Cerebral Aneurysm Disorder Treatment Doctor in Delhi, India

What is a cerebral aneurysm?

The cerebral aneurysms are basically outpouching of brain arteries, often at a weak spot and often looks like a berry hanging on a stem. A normal arterial wall is made up of three layers. If there is an abnormal loss or absence of the muscular layer of the artery wall, leaving only two layers, an aneurysm can form. 

The most common type of cerebral aneurysm is called a saccular, or berry aneurysm, occurring in 90 percent of cases. Other types of aneurysms are fusiform and dissecting aneurysm. Fusiform aneurysms are associated with atherosclerosis (Cholesterol plaque) and dissecting aneurysms are tears along wall of the artery, causing the blood to flow between the layers of the arterial wall. They can rupture because of trauma or in severe cases, can rupture spontaneously also.

Who is at a greater risk?

The ultimate cause of a brain aneurysm is an abnormal degeneration of the arterial wall causing its weakening. The effects of pressure from the pulsations of blood flowing through it enlarges it. However, there are a few identified risk factors for developing an aneurysm:

• Smoking
• High blood pressure
• Alcohol consumption or use of illicit drugs
• Advancing age
• Trauma to head
• Family history of aneurysms
• Arterio-venous malformations
• Coarctation of aorta
• Genetic diseases like Alpha-1-antitrypsin deficiency, Alpha Glucosidase deficiency, Klinefelter’s syndrome, Noonan syndrome, Tuberous sclerosis, Ehler Danlos syndrome, Fibromuscular dysplasia among others.
• Polycystic kidney disease

If you think you are an increased risk, get yourself screened by a trained neurosurgeon for presence of an aneurysm because timely treatment before it ruptures is lifesaving. We offer screening and consultation services for Cerebral aneurysms. Contact us

What does an aneurysm do? 

Aneurysms can sit silently in the brain for a very long time in the brain and grow larger and larger with time before finally giving away and causing catastrophic hemorrhagic stroke. Therefore, it is imminent to diagnose an aneurysm before it has ruptured to prevent any future disability or loss of life. 

If diagnosed early and treated, they are harmless and pose no threat to the individual or life. Unfortunately, in majority of the cases, an aneurysm is diagnosed when it has already ruptured or the weak spot gives away leading to a brain hemorrhage (a hemorrhagic stroke), technically called a “Subarachnoid hemorrhage”. The good news is that smaller aneurysms (less than 7mm) have a lower risk of rupture than the larger ones and thus, if detected early, while they are still small, they can be effectively treated before they burst. 

Aneurysms may cause symptoms by compression of brain structures which are usually caused by either an aneurysm in close proximity to nerves or by a large aneurysm technically known as a “Giant aneurysms”. Thus, they affect the function of that region of the brain. 

The most common symptom is closure of one eyelid. The other symptoms can be:

• Weakness of limbs 
• Pain above and behind one eye
• A dilated pupil
• Change in vision or double vision
• Numbness of one side of the face

If a hemorrhagic stroke has occurred due to aneurysmal rupture, the symptoms depend upon the site and severity of the stroke. 

Read more about stroke (Please insert the link)

How do I identify if an aneurysm has ruptured?

When an aneurysm ruptures, it is one of the most dramatic symptoms in medicine, often described as “very severe headache” or the “worst headache of my life”. Other symptoms of a subarachnoid hemorrhage are:

• Nausea and vomiting
• Stiff neck
• Blurred or double vision
• Sensitivity to light
• Seizure
• A drooping eyelid
• Loss of consciousness
• Confusion or altered mental status
• Dilated pupils
• Difficulty in moving one or more limbs or Imbalance
• Coma

It can also cause unconsciousness or the worst, sudden death.

The complications that can develop after the rupture of an aneurysm include:

• Re-bleeding: An aneurysm that has ruptured or leaked is at risk of bleeding again. Re-bleeding can cause further damage to brain cells.

• Vasospasm: After a rupture, blood vessels undergo constriction (vasospasm) as a defense to decrease the blood loss. This further decreases the blood supply to brain cells, causing them to die (ischemic stroke).
• Hydrocephalus: The leaked blood can block circulation of the brain fluid (CSF) leading to an excess of fluid and increased pressure on the brain, further damaging it.
• Hyponatremia: Subarachnoid hemorrhage can damage the vital centers of brain responsible for controlling the sodium in the body besides various other centers for our vital functions like breathing, awareness and blood pressure control. A decrease in sodium levels (hyponatremia) can lead to swelling of brain cells and cause permanent damage.

What increases risk of rupture of aneurysm?

While smaller aneurysms have lesser chances of rupture, there are various factors which predispose an aneurysm for rupture:

• Size more than 7 mm in diameter
• Aneurysm in the arteries supplying the backside of the brain
• Previous history of a ruptured aneurysm
• Trauma (injury) to head

How is an unruptured aneurysm diagnosed?

 With help of advanced imaging techniques used for brain scanning like CT scans, MRI and digital subtraction angiography (done in a Cath lab), we can efficiently diagnose even small aneurysms in the cerebral arteries. Hence, timely diagnosis and treatment is possible in all the cases if the patient presents to us in the early course of disease.

How do we diagnose Subarachnoid hemorrhage?

There are a number of investigations, ideally a CT scan done within first 6 hours helps in making a diagnosis of a Subarachnoid hemorrhage. Further presence, morphology and size of aneurysm is confirmed by Digital subtraction angiography (DSA).

How do we treat an aneurysm?

An unruptured aneurysm is can be treated via minimal access route (by making a small hole in the skull) or it can be treated by endovascular route, as preferred nowadays, in a modern neurovascular Cath lab by an endovascular surgeon. 

In Minimal access surgery, the blood flow into the aneurysm is stopped by clipping the blood vessel feeding into it. This is known as aneurysmal clipping. 

During the endovascular procedure (aneurysmal coiling or flow diversion), the surgeon enters the blood stream via the artery (usually of the groin) using a catheter and miniature devices like catheters, coils, flow diverters, flow disruptors and many other similar devices are used to wall off the blood flow into the outpouching or to obliterate the aneurysm itself. 

If an aneurysm has already been ruptured, it is a surgical emergency and needs to be managed like a stroke. 

Read more about treatment of stroke (insert link)

Is surgery a permanent cure?

A surgery by either of the routes is curative for the existing aneurysms and thus, preventing their risk of future rupture. But, it does not prevent formation of a new aneurysm elsewhere in the brain in future. Therefore, a regular follow up is necessary to see if any new aneurysms are growing.   

Can I treat aneurysms with medicines?

Unfortunately, intervention either interventional or microsurgical is the only treatment modality for an aneurysm. 

 I have been treating aneurysms by endovascalar route and microsurgical route since last 20 years or so, I can be called a hybrid neurosurgeon. I have continued to upgrade my skills like I did a fellowship in University of Zurich, University of Milawakee.

I also running a teaching fellowship in Neurovascaulr interventions for past 5 years now.

( Please add cartoon videos of coil embolizations and flow divertor and disruptors).

Patient testimonials.