Your guide to aneurysm: types, symptoms, diagnosis and treatment
What is an Aneurysm?
An aneurysm is an enlargement of a blood vessel caused by a weakening of its structure. When the blood vessel wall becomes thin blood pressure causes it to bulge outwards.
Aneurysms can happen almost anywhere in the body, but the most common is in the brain (Cerebral Aneurysms) and the aorta (Abdominal Aortic Aneurysms and Thoracic Aortic Aneurysms).
Many aneurysms will not rupture and do not have any symptoms – however, if they do rupture this can cause a haemorrhage (bleeding) and is a life-threatening condition.
Identifying aneurysms early on allows them to be treated to minimise their risk of growing larger and rupturing.
Types of Aneurysms
There are many types of aneurysms, which can happen in different areas of the body. The following are some of the most common types:
Cerebral Aneurysms, also known as intracranial or brain aneurysms, are located in the blood vessels of the brain, usually an artery. Most are very small, will not rupture and have no symptoms. However, if they do rupture they can be life-threatening and create severe symptoms (described below). There are different kinds of cerebral aneurysms but the most common is described as saccular, meaning the blood vessel will balloon outwards.
Abdominal Aortic Aneurysms (AAAs) happen in the aorta, a large artery that supplies blood to the abdomen, pelvis and legs. Small AAAs tend not to rupture and large ones are rare, but also pose a serious health risk and can be fatal.
Thoracic Aortic Aneurysms (TAAs) also happen in the aorta, but higher up in the chest area. TAAs rarely rupture but can be life-threatening when they do. They are also less common than both AAAs and cerebral aneurysms.
The different types of aneurysms tend to have common causes including age, smoking, obesity, high blood pressure or diabetes. However, some causes are more likely to be linked with different types of aneurysms. For example, cerebral aneurysms are more likely to be congenital or result from head trauma or high blood pressure (John Hopkins Medicine, 2023). A condition called atherosclerosis, which causes the arteries to narrow is related to all three conditions.
Symptoms and Warning Signs
Aneurysms tend to be symptomless until they rupture making them difficult to detect and treat. However, there are symptoms and early warning signs that can help you get medical treatment quickly if an aneurysm has ruptured or is dangerously enlarged.
If you experience the symptoms of a ruptured aneurysm it is a medical emergency and you should contact a health care professional immediately.
While many symptoms are dependent on the type of aneurysm that has ruptured there are some that will occur in many different cases. This includes a rapid heartbeat, sudden intense headache, nausea and vomiting and loss of consciousness.
Cerebral Aneurysms often present an extreme headache (people often describe it as the worst they have experienced), neck pain or stiffness, light sensitivity, confusion, blurred vision, changes in mental state and loss of consciousness.
AAAs usually lead to severe constant pain in the abdomen (belly or back), the sensation of a pulse in the abdomen and nausea or vomiting.
For TAAs pain may be located in the back or chest; coughing, difficulty swallowing and shortness of breath may also be present as well as pain in the jaw or neck.
If you experience these symptoms, you should seek medical attention urgently.
While aneurysms are usually not detected before they rupture, there are some early warning signs that may signal an aneurysm may be dangerously large. Pain in the associated area (belly, chest, back or head) can be associated with a dangerous aneurysm – while pain may be attributed to many factors if you experience it frequently alongside other warning signs it may be a good idea to consult your doctor. Other warning signs are the sensation of throbbing or pulsing in the area affected by the aneurysm. With cerebral aneurysms persistent and unexplained headaches is also a sign to look out for.
Diagnosis and Risk Factors
Aneurysms can be diagnosed in a variety of ways. Doctors will analyse symptoms, risk factors and use tests and scans to make a diagnosis.
Because they usually have no symptoms before rupturing, aneurysms are often diagnosed during a screening or an examination for a different condition.
If a cerebral aneurysm is suspected, an MRI or CT scan can be used. These technologies allow healthcare workers to examine the blood vessels within the brain and check if there are any signs of an aneurysm. If it is thought that the aneurysm is ruptured, CT angiography may be used in which a special kind of dye is injected into the bloodstream allowing clearer images of the blood vessels to be examined (NHS, 2022).
