Symptoms and Diagnosis of Brain Aneurysms
Ruptured Cerebral Aneurysm Symptoms
When an aneurysm ruptures, called subarachnoid hemorrhage, people often complain of "the worst headache of their life." Other ruptured cerebral aneurysm symptoms include:
- Nausea and vomiting
- Stiff neck or neck pain
- Blurred vision or double vision
- Pain above and behind the eye
- Dilated pupils
- Sensitivity to light
- Loss of sensation
Unruptured Cerebral Aneurysm Symptoms
Most aneurysms are asymptomatic, particularly ones that are small. Occasionally, large aneurysms may cause the following symptoms related to pressure on the adjacent brain or nerves:
- Peripheral vision deficits
- Thinking or processing problems
- Speech complications
- Perceptual problems
- Sudden changes in behavior
- Loss of balance and coordination
- Decreased concentration
- Short-term memory difficulty
Because the symptoms of brain aneurysms can also be associated with other medical conditions, diagnostic neuroradiology is regularly used to identify both ruptured and unruptured brain aneurysms.
Diagnosis of Brain Aneurysms
Aneurysms rupture at about 1-2% per year but varies with the size, location and history of previous aneurysm rupture. Unfortunately, most aneurysms present because they have ruptured. Occasionally, large aneurysms can present with vision changes, pain above and behind the eye, nerve paralysis, localized headache, neck pain, nausea and vomiting, or other neurological symptoms. Fortunately, an increasing number of aneurysms are found pryor to rupturing because CT (computed tomography) and MRI (magnetic resonance imaging) are now used commonly to assess patients with these complaints. These are noninvasive methods a radiologist uses to look at the blood vessels in the head. A physician will determine which is the better option for each patient. MR does not involve radiation or contrast risks, while a CT produces better resolution and is better for operative planning. Patients suspected of having a ruptured aneurysm typically undergo a CT scan of the head and a CT angiogram, which shows subarachnoid hermorrhage and the aneurysm.
While CT and MR can show many aneurysms, most patients with aneurysms need a cerebral angiogram for definitive diagnosis and to determine the best treatment. An angiogram is an invasive procedure during which a neuro-interventional surgeon guides a flexible tube (catheter) through an artery over the hip to the vessels of the brain. A liquid dye or contrast agent is injected into the vessel, and pictures are taken with a fluoroscope. An angiogram gives the highest detailed pictures of the location, size, and shape of the aneurysm. All of this information is used to develop the best treatment option for each patient.