An aneurysm is a bulge in a blood vessel that's caused by a weakness in the blood vessel wall, usually where it branches.
An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches.
As blood passes through the weakened blood vessel, the blood pressure causes a small area to bulge outwards like a balloon.
Aneurysms can develop in any blood vessel anywhere in the body, but the two most common places for them to form are in the abdominal aorta (the artery that transports blood away from the heart to the rest of the body) and the brain.
This topic is about brain aneurysms. Read the separate topic on abdominal aortic aneurysm.
About brain aneurysms
The medical term for an aneurysm that develops inside the brain is an intracranial or cerebral aneurysm.
Most brain aneurysms will only cause noticeable symptoms if they burst (rupture).
This will then lead to an extremely serious condition known as a subarachnoid haemorrhage, where bleeding caused by the ruptured aneurysm can cause extensive brain damage and symptoms such as:
- a sudden agonising headache – it has been described as a ‘thunderclap headache’, similar to a sudden hit on the head, resulting in a blinding pain unlike anything experienced before
- stiff neck
- sickness and vomiting
- pain on looking at light
About three in five people who have a subarachnoid haemorrhage will die within two weeks and half of those who survive are left with severe brain damage and disability.
Read more about the symptoms of a brain aneurysm.
A ruptured brain aneurysm is a medical emergency. If you suspect that you or someone in your care has had a ruptured brain aneurysm, call 999 immediately and ask for an ambulance.
How brain aneurysms are treated
If a brain aneurysm is detected before it ruptures, treatment may be recommended to prevent it from rupturing in future. Most aneurysms, however, will not rupture so treatment is only carried out if the risk of a rupture is particularly high.
Factors that affect whether treatment is recommended include your age, the size and position of the aneurysm, your family medical history and any other health conditions you have.
If treatment is recommended, this will usually involve either filling the aneurysm with tiny metal coils, or an open operation to seal it shut with a tiny metal clip.
If your risk of a rupture is low, you will have regular check-ups to monitor your aneurysm. You may also be given medication to reduce your blood pressure and advice about ways you can reduce your chances of a rupture, such as stopping smoking if you smoke.
The same techniques used to prevent ruptures are also used to treat brain aneurysms that have already ruptured.
Why brain aneurysms develop
Exactly what causes the wall of affected blood vessels to weaken is still unclear, although risk factors have been identified, including:
- high blood pressure
- a family history of brain aneurysms
In some cases, an aneurysm may develop because there was a weakness in the walls of the blood vessels at birth.
Read more about the causes of brain aneurysms.
Who is affected
It's difficult to estimate exactly how many people are affected by brain aneurysms because in most cases they cause no symptoms and pass undetected. Some experts believe it could be as high as one in 20 people, while others think the figure is much lower at around one in a 100 people.
The number of aneurysms that actually rupture is much smaller. Only around one in 12,500 people will have a ruptured brain aneurysm in any given year in England.
Brain aneurysms can develop in anyone at any age, but are more common in people over 40 years of age and women tend to be affected more commonly than men.
Preventing brain aneurysms
The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger and possibly rupturing, is to avoid activities that could damage your blood vessels, such as:
- eating a high-fat diet
- not exercising regularly
- being overweight or obese
Read more about preventing aneurysms.
Brain aneurysms occur due to a weakness in the walls of the blood vessels in the brain. There are several reasons why this may happen.
Brain aneurysms are caused by a weakness in the walls of blood vessels in the brain. There are several reasons why this may happen, although an exact cause is not always clear.
The brain requires a large supply of blood delivered via four main blood vessels that run up the neck and into the brain. These blood vessels divide into smaller and smaller vessels in the same way that the trunk of a tree divides into branches and twigs.
Most aneurysms develop at the points where the blood vessels divide and branch off, because these areas are often weaker.
There are a number of things that can increase your risk of developing a brain aneurysm. These are discussed below.
Smoking tobacco can significantly increase your risk of developing a brain aneurysm. Studies have shown the majority of people diagnosed with a brain aneurysm smoked or had done in the past.
