Brain Aneurysm Prognosis

What can you expect if you have a brain aneurysm?

If you or a loved one has been told that you have a brain aneurysm, you probably do not know what to expect. Here are answers to your most common questions about brain aneurysms.

 

What is a brain aneurysm?

An aneurysm is an abnormally shaped blood vessel with a bulging area. The out-pouching is often a weaker, more delicate section in the blood vessel wall.

Aneurysms can occur in any blood vessel throughout the body, but a brain aneurysm is an aneurysm located in the brain.

Brain aneurysms range in size, with some being small (millimeters) and some quite large (centimeters). Some brain aneurysms cause noticeable neurological symptoms, such as vision changes, double vision, headaches, or seizures, while many brain aneurysms do not cause any symptoms at all. Brain aneurysms that do not cause any pain or neurological symptoms are called asymptomatic brain aneurysms.

 

What is the significance of a brain aneurysm?

A brain aneurysm is a health concern because the out-pouching in the blood vessel’s wall may actually rip, tear, or rupture, leaking blood slowly or even pouring blood rapidly into the surrounding brain. Brain aneurysm bleeds are generally called subarachnoid hemorrhages or hemorrhagic strokes.

 

Will I die from a brain aneurysm?

Most brain aneurysms do not cause death, but when a large brain aneurysm ruptures, it may cause a severe disability, or even death.

According to a long-term study that followed people living with brain aneurysms for 21 years, there is about a 1.1% chance of aneurysm rupture per year, on average. The chance of aneurysm rupture was higher for people who had larger aneurysms, who smoked or who drank alcohol.

A scientific research study published in the Journal of the American Medical Association noted a higher chance of brain aneurysm rupture among people who had neurological symptoms such as seizures than among people with asymptomatic aneurysms.

 

Do I need surgery for my brain aneurysm?

This is a very individual high-level decision that you will make with the advice of your neurologist, your neurosurgeon and possibly a neuro-interventional radiologist. Brain aneurysm surgery is one of the most delicate surgical procedures, and it requires careful planning. Surgery may be the best way to prevent bleeding from brain aneurysms that are likely to rupture due to their size, location or due to another risk factor.

Brain aneurysm surgery involves placing a metal coil or a clip on the aneurysm in order to eliminate the aneurysm by ‘starving’ it of blood. Then, once the out pouching is no longer part of the blood vessel, the blood vessel heals and resumes blood flow.  

 

Can I stay active if I have a brain aneurysm?

There are some activities than can increase the likelihood of brain aneurysm rupture. Head trauma can provoke a large brain aneurysm to bleed. Extremely high blood pressure, often triggered by recreational drugs such as methamphetamine and cocaine, can trigger a brain aneurysm rupture.

Some surgeries increase the risk of brain aneurysm rupture.

 

What is the long-term plan with a brain aneurysm?

A research study from UCLA followed people living with brain aneurysms and found that those whose aneurysms grew in size over time were much more likely to experience a ruptured aneurysm.

Follow-up brain imaging is recommended if you have a brain aneurysm. The best follow up study depends on the size and location of your brain aneurysm. Follow up imaging studies include Brain MRI, Brain MRA, Brain CT scan, Brain CTA or an angiogram. You should make every effort to keep your actual brain scan or images of the scans for later comparison (in case you change doctors or hospitals) because the key to follow up is to evaluate whether the aneurysm changes or grows over time.

Can a brain aneurysm get better?

Yes, brain aneurysms can shrink or even disappear. This is more likely with smaller aneurysms than with larger aneurysms. Over time, unruptured aneurysms become more stable and less likely to rupture or bleed.

 

Sources:

Natural history of asymptomatic unruptured cerebral aneurysms evaluated at CT angiography: growth and rupture incidence and correlation with epidemiologic risk factors, Villablanca, JP, Duckwiler GR, Jahan R, Tateshima S, Martin NA, Frazee J, Gonzalez NR, Sayre J, Vinuela FV, Radiology, October 2013 

Natural history of unruptured intracranial aneurysms: a long-term follow-up study, Juvela S,Poussa K, Lehto H, Porras M, Stroke, September 2013

Outcome after conservative management or intervention for unruptured brain arteriovenous malformations, Al-Shahali Salmam, RWhite PM, Counsell CE, du Plessis J, Van Beinjnum J,Josephson CB, Wilkinson T, Wedderburn CJ, Chandry Z, St George EJ, Sellar RJ, Warlow cp, Scottish Audit of Intracranial Vascular Malformations Collaborators, Journal of the American Medical Association, April 2014

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