The sudden passing of "Saving Private Ryan" actor Tom Sizemore from a ruptured brain aneurysm has brought heightened awareness to this silent health condition. While aneurysms are relatively common—affecting 1 in 50 Americans—a rupture is rare.
What Is a brain aneurysm?
A brain aneurysm forms at a weak spot in a blood vessel, causing the wall to balloon or bulge out. In most cases, aneurysms go undetected because they do not cause any symptoms. However, aneurysms can occasionally grow to a size where they start to cause neurologic symptoms, like a drooping eyelid or dilated pupil, due to the mass effect.
Aneurysms can also rupture, and if they do, blood begins to spill around or in the brain, causing excruciating headaches that are often described as a lightning bolt to the head. Symptoms are sudden and require an immediate call to 911.
What are the symptoms of a ruptured aneurysm?
- Sudden and severe headache
- Stiff neck
- Nausea and vomiting
- Loss of consciousness
What are my risks?
People over age 40 and women have a high risk of experiencing an aneurysm. Some other common risk factors include:
- Genetics (first-degree relatives)
- Connective tissue disorders such as Ehlers-Danlos syndrome, Marfan syndrome, and fibromuscular dysplasia
- Other genetic disorders such as polycystic kidney disease
- Habitual smoking
- Illicit drug use, particularly amphetamines
- High blood pressure
How are brain aneurysms detected?
Doctors use various imaging tests to diagnose a brain aneurysm. However, most unruptured aneurysms are discovered by surprise when patients are undergoing imaging scans for something else. Unfortunately, some patients may never get a diagnosis until a rupture happens, which is something Craig Kilburg, MD, a specialist in neurosurgery at University of Utah Health’s Clinical Neurosciences Center, would like to avoid.
"While some risk factors for aneurysms are not preventable, a lot are,” Kilburg says. “It’s important for people to know about their risk factors—controllable or uncontrollable—so they know to get screened and take steps toward reducing their risk.”
What happens after I’m diagnosed?
It is recommended that patients with large aneurysms (7 millimeters or larger) get surgery as soon as possible. Patients with smaller aneurysms should undergo regular screenings to monitor for changes in the size and shape of their aneurysm. If changes are detected, surgery will likely be advised. Surgery may also be recommended for high-risk patients (habitual smokers, drug users, genetics, etc.), regardless of the size of their aneurysm.
Surgery options include:
- Open surgery: Neurosurgeons make an incision in the skull and then place a metal clip over the aneurysm to treat it.
- Endovascular surgery: Neurosurgeons access an artery (typically in the wrist or groin) and then treat the aneurysm from inside the blood vessel it arises from, either with coils or other devices such as a stent.
What can I expect in recovery?
Endovascular surgery is a less invasive procedure, so patients typically go home the next day. With open surgery, patients can expect to go home after two days. After treatment, patients are advised to take it easy and minimize brain-stimulating activities.
Patients who had emergency surgery after a ruptured aneurysm stay in the hospital for several weeks or months, depending on the severity of the bleed. Rehabilitation therapy may also be needed for a full recovery.
Something to remember
Ruptured brain aneurysms are fatal in about 50% of all cases, and 66% of survivors suffer some permanent neurological disabilities. This is why it is critical to follow doctor's orders and get screened regularly when diagnosed with an aneurysm. If you may be at risk, speak with your doctor about scheduling a screening.
“Chances of survival and recovery are so much higher when people can have their aneurysm treated electively instead of after a rupture,” Kilburg says.