Aneurysms are often asymptomatic. Thus, it may take some time for the patient to discover the condition. They can gradually grow and then start to show symptoms. The pictures can be severe and are related to the size and location of the aneurysm .
An aneurysm is a dilation that forms in an artery as a result of abnormal vasodilation. This bulge grows progressively, until it breaks, and can lead to death. Contrary to common sense, it can appear in different parts of the body.
Vasodilation is a fundamental process for the balance of blood pressure and the thermal regulation of the body.
The process consists of an enlargement, that is, an increase in the diameter – or, roughly, in the enlargement – of a blood vessel, caused by the temporary relaxation of the muscular tissue that makes up the wall of these vessels. Under normal conditions, the dilation of the vessels is completely natural.
The aneurysm is a direct result of a vasodilation process that should not be happening, usually caused by a chronic weakening of the muscle tissue. This results in a kind of localized swelling, similar to the shape of a small balloon, which grows when fed by the bloodstream.
In general, the mere presence of an aneurysm does not cause any symptoms. Many people even live with the phenomenon all their lives without even being suspicious and end up dying of other causes that have nothing to do with the problem.
However, the risk of rupture increases over the years, and the consequences can be catastrophic: 30% of patients who suffer from an aneurysm rupture die before they even reach the hospital.
Among the survivors, 55% have severe sequelae. Brazil has an average of 15 thousand cases of hemorrhage annually caused by the rupture of aneurysms.
What is a ruptured brain aneurysm?
Ruptured cerebral aneurysm is the name of the condition in which the aneurysm ruptures.
When the aneurysm ruptures, the condition is considered to be emergency and life-threatening. In general, these pictures are discovered the moment the rupture occurs.
Aneurysms that are found or discovered in non-emergency conditions are those that, in general, do not manifest symptoms and are discovered through routine examinations.
There are some types of aneurysms and they can be classified according to three characteristics: their location, their shape and their origin or causative agent. Each aneurysm is identified according to a combination of these three factors.
Classification by location
Depending on the location, aneurysms can be of the following types:
Also called saccular aneurysm, it consists of the appearance of an aneurysm in cerebral arteries. It is estimated to affect 3% to 5% of the world population, thus being the most common form of the disease.
In most cases, it develops in the lower part of the brain, especially in points near the base of the skull.
Abdominal aortic aneurysm
The aorta is the largest and most important artery in the entire circulatory system, as it is responsible for transporting oxygenated blood to all parts of the body. This vessel basically passes through the organism, since it leaves the heart and extends to the abdomen. An aneurysm of the abdominal aorta is precisely an aneurysm that is established in this last stretch of the aorta.
It is the type of aneurysm that has the highest mortality rate after rupture. After a rupture, it is estimated that only 10% to 15% of patients survive.
Thoracic aortic aneurysm
As the name suggests, a thoracic aortic aneurysm refers to a dilation that arises in the section of the aortic artery that passes through the chest. Like the abdominal aortic aneurysm, it has a high mortality rate due to the intense blood flow in the region.
Although the aortic aneurysm is more frequent, other arteries in the body can also be affected. For example, in the intestine.
It is possible to develop aneurysms in places other than those already mentioned, such as in the spleen and behind the knees. However, these are very rare cases.
Classification according to form
According to the shape of the aneurysm, they can receive the following classifications:
Saccular aneurysms have this name due to their appearance similar to a blister, or a “sac”. They usually appear in areas that receive greater pressure from the blood flow, such as bifurcations and curves.
Fusiform aneurysms are characterized by the widest measurements, forming a kind of rhombus.
Dissecting aneurysms appear more frequently in the aorta, although it is possible that they may appear elsewhere. It is a condition in which the lesion settles on the internal walls of the artery. The outer walls, however, remain intact.
Classification according to origin
It is also possible to classify aneurysms according to their origin:
Atherosclerotic aneurysms are a consequence of atherosclerosis (for more information, read the section “Risk factors”). In this case, the formation of atheromatous plaques typical of the disease weakens the artery walls, forming the aneurysm.
More rare, infectious aneurysms are the result of a weakening of the arterial walls caused by specific infections – such as syphilis , for example.
It is very rare for a person to be born with a congenital aneurysm, that is, that is already formed since birth. What can happen is that the patient is born with a predisposition to the formation of aneurysms (for more information, read the section “Causes”).