The risk is particularly high in people with a family history of brain aneurysm (see below).
Exactly why smoking increases the risk of brain aneurysms is unclear. It may be that the harmful substances in tobacco smoke damage the walls of your blood vessels.
High blood pressure
High blood pressure can place increased pressure on the walls of the blood vessels inside the brain, increasing your chances of developing an aneurysm.
You are more likely to develop high blood pressure if you:
- are overweight
- have a relative with high blood pressure
- are of African or Caribbean descent
- eat a lot of salt
- don't eat enough fruit and vegetables
- don't do enough exercise
- drink a lot of coffee (or other caffeine-based drinks)
- drink a lot of alcohol
- are aged over 65
Having a first-degree relative (such as a parent, brother or sister) with a history of a brain aneurysm means that you're twice as likely to develop one as someone with no family history of the condition.
However, the increased risk is still small – only around one in 50 people with a family history of a ruptured brain aneurysm will go on to have a rupture themselves.
Your risk of developing a brain aneurysm increases as you get older, with most cases diagnosed in people over 40.
This may be because the walls of the blood vessels weaken over time due to the constant pressure from blood flowing through them.
Pre-existing weakness in the blood vessels
In some cases, brain aneurysms are caused by weaknesses in the blood vessels, present from birth.
Severe head injury
A brain aneurysm can develop after a severe brain injury if the blood vessels in the brain are damaged, although this is very rare.
Cocaine abuse is another risk factor for brain aneurysms. Cocaine can inflame the walls of the blood vessels and raise your blood pressure. The combination of these two factors increases your risk of developing a brain aneurysm.
Autosomal dominant polycystic kidney disease
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic condition that causes multiple cysts to develop on the kidneys. Cysts are small sacs filled with fluid.
Around one in every 1,000 people is born with ADPKD. Of these people, around one in 20 will develop an aneurysm in the brain.
Body tissue disorders
This is because these conditions can sometimes cause weaknesses in the walls of your blood vessels.
Coarctation of the aorta
People with coarctation of the aorta are also at an increased risk of developing a brain aneurysm.
Coarctation of the aorta is the term used to describe narrowing of the main artery in the body (the aorta), which is present from birth (congenital). It is a common type of congenital heart disease.
Brain aneurysms can be treated using surgery if they have burst (ruptured) or there is a risk that they will.
Brain aneurysms can be treated using surgery if they have burst (ruptured) or if there is a risk that they will.
However, preventative surgery is usually only recommended if it's thought the risk of a rupture is significant. This is because surgery has it's own risk of potentially serious complications, such as brain damage or stroke.
Assessing your risk
If you are diagnosed with an unruptured brain aneurysm, a risk assessment will be carried out to assess whether surgery is necessary.
The assessment process is usually based on the following factors:
- your age – research has found that in older adults, potential benefit of surgery in terms of extending natural lifespan is often outweighed by the risks associated with surgery
- the size of the aneurysm – aneurysms larger than 7mm often require surgical treatment, as do aneurysms larger than 3mm in cases where there are other risk factors
- the location of the aneurysm – brain aneurysms located on larger blood vessels have a higher risk of a rupture
- family history – brain aneurysms are considered to be at a higher risk of rupturing if you have a history of ruptured brain aneurysm in your family
- underlying health conditions – some health conditions increase the risk of a rupture, such as autosomal dominant polycystic kidney disease (ADPKD) or poorly controlled high blood pressure
After these factors have been taken into consideration, your surgical team should be able to tell you whether the benefits of surgery outweigh the potential risks in your case.
If the risk of rupture is considered low then a policy of active observation is normally recommended. This means you won't receive immediate surgery, but be given regular check-ups so your aneurysm can be carefully monitored.
You may also be given medication to lower your blood pressure and your doctor may discuss lifestyle changes that can help reduce the risk of a rupture, such as losing weight and reducing the amount of fat in your diet.
Surgery and procedures
If preventative treatment is recommended, the two main techniques used are called neurosurgical clipping and endovascular coiling.