With AAAs, an ultrasound is usually used. Using sound waves, the technology can create an accurate picture of blood vessels within the abdomen.
Some people are at greater risk of developing an aneurysm. This includes:
- Smokers or ex-smokers
- Those with a family history of aneurysms
- People with genetic conditions like Marfan syndrome and Ehlers-Danlos syndrome (Meester et al, 2017)
- People over 65
- Men (men are more likely than women to develop aneurysms, especially AAAs)
- Anyone who has previously had an aneurysm
It is important to understand which factors can contribute to the development of an aneurysm, as this can help you to be aware of how at risk you are and attend a screening or medical examination if necessary.
Treatment Options
If aneurysms are identified before they rupture, they are usually monitored with regular scans and treated only if they are at risk of rupturing — this may involve medication but usually requires surgery. Surgery for an aneurysm involves repairing or strengthening the weakened blood vessel, or cutting off blood flow to prevent it from rupturing.
Once an aneurysm has ruptured, emergency surgery is needed to repair or replace the damaged blood vessel.
For cerebral aneurysms two surgical procedures are usually carried out: Neurosurgical clipping and Endovascular coiling.
Neurosurgical clipping involves locating the aneurysm in the brain while the patient is under general anaesthetic and ‘clipping’ it. This refers to placing a metal clip on the aneurysm which will prevent it from growing or rupturing.
Endovascular coiling is a less invasive procedure which involves inserting a tiny metal coil into the bloodstream (in an artery in the groin). The coil is then passed through the bloodstream to the site of the aneurysm where it is used to prevent blood flow into the aneurysm, which may prevent it from rupturing.
For large AAAs or TAAs at risk of rupturing, open surgery may be used to repair the weakened aorta. An incision is made in the abdomen and the damaged part of the aorta is removed and replaced with a graft.
An alternative is an Endocasvular surgery – similar to coiling this involves passing a graft through the bloodstream to the site of the aneurysm.
Surgeries for aneurysms are high risk, with many possible complications. This is why they are only recommended when an aneurysm is at a high risk of rupturing. In other cases, doctors will usually monitor an aneurysm and recommend preventive measures to limit the chances of rupture.
Preventive Measures
Preventing aneurysms is not always possible depending on the cause, but making lifestyle changes can help reduce the risk of developing an aneurysm. For existing aneurysms ensuring that they are regularly monitored and following your doctor’s advice on any changes in your diet or lifestyle is the best way to limit the possibility of allowing the aneurysm to rupture.
Aneurysms are linked to general health. Exercise, a healthy diet and avoiding smoking and drinking a lot of alcohol can help to improve your cardiovascular health.
Smoking or using tobacco products is a well-established cause of aortic aneurysms. Quitting smoking can be difficult, but there are many resources available to help give up the habit, which can make a huge difference to your long-term health, including reducing your risk of aneurysm.
Alcohol abuse has also been linked to cerebral aneurysms and stopping drinking or reducing the amount you drink can help to improve your general health.
A balanced diet with a lot of fruit and vegetables with limited fats (especially saturated and trans fats) and salt can help to prevent aneurysms. While no specific vitamins or supplements have been directly linked to reducing the risk of aneurysms, many can improve general and cardiovascular health.
High blood pressure is a significant cause of aneurysm risk. Staying healthy can keep your blood pressure within a good range and help to reduce your risk of developing aneurysms and their rupture.
If you are at greater risk of aneurysms, screenings could help to diagnose them earlier, leading to more effective treatment or management. Book an eye test today, to ensure your eye health is not compromised.
References
Johns Hopkins Medicine (2023) Aneurysm. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/aneurysm
Meester, J., Verstraeten, A., Schepers, D., Alaerts, M., Van Laer, L. and Loeys, B. (2017). Differences in manifestations of Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Annals of Cardiothoracic Surgery, 6(6), pp.582–594. Doi: https://doi.org/10.21037/acs.2017.11.03.
NHS. (2022) Diagnosis - Brain aneurysm. Available at: https://www.nhs.uk/conditions/brain-aneurysm/diagnosis/#:~:text=CT%20angiography%20is%20usually%20preferred,up%20by%20a%20CT%20scan