What is the difference between cerebral aneurysm and stroke?
Although many people confuse the two problems, strokes and brain aneurysms are distinct diseases, although a ruptured aneurysm can be the cause of a stroke.
A stroke is a phenomenon that causes part of the brain to not receive blood flow and, consequently, oxygen, losing some functions.
Most strokes are ischemic, that is, they consist of the interruption of blood circulation in some brain area. It can be caused by vasodilatations, which are, among other things, a complication of ruptured brain aneurysms (for more information, see section “Complications”).
Hemorrhagic strokes, on the other hand, are those in which there is bleeding, swelling and increased intracranial pressure. The cause of a hemorrhagic stroke can be the rupture of the aneurysm itself.
The cause of the aneurysm is the weakening of the arterial walls. In the long run, the weakened walls dilate due to the impact of blood pressure, forming the aneurysm. This phenomenon can happen for several reasons.
Some of them are related to habits acquired throughout life, while others are related to congenital conditions, that is, that are hereditary or are already born with the patient.
However, although some people may have a genetic predisposition to the development of aneurysms, it is important to note that it is very rare to be born with a congenital aneurysm.
The disease is very rare in children, being more common in adults over 40 years of age. In a section by gender, it affects women more often than men.
Some habits, health problems or even immutable conditions can favor the weakening of the arterial walls, and, consequently, the appearance of aneurysms. Are they:
To be over 50 years old
The weakening of the physical structure of the arterial walls is one of the consequences of approaching old age. People aged 50 and over represent the group most affected by aneurysms.
Studies show that cigarettes are responsible for weakening a gene directly responsible for protecting arteries. According to a survey by the University of Pennsylvania, smokers have up to a 12% increased risk of developing problems related to blood vessels, including aneurysms.
Excessive use of alcohol and drugs
The feeling of euphoria caused by the use of certain drugs – mainly cocaine and stimulants – is directly related to a sudden increase in heart rate and blood pressure. These reactions overload the arteries, weakening their walls.
This type of harm, however, is not limited to illicit drugs. Regular consumption of alcoholic beverages can cause several cardiovascular problems, including the progressive hardening of the arteries.
In people with high blood pressure, the force with which the blood hits the artery walls is much greater than normal. This overload leads to an eventual weakening, which can favor the appearance of aneurysms.
One of the main characteristics of the disease is that it causes blood vessels to narrow, damaging the structure of your walls in the short term.
Polycystic kidney disease
Also known as “polycystic kidneys”, hereditary disease is responsible for replacing the kidney tissue with innumerable cysts, which grow progressively.
The relationship between this disease and aneurysms is that the phenomenon affects not only the kidneys, but several organs, such as the liver, pancreas, heart, large intestine and brain – which favors the formation of cerebral aneurysms, which can increase the risk of up to 7 times. the occurrence of dilations.
It is estimated that 5% to 40% of patients with polycystic kidney disease develop aneurysms.
Blows to the head, chest or abdomen can rupture vessels and arteries, favoring the appearance of aneurysms. Therefore, after violent trauma – such as car accidents, for example – it is essential to monitor any neurological, thoracic and abdominal damage.
Estrogen is a hormone known to act as a regulator of the menstrual cycle. What few people know is that the substance is also responsible for protecting women’s arteries. Therefore, in menopause , when estrogen levels are low, arterial walls tend to weaken.
Blood inflammation, also called vasculitis, directly affects the health of vascular walls, including arterial walls.
The diabetes untreated is directly related to a number of cardiovascular problems such as fat accumulation in the arterial walls, development of atherosclerosis and hardening of the arteries. Hence the relationship between the disease and aneurysms.
Elevated cholesterol levels form a fatty plaque on the wall of the arteries, which, in turn, eventually weakens.
Some people have a hereditary predisposition to the development of aneurysms. The specialist doctor should order specific tests if the patient has two or more cases of the disease in the family, especially in first-degree relatives (such as parents and siblings).
Connective tissue disorders
Some inherited diseases that affect connective tissue, such as Ehlers-Danlos Syndrome and Loeys – Dietz Syndrome, directly affect the elasticity of some body structures, including arteries.
