How Are Brain Aneurysms Diagnosed?
If you or your doctor suspect you have a brain aneurysm, it’s important to seek specialized medical care. Brain aneurysms are usually diagnosed in the emergency department (when someone has had a rupture), during screening in people with a family history of brain aneurysms, or incidentally (when the patient is having tests done for something else).
To determine if a brain aneurysm is present, doctors use:
- Computed tomography angiography (CTA), which focuses on blood vessels
- Computed tomography (CT) scanning
- Magnetic resonance angiography (MRA), a special type of MRI that shows details of the blood vessels
- Cerebral angiography, or digital subtraction angiography (DSA), which is used to acquire more detailed images of brain arteries
- Spinal tap (lumbar puncture), to take a sample of cerebrospinal fluid and see if it contains blood
How Are Brain Aneurysms Treated?
Brain aneurysm care depends on the size and location of the aneurysm and whether it has ruptured. At NewYork-Presbyterian, we treat people with ruptured aneurysms in our Neurological Intensive Care Units (Neuro-ICUs) to monitor their brain health, minimize secondary brain injury, and reduce the risk of complications. Unruptured aneurysms that are asymptomatic can usually be monitored by a doctor.
If your aneurysm isn’t causing symptoms, particularly if it is small (less than 5 mm) and has low-risk features, your doctor may observe it rather than perform surgery. The risk of rupture from small aneurysms is often low and surgery for a brain aneurysm may carry some risk. In such cases, our physicians assess you regularly with imaging studies (such as CTA or MRA) to ensure the aneurysm is not growing.
With microvascular clipping, our cerebrovascular surgeons use a microsurgical approach to place a tiny metal clip, similar to a clothespin, at the base of the aneurysm to cut off its blood supply. This brain aneurysm treatment can prevent it from growing or rupturing. For an unruptured aneurysm, you may spend two nights in the hospital after the procedure (longer if the aneurysm ruptured). Aneurysms that are clipped usually don’t recur.
Endovascular coiling (or embolization)
With this minimally invasive approach, a catheter is inserted into an artery in the groin or wrist and threaded to the site of the brain aneurysm. Surgeons introduce tiny platinum coils through the catheter and fill the aneurysm to help it heal and lower the chance of rupture. You may stay in the hospital for one day after coiling or embolization for an incidental aneurysm (longer if it had ruptured).
Endovascular flow diverters
In this minimally invasive approach, an endovascular surgeon inserts a flow diverter (tiny mesh tube) via a catheter into the affected artery to reduce blood flow to the aneurysm and promote occlusion (closing of the artery).
For some complex cases, doctors may use a combination of brain aneurysm treatment approaches. They can use a bypass approach, in which blood flow around your aneurysm is rerouted and treated with clipping or endovascular embolization. They may also use special brain mapping techniques to approach delicate areas of your brain with precision to avoid injuring healthy brain tissue. Stenting can also be used in conjunction with coils.
In some cases, your doctor may prescribe medications to treat symptoms and complications of brain aneurysms.
A ruptured brain aneurysm may cause an intense headache, vision problems, or other symptoms, while an unruptured aneurysm may cause pain above and behind an eye, vision changes, or no symptoms at all.
Not all brain aneurysms are hereditary, but you may have an increased risk of developing one if you have close family members who had one.
It can take many years or as little as a week for a brain aneurysm to grow; some never do grow, and this is why continued monitoring is important. If you’ve been diagnosed with an unruptured aneurysm, your doctor will observe you over time to determine if and when treatment is needed.
You may have a brain aneurysm and not even know it, or you may have symptoms that resemble those of other conditions. Seek specialized care if you have brain aneurysm symptoms or if your doctor spots signs of an aneurysm through an MRI. If you experience a sudden, severe headache, especially when it is combined with any other neurological symptoms, you should get medical attention immediately.
A brain aneurysm can cause pain in the neck or head areas, or not at all. It may cause pain above and behind an eye or, if ruptured, it may cause what feels like the “worst headache of your life.”
About 6 percent of people in the United States have an unruptured brain aneurysm. Ruptured aneurysms affect 30,000 Americans each year.
Trust NewYork-Presbyterian for Brain Aneurysm Treatment
At NewYork-Presbyterian, we use the latest technologies to diagnose and treat brain aneurysms accurately and effectively, including specialized monitoring and minimally invasive surgery. Many patients are transferred to our centers because we provide advanced neurologic care that’s not available in many other hospitals.
Our Neuro-ICUs provide monitoring around the clock and specialized treatment for our most critically ill patients. They are among the few in the world with dedicated scanners within each unit, enabling us to perform immediate imaging of the brain. We integrate rehabilitation as early as possible into the care of our patients who need it, using state-of-the-art treatments not widely available at other centers in the New York metropolitan area.
If you have aneurysm symptoms or have already been diagnosed, call today to make an appointment with one of our experts.