A cerebral aneurysm is a dilatation of an arterial wall mainly due to a structural alteration of the same, which leads to a thinning and consequently to a possible rupture, resulting in a cerebral hemorrhage known as subarachnoid hemorrhage.
Cerebral aneurysms are usually asymptomatic. Incidentally, their existence may be known when the patient undergoes a brain MRI scan looking for another pathology. More often they are detected after the patient suffers a subarachnoid hemorrhage that is diagnosed by brain CT and subsequently by a cerebral arteriographic study, which is the gold standard test for diagnosis.
Consequences of aneurysm rupture
The rupture of an aneurysm produces a sudden and intense headache that may be accompanied by nausea and vomiting and may affect the level of consciousness, even leading to coma or sudden death. This rupture cannot be prevented, since the symptomatology it produces is when the aneurysm has already ruptured. In the case of incidental aneurysms, surgical or endovascular treatment prevents rupture.
A ruptured cerebral aneurysm should be considered an emergency and the patient should be monitored in an ICU unit. A complete cerebral arteriographic study should be performed to reach the diagnosis and then a multidisciplinary team formed by vascular neurologists, neuroradiologists and neurosurgeons will decide the most appropriate treatment for the case. This treatment may be endovascular, which consists of filling the aneurysmal sac with coils up to the neck of the aneurysm; or surgical, which consists of performing a craniectomy and approaching the aneurysm through the brain, placing a clip at the neck of the aneurysm to close it definitively.
Sequelae after suffering an aneurysm
A patient who suffers a ruptured cerebral aneurysm can reach up to 50% mortality rate regardless of the treatment applied. Of the remaining 50%, one third are left with severe and disabling sequelae (hemiplegia, aphasia …), another third are left with less severe sequelae but that disable them for their usual work (memory disorders) and the remaining third return to their usual life. Thus only 1 in 6 patients who suffer an aneurysmal rupture return to their usual work. If we detect an aneurysm prior to rupture, the possibility of bleeding varies between 1 and 3% per year. We advise treatment of these incidental aneurysms.