Fibromuscular dysplasia is a disease that affects the cellular balance of arterial walls, causing several anomalies, including the weakening of the tissue.
Also called arteriovenous malformations (identified by the acronym MAV), they are birth defects that, in 15% of cases, become aneurysms.
When the topic is aneurysm, the numbers are among the factors that most impress those who live with the problem. To give you an idea, according to the Data Processing Company of Porto Alegre (Procempa):
- It is estimated that between 1% to 5% of the adult population live with aneurysms;
- 10% of patients who face an aneurysm rupture die before reaching the hospital;
- 30% to 40% of patients do not survive even after adequate treatment;
- Among the survivors, 25% have serious consequences for the rest of their lives. 45% develop memory problems;
- The mortality rate is around 45%;
- 5% of strokes are caused by ruptured aneurysms;
- For those who have two or more cases of aneurysms in the family, the chance of being affected by the problem grows by 8%.
However, not all numbers in the survey are hopeless.
- If an aneurysm is less than seven millimeters, the chances of rupture within five years revolve around zero;
- Less than 1% of patients with ruptured aneurysms are less than 20 years old;
- In exactly half of the cases (50%), the aneurysm never breaks and the patient lives normally.
In the early morning of October 1999, after an absolutely normal day, the merchant Paulo César Santos de Oliveira woke up suddenly with the feeling that his whole head was heating up , while the rest of his body looked cold.
Then he felt sick and weak , without the strength to stand for a long time. He rushed to the hospital at the same time, where he was diagnosed with migraine . Medicated, the brasiliense who, at the time, was 34 years old, continued feeling bad.
Progressively, the symptoms worsened. Paulo was unable to move his neck sideways, felt a general malaise and vomited.
She had to go to the emergency room five times until, after much insistence from the patient’s family and an MRI with inconclusive results, the doctor on duty ordered a CSF collection test (for more information, read the section “How is the procedure done? diagnosis of an aneurysm ”).
The liquid, which was supposed to be transparent in normal cases, came out completely dark. The merchant was immediately taken to the operating room. He had a brain aneurysm that had a fissure, but it had not yet broken. It was, however, a matter of time.
As in the case of Paulo, most aneurysms are totally asymptomatic until they present a problem.
If the dilation is large and presses on a specific region, there may be generic symptoms related to the part that is being compressed – such as blurred vision , in the case of brain aneurysms, or cough , for aneurysms of the thoracic aorta, for example.
Furthermore, the signs only appear when the aneurysm has already ruptured or is about to rupture. Some people report very severe and sudden localized pain a few days before the rupture of the vessel. These pains, however, happen in quick episodes and soon pass, without persisting for enough time or intensity to worry the patient.
Symptoms of ruptured aneurysm
The symptoms of a ruptured aneurysm cannot be ignored. At the slightest sign of them, it is recommended to see a doctor as soon as possible. Are they:
- Sudden pain in the head, abdomen or chest, according to the location of the aneurysm. The sensation is very characteristic. It is as if, out of nowhere, the patient has been hit hard;
- Sudden sensation of hotness in the head, abdomen or chest;
- Difficulty walking or standing;
- Blurred or double vision;
- Sudden dizziness;
- Jet vomiting;
- Crises convulsivas;
- Loss of consciousness.
Tests to map possible aneurysms are not included in the check-up routine, except in cases of suspected genetic predisposition. As they are silent and asymptomatic, they are usually discovered by chance or only when they break.
Diagnosis of brain aneurysm
The first step in diagnosing a ruptured aneurysm – as they are called ruptured aneurysms – is to perform a Computed Tomography (CT) scan, which has the ability to show localized bleeding.
Then, a lumbar puncture can be performed as a complementary exam. The puncture consists of a collection of a fluid called cerebrospinal fluid (CSF), popularly known as cerebrospinal fluid, which is located around the spinal cord and cerebral cortex.
If the CSF sample contains blood, there is a strong indication of a ruptured aneurysm.
In order to determine the size and exact location of the aneurysm, the neurologist should order a brain angiography . The exam is basically the insertion of a kind of flexible tube called a catheter in an artery of the leg, which must follow the blood vessels of the body until it reaches the aneurysm.
Depending on the particularities of the case, the doctor may choose to replace the angiography with an angiotomography , a non-invasive test that uses contrast.
