Unmasking the Silent Threat: Understanding Brain Aneurysms and Empowering Individuals with Life-Saving Knowledge

Brain aneurysms represent a silent but serious threat to the health of millions across the globe. According to the Brain Aneurysm Foundation, an estimated 6.7 million people in the United States have an unruptured brain aneurysm—representing one in 50 people. This organization also reports that approximately 30,000 people in the U.S. suffer a brain aneurysm rupture each year, a potentially deadly scenario. Importantly, most people who have a brain aneurysm will not suffer from an aneurysm rupture, but a certain fraction will. 

The problem is, they stealthily develop without major signs or symptoms, often going unnoticed until they rupture with potentially fatal consequences. This begs the question: Why is this threat so “silent”? And, how can individuals and their loved ones prepare for the risk of an aneurysm? 

The following insights provide crucial information for anyone who falls into a high-risk category for brain aneurysm—but also provides key insights for anyone who may be worried about the potential for an unexpected brain aneurysm. 

What Is a Brain Aneurysm?

A brain aneurysm, also known as a cerebral aneurysm, is a condition where a weak spot in a brain’s blood vessel wall bulges or balloons out. This occurs because the pressure from the blood flowing through the vessel causes the weakened portion to swell outward. 

There are several types of brain aneurysms:

• Saccular Aneurysms. These are the most common type of aneurysm and are characterized by a sac-like bulge in the blood vessel. They are also known as “berry” aneurysms because they often look like berries hanging on a vine. Saccular aneurysms typically occur at the base of the brain.
• Fusiform Aneurysms. Instead of ballooning out on one side, the blood vessel wall bulges out all around its circumference. These aneurysms don’t have a well-defined “neck” and resemble the widening of the blood vessel.
• Mycotic Aneurysms. These are usually caused by infections and can occur in any artery in the brain. They are generally located along smaller arteries.

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What are the Symptoms?

Most brain aneurysms do not present evident symptoms until they become large or rupture—hence the “silence.” Some signs of an unruptured brain aneurysm can include general headache, pain above or behind the eye, a dilated pupil, change in vision. The vast majority of aneurysm patients will have no symptoms at all unless a rupture, or hemorrhage, occurs from the aneurysm.

When a brain aneurysm ruptures, symptoms include a sudden, severe headache (often described as “the worst headache of your life”), nausea, vomiting, stiff neck, and loss of consciousness. It is imperative to seek medical assistance immediately if you suspect a brain aneurysm has ruptured. 

Unfortunately, the National Library of Medicine (NLM) reports that nearly 25% of individuals who suffer a ruptured brain aneurysm will die within the first 24 hours and about 50% will succumb to the circumstances in the following three months. Urgency cannot be understated in getting to the emergency room immediately.

What Causes a Brain Aneurysm?

Causes of brain aneurysm vary, ranging from genetic diseases and family history to high blood pressure and atherosclerosis, which is a build-up of cholesterol in the heart’s arterial walls. Two additional causes are linked to polycystic kidney disease and something called arteriovenous malformations. The latter occurs when veins and arteries in the brain get “tangled” thus restricting blood flow.

Smoking, excessive alcohol consumption, and the use of illicit drugs can also contribute to the development of aneurysms. Ethnicity and age is another component. Research indicates that African American and Hispanic people are at twice the risk of having a  brain aneurysm. 

Prior to age 50, women and men have a 1:1 ratio of risk. After 50, women are more at risk than men (2:1). It should be noted that the average age at which brain aneurysms occur is 50. 

Are there Preventative Measures?

Brain aneurysm prevention begins with managing risk factors. Controlling high blood pressure, quitting smoking, reducing alcohol consumption, and maintaining a healthy diet and regular exercise routine can significantly lower the risk of developing a brain aneurysm. Some experts recommend following either the Dietary Approaches to Stop Hypertension (DASH) diet or the Mediterranean diet (or both).

