Aneurysm

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 22, 2016
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Aneurysms typically occur in arteries and can be located in many areas throughout the body. There are many types of aneurysms and typically they cause no symptoms. Cerebral aneurysms and aortic aneurysms are more likely to rupture than peripheral aneurysms. A ruptured aneurysm has the potential to be fatal and immediate medical attention is necessary if symptoms arise.

Contents

Definition & Facts

A balloon-like bulge or swelling in the wall of a blood vessel is called an aneurysm. There are many types of aneurysms including cerebral and aortic aneurysms. Aneurysms occur when conditions within the body injure or cause weakening of the blood vessel walls.

Aneurysms most commonly occur in the aorta, which is a large blood vessel that circulates oxygen-rich blood from the heart and lungs to the rest of the body. An abdominal aortic aneurysm occurs within an area of the aorta that passes through the middle to lower abdomen. A thoracic aortic aneurysm occurs within the aorta that passes through the thoracic or chest cavity.

An aneurysm can be located in any part of the body. Peripheral aneurysms are found in arteries other than the aorta and can occur in the groin, neck, or behind the knees. Peripheral aneurysms are less likely to rupture, but they can form blood clots that can break away causing a blockage in blood flow in the artery.

Symptoms & Complaints

It is common for an individual to experience no symptoms of a brain (cerebral) aneurysm and for it to only be discovered during testing for another condition. An unruptured cerebral aneurysm can create problems by putting pressure on other areas of the brain. The pressure can cause symptoms such as blurred vision, severe headaches, neck pain, and changes in speech. These symptoms are dependent upon the area of the brain experiencing excess pressure.

A cerebral aneurysm can rupture and cause immediate symptoms including neck pain, sensitivity to light, sudden severe headache that is not similar to any previous headache pain, nausea and vomiting, seizures, fainting or loss of consciousness.

Aortic aneurysms may not cause symptoms, but if symptoms are present, they include the following:

If an aortic aneurysm ruptures it may cause a stroke, shock, heart attack, loss of consciousness, or sudden and severe pain in the back, abdomen, or chest.

Causes

An individual can inherit the tendency to develop aneurysms if there is a family history. A cerebral aneurysm can occur as a result of age and when atherosclerosis, which is hardening of the arteries, is present. The factors that can place an individual at risk for the development of a brain aneurysm or the rupture of an aneurysm that is already present include the following:

  • Gender – Women are at higher risk of developing a brain aneurysm or to suffer a subarachnoid hemorrhage in the event of aneurysm rupture.
  • Race – African Americans have a higher risk of suffering a subarachnoid hemorrhage.
  • Previous aneurysm – Individuals who have previously had a brain aneurysm have an increased risk of developing another.
  • High blood pressure
  • Smoking

Aortic aneurysms can be caused simply by aging or from a local injury to the artery. Other causes include atherosclerosis that weakens the arterial walls, high blood pressure, congenital abnormalities such as Marfan syndrome or the presence of bicuspid aortic valves at birth, and syphilis.

Diagnosis & Tests

It may be difficult to diagnose an aortic aneurysm without the presence of symptoms. If found during an examination, a physician may notice a heart murmur. Upon detection of an aneurysm it must be monitored, because as they grow, they are at a higher risk for rupture. While monitoring an aneurysm, a physician may recommend repair if it is noted to be more than 5 centimeters wide. Testing that can detect the presence of an aneurysm includes a computed tomography (CT) scan, MRI, ultrasound, and a dye test to examine the aorta called angiography.

Unruptured brain aneurysms typically do not cause symptoms; therefore, many aneurysms are detected during testing for other unrelated conditions. If a physician suspects the presence of a brain aneurysm, he/she may order diagnostic tests including a CT angiogram, a type of MRI called a magnetic resonance angiography (MRA), or a cerebral angiogram.

Treatment & Therapy

Prior to treating a cerebral aneurysm, a physician will consider a patient's age, additional risk factors, overall health, and size of the aneurysm to ensure the proper treatment options are chosen. A physician may decide to closely monitor a cerebral aneurysm smaller than 10mm as they are more unlikely to rupture and undergoing surgery has many risks.

Surgery is recommended for larger cerebral aneurysms or those causing symptoms or pain. Aneurysm clipping and aneurysm embolization are two surgeries that are used to treat unruptured cerebral aneurysms and those that have ruptured.

If an aortic aneurysm is small and not causing symptoms, it is typically just monitored over time. If the aneurysm is large or causing associated symptoms, the section of the vessel that is weakened can be removed surgically and replaced with an artificial material graft. If the aneurysm is located in close proximity to the aortic valve, a physician may recommend replacement of the valve as well.

Repairing an aneurysm can require abdominal surgery or open heart surgery under general anesthesia. Typically, individuals can expect a hospital stay of at least five days. In appropriate circumstances, newer techniques may be used for the repair of thoracic and abdominal aneurysms. In these cases, a graft can be placed without a surgical procedure.

Prevention & Prophylaxis

The only measures to prevent the occurrence of brain aneurysms are getting regular physical exams, eliminating smoking and controlling high blood pressure. Women who take oral contraceptives may benefit from considering alternative measures for contraception if they are concerned about risks associated with high blood pressure as oral contraceptives can cause elevated blood pressure levels.

Individuals with coronary artery disease or carotid artery blockages from atherosclerosis can prevent the occurrence of an aortic aneurysm by getting regular examinations from their physician. In addition, a healthy diet and regular exercise can promote a healthy lifestyle and aid in the prevention of risk factors that are associated with the development of aneurysms.

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