Diagnosis of abdominal aortic aneurysm
In addition to tomography and angiography, to diagnose an abdominal aortic aneurysm, the doctor may also order an MRI and a chest ultrasound . Both have the function of mapping the extension of the aneurysm and, depending on the case, of the hemorrhage.
Diagnosis of thoracic aortic aneurysm
In case of suspected thoracic aortic aneurysm, as in the previous cases, the doctor may order tomography, MRI and angiography. A difference is that the professional can also request an echocardiogram , since thoracic aneurysms are usually dangerously related to the heart.
The cure for the aneurysm is surgical intervention, which can happen through embolization or, more commonly, by clipping the aneurysm. In cases of ruptured aneurysm, the patient will be taken to surgery immediately.
The post-rupture survival rate is higher in cases of cerebral aneurysm – it is estimated that ⅔ of the patients survive, being ⅓ without severe sequelae. As for aortic aneurysms, because they happen in a larger artery, they are more serious. About 90% of the people affected by the event do not survive.
However, if the aneurysm is discovered before bleeding, the doctor will decide whether the best option is surgical intervention or not. For this, the professional will take into account the size and location of the aneurysm, in addition to the patient’s history.
In general, when the dilation is less than 5.5 centimeters in diameter, the medical team should recommend frequent follow-up of the condition, without surgery. This is because, statistically, the risks of a small aneurysm rupture are minimal compared to the risks of a delicate surgical procedure.
Cerebral aneurysm surgery
The procedure for cerebral aneurysm can occur in two ways: through an embolization or, more commonly, by clipping.
Embolization, also called endovascular treatment, is a less invasive method, done with the insertion of a catheter in the femoral artery, located in the thigh. The catheter advances through the body until it reaches the aneurysm, where it installs platinum springs that prevent bleeding.
Despite the advantage of not requiring the opening of the skull, embolization is not usually recommended for aneurysms larger than 10 cm or that have already ruptured. There is also a small risk that the aneurysm will refill with blood after the procedure.
Although it is a less modern procedure, clipping surgery remains the most used method for treating brain aneurysms, mainly due to its effectiveness – once the patient is operated on, there is no risk of the aneurysm reoccurring.
Aortic aneurysm surgery
Due to the importance of the aorta in the body, surgical procedures involving this artery tend to be more delicate and complex. For abdominal aortic and thoracic aortic aneurysms, there are two possibilities.
The first is conventional surgery, in which the part of the aorta where the aneurysm is located is completely removed and replaced by a tube. For this, there is an interruption of blood flow in the region. It is a high-risk procedure and is currently the least used treatment option for aortic aneurysms.
The second, as in the case of cerebral aneurysm, is an endovascular treatment. The tube that will replace the part of the artery that supports the aneurysm is inserted through a catheter.
As this procedure is relatively new (it was performed for the first time in 1991), patients undergoing it need frequent follow-up so that the doctor responsible for the case can make sure that the stent is in the correct place and does not need repairs.
Paulo, the aforementioned merchant, resumed the routine just 2 weeks after the brain aneurysm clipping surgery.
The accelerated recovery was so surprising that it became the theme of medical symposia, although it can be partially explained by the patient’s history: a young man, who did not smoke or drink and practiced physical exercises regularly.
In general, people who undergo surgical interventions to treat aneurysms take, on average, 3 months to return to normal activities.
Right after surgery, while still in the hospital, the patient will be monitored hourly for the first 24 or 48 hours, depending on the severity of the case. This routine is a precaution to ensure that there are no post-surgical complications, such as embolisms or hemorrhages, for example.
When at risk, the patient can be transferred to a room, where he will continue to be observed according to the guidelines of the medical team. Hospitalizations after this type of surgical intervention usually last at least 5 days.
Postoperative care is as delicate as surgery. It is important to remain in a peaceful and quiet place, in addition to being aware of physiological variations, such as a trapped intestine, for example, which may indicate that something is not going well. Absolute rest and a light diet are essential, without fatty foods.
Patients who have undergone endovascular treatments should avoid making sudden movements with their legs, especially by forcing the thigh or groin. Those who have been exposed to more invasive surgical procedures are forbidden to sunbathe at the incision site.
