rupture risk. It's also believed that irregular shapes indicate an underlying weakness in the vessel wall, making them more susceptible to rupture. Other contributing factors that can increase the risk of an aneurysm rupturing include the location and size of the aneurysm, as well as the patient's overall health, as people with health conditions such as high blood pressure are more likely to experience a rupture.
How Are Irregular Aneurysms Diagnosed?
The scary thing about brain aneurysms is that they usually don't exhibit symptoms until they leak or rupture. This means that they usually aren't discovered until they rupture, or they may be detected when a doctor is running a test for other conditions. Common tests a doctor may use to diagnose or confirm the presence of a brain aneurysm include:
If you experience symptoms that could indicate the presence of an aneurysm, such as vision changes, balance issues, or a sudden, severe headache, you must seek emergency medical treatment from a brain aneurysm specialist. They can perform detailed imaging tests to determine if an aneurysm is present, and they can assess its shape, size, and structure to determine the best course of treatment.
Management and Treatment Options
If you are diagnosed with a ruptured aneurysm, this will require emergency surgery to stop the bleeding in your brain. However, if you are diagnosed with an unruptured aneurysm, you have more treatment options. Small aneurysms, even if irregularly shaped, may just be monitored with regular scans. However, depending on the size, location, and shape of your aneurysm, as well as the severity of your symptoms, surgery may be recommended. While your brain aneurysm specialist will take a tailored approach dependent on your aneurysm's characteristics and your overall health, some of the most common treatment options include:
- Endovascular Coiling
- Flow Diverters
- And Surgical Clipping
The Role of a Specialized Brain Aneurysm Clinic in Singapore
If you are diagnosed with an irregular aneurysm, it's essential that you receive treatment from a specialized brain aneurysm clinic in Singapore such as Supreme Vascular and Interventional Clinic. Receive compassionate care from a multidisciplinary specialist, Dr. Manish Taneja, who utilizes advanced imaging and personalized treatments to ensure you get the best quality care. Additionally, a specialist will be able to assess your aneurysm and come up with the best treatment option based on the size, shape, and characteristics of your aneurysm to ensure the best outcome.
What Patients Should Watch Out For
If you are diagnosed with an irregularly-shaped aneurysm, you may find yourself wondering how you will know if your aneurysm starts to leak or rupture. Symptoms that may suggest an aneurysm is growing or at risk of rupture include:
- Sudden, Severe Headache
- Vision Changes
- Nausea
- Stiff Neck
- And Neurological Symptoms
When to Consider a Vascular Specialist Assessment in Singapore
An irregular-shaped brain aneurysm often requires detailed evaluation by a neurointerventional specialist, even when it has been discovered incidentally. Early assessment helps determine your individual risk profile and whether monitoring or treatment is the most appropriate course of action.
Consider seeking a specialist assessment if you:
- Have been diagnosed with an irregular-shaped or lobulated brain aneurysm on CTA, MRA or cerebral angiography
- Have an aneurysm that has changed in size or appearance on follow-up imaging
- Have a family history of brain aneurysms or aneurysmal subarachnoid haemorrhage
- Have polycystic kidney disease (PKD), vascular Ehlers-Danlos syndrome (vEDS) or another inherited condition associated with aneurysm risk
- Have persistent headaches or neurological symptoms together with abnormal brain imaging
- Have been advised that treatment may be required and would like to understand whether minimally invasive endovascular treatment is appropriate
- Would like a second opinion regarding rupture risk, surveillance intervals or treatment recommendations
A specialist consultation includes a comprehensive review of your medical history, symptoms and imaging. Your aneurysm is assessed using multiple factors—including its shape, size, location, growth pattern and your overall health—before a personalised management plan is recommended. This may involve continued surveillance, additional imaging or minimally invasive treatment where appropriate.
Seek emergency medical attention immediately if you experience a sudden severe headache, weakness, difficulty speaking, seizures, confusion, loss of consciousness or sudden vision changes. These symptoms may indicate a ruptured brain aneurysm or another neurological emergency requiring urgent treatment.
Access Compassionate and Comprehensive Brain Aneurysm Care and Treatment with the Supreme Vascular and Interventional Clinic
An aneurysm rupture can come on suddenly and put you in serious danger, which makes it essential that you seek emergency medical treatment if you experience any of these symptoms. However, the most important thing for you to do if you have been diagnosed with an aneurysm is to maintain a healthy diet, exercise, and get regular check-ups to monitor your aneurysm for changes.
When it comes to aneurysms, early detection and expert assessment save lives. If you have been diagnosed with an aneurysm, or you are concerned about your aneurysm risk, we invite you to contact us today to schedule a consultation. Dr. Manish Taneja can help go over your risk factors, perform advanced imaging tests, and review your treatment options with you.
Brain Aneurysm Resources
Discover brain aneurysm resources that go beyond the basics designed for patients. Understand the meaning of a brain aneurysm condition, the causes, symptoms, signs, and more. Connect with your brain health.
Put Brain Aneurysm on Your Health Radar
Did you experience the worst headache of your life? Thoughts could be racing through your mind. A brain aneurysm is a weak spot in a blood vessel in the brain that can change over time. The key concern is when an aneurysm ruptures, which can disrupt blood flow, affect brain tissue, and lead to serious brain damage. Controllable conditions like high blood pressure can increase this risk and treatment options can depend on the condition. Surgical clipping is one option that prevents blood from entering the weakened area. In many cases, minimally invasive treatments can also be used to restore normal blood flow and reduce risk. We have created structured guides to help you explore each stage in more detail:
A simple (computed tomography) CT scan could be just what the doctor ordered and the first step in early detection and prevention of a brain aneurysm. Come in for an easy consultation with our brain aneurysm specialist in Singapore to be on your health radar.
Other Health Conditions
The Supreme Vascular and Interventional Clinic is your "go-to" facility for various neurointerventional / stroke conditions and treatments. To arrange an appointment with Dr. Manish Taneja, our brain aneurysm specialist, contact us. You can also call us at (+65) 6904 8084 for a consultation.