What You Should Know About Brain Aneurysms According to Dr. Alireza Minagar
Health concerns can be a vast and varied topic for patients, ranging from smaller things like cuts and abrasions to much bigger concerns such as heart failure. Although many health concerns can go unnoticed — especially if patients have not been formally diagnosed and they are passing off their symptoms to other smaller issues — it is important to be clear on the warning signs of diseases affecting the brain. Dr. Alireza Minagar is a neurologist from Shreveport, Louisiana who specializes in vascular neurology, and sees patients whose symptoms have been written off as minor all too often — especially those with vascular issues such as brain aneurysms. Dr. Alireza Minagar took the time to discuss brain aneurysms, more specifically; what they are, the warning signs and symptoms, the treatment, and related conditions.
A brain aneurysm is caused by weakening of the wall of a blood vessel, leading to bulging or ballooning of the vessel. Dr. Alireza Minagar explains that many times the vessel can resemble a berry hanging on a branch, and hence the name “berry aneurysm” which is the most common type (over 90%).
Brain aneurysms are of concern as they can leak or rupture, causing a brain hemorrhage, many times leading to coma, or even death. More benign aneurysms typically can go unnoticed without causing any sort of symptoms in patients and are found incidentally on scans or tests for other conditions. Aneurysms can be caused by both genetic and environmental factors such as connective tissue disorders, family history, smoking, hypertension, and traumatic brain injuries.
Aneurysms can be broken down into unruptured, leaking, and ruptured, all presenting with varying symptoms. While not all symptoms may be present in all patients, Dr. Alireza Minagar points out that unruptured aneurysms may go unnoticed when they are fairly small, but if they grow larger they may begin to compress nerves in the surrounding areas leading to symptoms such as drooping eyelids, blurry or double vision, numbness and/or weakness, and dilated pupils.
A leaking aneurysm may present in ways similar to unruptured, or ruptured aneurysms, but one warning sign could potentially be a sudden, severe headache, which is caused by blood leakage between the brain and the tissue covering the brain. A severe form of this can be seen in ruptured aneurysms, most typically a ruptured berry aneurysm leading to a subarachnoid hemorrhage, when patients will present with what they describe as the worst headache of their lives. This is caused by blood pooling in between the arachnoid layer (tissue covering the brain) and brain matter itself, many times causing compression. Other symptoms of a ruptured aneurysm include neck tightness/pain, nausea/vomiting, photo phobia, seizures, confusion, and even loss of consciousness.
As mentioned, Dr. Minagar notes that many times these aneurysms can go unnoticed for years, or patients can pass away at old age and never even realize they had one. They are typically diagnosed through imaging such as MRI or CT, many times with contrast as vasculature is better appreciated.
For patients who have presented with symptoms and an aneurysm has been found to be the cause, they can either use a wait and watch approach with careful monitoring of the aneurysm or can treat with endovascular coiling or surgical clipping. Endovascular coiling involves accessing the aneurysm by means of a catheter through blood vessels and using a coiling soft metal to essentially plug up the aneurysm, helping decrease the risk of rupture.
Dr. Alireza Minagar explains that endovascular meshes have also been used in a similar fashion to help decrease blood flow to the weak part of the vessel. Surgical clipping is done by placing a small clip around the base of the aneurysm, helping to alleviate pressure and flow in the hopes of decreasing the chance of rupture.
Dr. Alireza Minagar points out that there are a few conditions in which patients are at a higher risk for having, or eventually getting a brain aneurysm, and these patients should be closely monitored and have testing done. These include patients who have poly cystic kidney disease, those with connective tissue disorders such as Marfan’s Syndrome or Ehlers-Danlos, those with a family history of berry or brain aneurysms, patients with coarctation of the aorta (narrowing of the aorta), and those who have cerebral arteriovenous malformations.