Additionally, regular check-ups with a healthcare provider can help in early detection and management. They may detect a concerning symptom and direct patients to a neurosurgical professional for further evaluation. The first screening test is usually an MR Angiogram (MRA) or a CT Angiogram (CTA). At New Jersey Brain and Spine, we may also employ cerebral angiography, which is the most reliable and sensitive diagnostic test for the detection and clarification of the anatomy of brain aneurysms. This test is more accurate than CT angiography (CTA) or MR angiography (MRA).

If you have a family history of brain aneurysms, you should undergo noninvasive screening periodically. This is typically accomplished with an MRA. 

If an unruptured brain aneurysm is detected, a Neurosurgeon will determine the next best steps. In some cases, the recommendation is to monitor the aneurysm over time—called “watchful waiting.” Other times, either a minimally invasive procedure or surgery for the aneurysm is the best action. Two common procedures include:

• Brain aneurysm coiling. This is a minimally invasive procedure in which special metallic platinum coils are carefully advanced into the aneurysm until it is completely filled. The coils within the aneurysm cause blood to stop flowing within the aneurysm. Doing so prevents leakage of blood and supports permanent healing of the aneurysm. In certain cases a stent or stent-assisted coiling is performed to treat the aneurysm.
• Microsurgical clipping. In this surgery, neurosurgeons make a small incision in the scalp and using microsurgery, place a metal clip over the aneurysm to prevent blood from flowing into the aneurysm.

Expertise in Vascular Neurosurgery Matters

Patients with a cerebral aneurysm need expert level evaluation. It is important to seek an evaluation  by a vascular/endovascular neurosurgeon, who can offer all available treatment options. Vascular neurosurgeons undergo 7 years of specialized training in brain surgery and an additional 2 years of specialized training in endovascular procedures. There are other specialists (neurologists and radiologists) that can undergo 2 years of training in endovascular neurosurgery but they are not Neurosurgeons and cannot offer all treatment options. At New Jersey Brain and Spine, our Neurovascular team are all fellowship trained vascular neurosurgeons. Patients should always ask their doctor for their qualifications in Neurosurgery.

Distinguishing Between Brain Aneurysm and Stroke

Brain aneurysms and strokes share some symptoms but have different underlying causes. A stroke occurs when blood flow to a part of the brain is cut off. There are two main types of stroke:

• Ischemic stroke is the most common type of stroke, accounting for about 87% of all cases. It occurs when the blood flow to part of the brain is interrupted or significantly reduced, depriving the brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. Ischemic strokes are usually caused by blockages or clots in the blood vessels that supply blood to the brain.
• Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. As a result, blood spills into the brain tissues, causing damage to brain cells. The most common causes of hemorrhagic stroke are high blood pressure and aneurysms (weaknesses in blood vessel walls). A brain aneurysm can lead to a hemorrhagic stroke if it ruptures.

The symptoms of a stroke include sudden numbness or weakness in the face, arm, or leg, especially on one side of the body, confusion, trouble speaking, difficulty seeing, and loss of balance. While there is an overlap in symptoms—particularly when a brain aneurysm leads to a hemorrhagic stroke—the sudden, severe headache is more characteristic of a ruptured brain aneurysm.

In both cases, seek immediate medical attention. The sooner a person receives treatment, the greater the chance of survival and recovery. 

Knowledge Is Power

Empowering yourself with knowledge about brain aneurysms is a life-saving decision. Understanding brain aneurysm symptoms, causes, and risk factors is essential for early detection and prevention. Being able to distinguish between a brain aneurysm and a stroke can also guide you in seeking the appropriate medical intervention. Prevention and vigilance, supported by a lifestyle that prioritizes brain health, will serve as your armor against this silent threat.

New Jersey Brain and Spine has the most experienced and sophisticated neurovascular program in the region. Each year, we evaluate nearly 1,000 brain aneurysm patients and perform about 100 to 130 aneurysm treatments. Our patient outcomes are superior to those reported in the national literature.

If you or a loved one is concerned about the potential for brain aneurysms, please don’t wait to address it. There are many solutions we can implement to avoid the worst-case scenario. Connect with our physicians to learn more.