Brain Aneurysm: Symptoms, Diagnosis & Treatment in Pune by Expert Neurosurgeon

Symptoms of a brain aneurysm vary significantly depending on whether it has ruptured or not.

Symptoms of an Unruptured Brain Aneurysm (if present): Most small, unruptured brain aneurysms don’t cause any symptoms. However, if an unruptured aneurysm grows large enough or presses on nearby nerves or brain tissue, it may cause:

• Pain above and behind one eye
• A dilated (enlarged) pupil in one eye
• Changes in vision or double vision
• Numbness or weakness on one side of the face
• Drooping eyelid
• Seizures

Symptoms of a Ruptured Brain Aneurysm (Medical Emergency): A ruptured brain aneurysm causes a sudden and extremely severe headache, often described as “the worst headache of my life.” This is a critical medical emergency requiring immediate attention. Other symptoms can include:

• Sudden, excruciating “thunderclap” headache
• Nausea and vomiting
• Stiff neck
• Blurred or double vision
• Sensitivity to light (photophobia)
• Seizures
• Loss of consciousness or confusion
• Drooping eyelid or a dilated pupil
• Weakness or numbness in part of the body

In some cases, an aneurysm may leak a small amount of blood (a “sentinel bleed”) days or weeks before a major rupture. This can cause a sudden, severe headache that may serve as a warning sign. If you experience any of these symptoms, especially a sudden, severe headache, seek emergency medical care immediately.

The exact cause of most brain aneurysms is not fully known, but they are generally believed to develop due to a combination of thinning artery walls over time and pressure from blood flow. Certain factors can increase the risk of developing an aneurysm or, more critically, increase the risk of an aneurysm rupturing:

Factors that can increase the risk of developing a brain aneurysm:

• Smoking: Tobacco use significantly damages blood vessel walls.
• High Blood Pressure (Hypertension): Untreated high blood pressure puts constant strain on artery walls.
• Age: More common in individuals over 40.
• Family History: Having a first-degree relative (parent, sibling) with a history of brain aneurysms.
• Certain Medical Conditions: Such as polycystic kidney disease, Ehlers-Danlos syndrome, Marfan syndrome, and arteriovenous malformations (AVMs).
• Drug Abuse: Especially cocaine and amphetamines, which can significantly raise blood pressure and damage vessel walls.
• Excessive Alcohol Use.
• Head Trauma or Infection (rarely): Leading to traumatic or mycotic aneurysms.

Factors that increase the risk of aneurysm rupture:

• Size of the Aneurysm: Larger aneurysms have a higher risk of rupture.
• Location: Aneurysms in certain locations (e.g., posterior circulation) may have a higher risk.
• Smoking.
• Untreated High Blood Pressure.
• Specific Aneurysm Shape: Irregularly shaped aneurysms or those with “daughter sacs” (small outpouchings).

Sudden Increase in Blood Pressure: Due to straining, strong emotions, or heavy lifting.

Early and accurate diagnosis is critical for managing brain aneurysms, especially when they rupture. Dr. Jaydev Panchwagh utilizes advanced diagnostic tools to identify aneurysms, assess their characteristics, and guide treatment decisions:

• Neurological Examination: A thorough assessment of your vision, reflexes, balance, and cognitive function.
• Imaging Tests:
  • CT Scan (Computed Tomography) and CT Angiography (CTA): Often the first scan in an emergency to detect bleeding in the brain (subarachnoid hemorrhage). CTA provides detailed images of the blood vessels to identify the aneurysm.
  • MRI (Magnetic Resonance Imaging) and Magnetic Resonance Angiography (MRA): These provide highly detailed images of the brain and its blood vessels, effectively detecting unruptured aneurysms and assessing their size, shape, and location.
  • Cerebral Angiography (DSA – Digital Subtraction Angiography): This is considered the gold standard for definitively diagnosing brain aneurysms. A catheter is inserted into an artery (usually in the groin) and guided to the brain, where a contrast dye is injected to produce highly detailed X-ray images of the blood vessels. This test precisely maps the aneurysm’s anatomy, which is crucial for surgical or endovascular planning.

Cerebrospinal Fluid (CSF) Analysis (Lumbar Puncture): If a ruptured aneurysm is suspected but imaging is inconclusive for blood, a lumbar puncture may be performed to check for blood in the cerebrospinal fluid.This decision is taken by the neurosurgeon after weighing the clinical scenario with the alternatives.

The treatment approach for a brain aneurysm depends heavily on whether it has ruptured and, for unruptured aneurysms, factors like its size, location, symptoms, and the patient’s overall health and risk factors. Dr. Jaydev Panchwagh, with his specialized training in vascular neurosurgery, provides expert guidance on the best treatment options.

For Ruptured Aneurysms (Emergency Treatment): The primary goal is to stop the bleeding and prevent re-bleeding, followed by managing complications. This is a critical emergency, and treatment needs to happen immediately.

For Unruptured Aneurysms (Preventive Treatment): Decisions for treating unruptured aneurysms involve carefully weighing the risk of rupture against the risks of treatment. Dr. Panchwagh discuss this extensively with patients and interventional neurologists. Options include:

1. Observation (Watchful Waiting):
   • For very small, asymptomatic aneurysms, especially in older patients or those with other significant health issues, regular imaging (MRI/MRA) may be recommended to monitor the aneurysm’s size and shape. Lifestyle modifications (controlling blood pressure, quitting smoking) are strongly advised.
2. Surgical Clipping (Microsurgical Clipping):
   • How it Works: Performed as an open brain surgery (craniotomy). Under a powerful neurosurgical microscope, Dr. Panchwagh carefully accesses the brain and identifies the aneurysm. One or more titanium clips of various shapes is/are chosen to be placed at the neck (base) of the aneurysm to seal it off from the main blood vessel, preventing blood from entering and rupturing it.
   • Benefits: This is a highly effective and often permanent treatment, especially for aneurysms with a well-defined neck. Dr. Jaydev Panchwagh’s training with Prof. KVR Sastri (NIMHANS) in Aneurysm Surgery at the beginning of his career, underscores his expertise in this complex procedure.
   • Best Option: Often considered the most definitive treatment for many types of aneurysms.
3. Endovascular Coiling (Coil Embolization):
   • Minimally Invasive: This procedure is performed by an interventional neuroradiologist or neurosurgeon. A thin catheter is inserted into an artery (usually in the groin) and guided through the blood vessels to the aneurysm in the brain. Tiny, soft platinum coils are then released into the aneurysm, filling it and blocking blood flow, causing it to clot and seal off.
   • Benefits: Less invasive than open surgery, meaning a smaller incision and often a shorter hospital stay and recovery time.
   • Considerations: May not be suitable for all aneurysms, and sometimes the aneurysm may re-open or recanalise over time, requiring repeat procedures.
4. Flow Diversion:
   • A newer endovascular technique used for large or complex aneurysms. A stent-like device (flow diverter) is placed in the parent artery across the neck of the aneurysm. This device diverts blood flow away from the aneurysm, allowing it to gradually clot and shrink over time.