The surgeon may recommend the use of some medications after surgery, such as anticonvulsants, calcium channel blockers and pain medications.
For those who have aneurysms that have not ruptured, it is necessary to remain calm. Although ruptured aneurysms are very serious, non-ruptured aneurysms can never cause any problems, always remaining asleep. This is because the chances of disruption are very low, varying from 1% to 2.7% per year.
It is important to talk to the neurosurgeon to clear up any doubts and understand the reasons that lead you to conclude that the risks of surgery are greater than the risks of living with the aneurysm.
Patients living with non-ruptured aneurysms need to monitor the situation periodically. In general, check-up tests in these cases usually happen as follows:
Aneurysm diameter (in centimeters)
3,0 a 3,4
Every three years
3,5 a 4,4
4,5 a 5,4
Starting from 5.5
To avoid complications, it is very important that the patient has a healthy and regulated lifestyle. Healthy eating, exercise and disease control that can act as triggers for the aneurysm, such as hypertension and high cholesterol, for example, are essential.
The person living with a non-ruptured aneurysm also needs to give up habits that are not beneficial, such as smoking, drinking alcohol and using stimulating drugs.
What are the chances of an aneurysm to rupture?
According to a survey organized by Procempa, the numbers are as follows:
Chances of rupture
Up to 7
Less than 1%
From 7 to 12
13 a 25
The only possible complication for a non-ruptured aneurysm is that it ruptures. From the disruption, there are a number of bad developments that can happen, such as:
The rupture of an aneurysm can be the cause of a hemorrhagic stroke. This is because bleeding can cause an increase in intracranial pressure, which leads to loss of brain function.
The thrombosis is the formation of one or more clots that block certain veins, and it is relatively common after surgery. These clots can also detach and “navigate” through the bloodstream, becoming trapped in important organs and generating a phenomenon called embolism, which can lead to death.
Thrombosis is a more common event after surgery to repair aortic aneurysms.
Aneurysms that have already ruptured are at risk of bleeding again, especially during or after surgery. This can increase the extent of existing damage or even require new surgical procedures for repair.
Pre- and intra-procedure blood loss, in the case of ruptured aneurysms, can lead to episodes of post-surgical pressure drops, which directly affects the patient’s cardiovascular recovery.
Hemorrhages resulting from cerebral aneurysms can cause involuntary contractions of the arteries, a phenomenon that goes by the clinical name of vasospasm. These arterial spasms hinder the adequate passage of blood flow, which can cause ischemic strokes.
Hyponatremia is the drop in sodium levels in the blood, which can be caused by bleeding from ruptured aneurysms. This imbalance can cause a kind of swelling of brain cells and cause serious and irreversible damage.
Hydrocephalus is the name given to the accumulation of water inside the skull. It can happen if hemorrhage caused by an aneurysm blocks the flow of cerebrospinal fluid in the brain and spinal cord, causing a localized excess of cerebrospinal fluid.
Hydrocephalus increases intracranial pressure and can cause several permanent damages, reaching abilities such as speech, locomotion, memory and vision, for example.
Paralysis are rare sequelae for brain aneurysms, but they can happen. They are usually partial and can affect one side of the patient’s face or body.
Motor and speech difficulties
Dysfunctions in psychomotor abilities are common during the rehabilitation period after the rupture of an aneurysm. They can be reversible or permanent.
Depending on the extent and intensity of bleeding after an aneurysm rupture, bleeding can cause the patient to pass out or even fall into a coma.
An aneurysm can kill immediately, but also several days after its rupture, due to the intensity of the initial bleeding and rebleeding.
The death rate after an aneurysm rupture, both in the brain and in the aorta, is very high. In Brazil, the disease causes an average of 6,500 deaths per year, according to data from the Ministry of Health.
The best way to prevent weakening of the arterial walls is to cultivate healthy habits, such as:
- Practice exercises;
- Keep blood pressure and cholesterol levels under control;
- Eat properly;
- Drink alcoholic beverages in moderation and do not smoke or use stimulant drugs.
For those who have a family history or health problems that may favor the development of aneurysms, it is important to seek medical care.
Broken aneurysms are very serious problems and must be treated seriously. At the slightest sign that something may be wrong, seek medical attention immediately. In cases like these, time is crucial to defining the patient’s destiny.