Both techniques help prevent ruptures by stopping blood from flowing into the aneurysm.
Neurosurgical clipping is carried out under general anaesthetic, so you will be asleep throughout the operation. A cut is made in your scalp (or sometimes just above your eyebrow) and a small flap of bone removed so the surgeon can access your brain.
When the aneurysm is located, the neurosurgeon (an expert in surgery of the brain and nervous system) will seal it shut using a tiny metal clip that stays permanently clamped on the aneurysm. After the bone flap has been replaced, the scalp is stitched together.
Over time, the blood vessel lining will heal along the line where the clip is placed, permanently sealing the aneurysm and preventing it from growing or rupturing in the future.
Clipping the artery on which the aneurysm formed – as opposed to clipping the aneurysm itself – is rarely necessary. This is usually only carried out if the aneurysm is particularly large or complex.
When this is necessary, it is often combined with a procedure called a bypass. This is where the blood flow is diverted around the clamped area using a blood vessel removed from another place in the body (usually the leg).
Endovascular coiling is also usually carried out using general anaesthetic. The procedure involves inserting a thin tube called a catheter into an artery in your leg or groin. The tube is guided through the network of blood vessels into your head and finally into the aneurysm.
Tiny platinum coils are then passed through the tube into the aneurysm. Once the aneurysm is full of coils, blood cannot enter it. This means the aneurysm is sealed off from the main artery, which prevents it from growing or rupturing.
Coiling versus clipping
Whether clipping or coiling is used will often depend on things such as the size, location and shape of the aneurysm. Talk to your healthcare team about your treatment options.
If it's possible to have either procedure, you should discuss the benefits and risks of coiling and clipping with your care team.
Coiling has generally been shown to have a lower risk of complications (such as seizures) than clipping in the short-term, although the benefits over clipping in the long-term are not certain.
With coiling, there is also a small chance you will need to have the procedure more than once to best reduce your chances of the aneurysm rupturing. About one in five people who have the coiling procedure will need further treatment.
However, as coiling is a less invasive procedure, you can usually leave hospital sooner after the operation than with clipping. After clipping you will usually need to stay in hospital for around four to six days, whereas you can usually go home one or two days after coiling.
The time it takes to fully recover is also typically shorter with coiling. Many people make a recovery within a few weeks of coiling, whereas recovering from clipping can take several weeks or months.
If you require emergency treatment because of a ruptured brain aneurysm, you will initially be given a medication called nimodipine to reduce the risk of the blood supply to the brain becoming severely disrupted (cerebral ischaemia).
Either coiling or clipping can then be used to repair the ruptured brain aneurysm. The technique used will usually be determined by the expertise and experience of the surgeons available.
In such emergency cases, the differences between the techniques are less important because things such as your recovery time and hospital stay depend more on the severity of the rupture than the type of surgery carried out.
You cannot always prevent brain aneurysms, but there some things you can do to reduce your risk.
You cannot always prevent brain aneurysms, but you can reduce your risk.
Most importantly, you should avoid two of the main things that increase your chances of developing a brain aneurysm – smoking and high blood pressure.
If you smoke, stopping can significantly reduce your risk of developing a brain aneurysm.
If you decide to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will give you dedicated help and advice about the best ways to give up smoking. You can also call the NHS Smoking Helpline on 0300 123 1044. The specially trained helpline staff can offer you free expert advice and encouragement.
If you're committed to giving up smoking but don't want to be referred to a stop-smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms you may have after quitting.
High blood pressure
Having high blood pressure can also significantly increase your chance of developing a brain aneurysm.
You can help reduce high blood pressure by:
- eating a healthy diet – in particular, cutting down on salt and eating plenty of fruit and vegetables
- moderating your alcohol intake – it's recommended men shouldn't regularly drink more than three to four units a day and women shouldn't regularly drink more than two to three units a day
- maintaining a healthy weight – even losing just a few pounds will make a big difference to your blood pressure and overall health
- exercising regularly – being active and taking regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition
Read more about preventing high blood pressure.