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Cerebral aneurysms

Cerebral aneurysms are very rare in children. Often there are no symptoms leading up to the aneurysm. However, if your child complains about headaches, has trouble seeing, or loses consciousness, they should be seen by a doctor as soon as possible. While there is no known way to prevent aneurysms, emergency surgery can usually save the life of a child who is seen right away.

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What is a cerebral aneurysm?

A cerebral aneurysm (also known as an intracranial or intracerebral aneurysm) is a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood. The bulging aneurysm can put pressure on a nerve or the surrounding brain tissue. It may also leak or rupture, spilling blood into the surrounding tissue. This is called a hemorrhage. Some cerebral aneurysms, particularly those that are very small, do not bleed or cause other problems. Cerebral aneurysms can occur anywhere in the brain, but most are located along a loop of arteries that run between the underside of the brain and the base of the skull.

Aneurysms may burst and bleed into the brain, causing serious complications, including hemorrhagic stroke, permanent nerve damage and sometimes they can be fatal. Once it has burst, the aneurysm may burst again and bleed into the brain, and additional aneurysms may also occur. More commonly, rupture may cause a subarachnoid hemorrhage— bleeding into the space between the skull bone and the brain. A delayed but serious complication of subarachnoid hemorrhage is hydrocephalus, in which the excessive buildup of cerebrospinal fluid in the skull dilates fluid pathways called ventricles that can swell and press on the brain tissue. Another delayed postrupture complication is vasospasm, in which other blood vessels in the brain contract and limit blood flow to vital areas of the brain. This reduced blood flow can cause stroke or tissue damage.

There are three types of cerebral aneurysm:

Aneurysms are also classified by size:

Who gets them?

Brain aneurysms can occur in anyone, at any age. They are more common in adults than in children and slightly more common in women than in men. Children and adults with certain inherited disorders are also at higher risk.

All cerebral aneurysms have the potential to rupture and cause bleeding within the brain. The incidence of reported ruptured aneurysm is about 10 in every 100,000 persons per year (about 30,000 individuals per year in the U.S.), most commonly in people between ages 30 and 60 years. Possible risk factors for aneurysms seen in children are severe head trauma and infection.

What causes a cerebral aneurysm?

Cerebral aneurysms can be congenital, resulting from an abnormality in an artery wall that occurs before a baby is born. Cerebral aneurysms are also more common in people with certain genetic diseases, such as connective tissue disorders like Marfan syndrome and polycystic kidney disease, and certain circulatory disorders, such as arteriovenous malformations (snarled tangles of arteries and veins in the brain that disrupt blood flow).

Other causes include trauma or injury to the head, high blood pressure, infection, tumors, atherosclerosis (a blood vessel disease in which fats build up on the inside of artery walls) and other diseases of the vascular system, cigarette smoking, and drug abuse. Aneurysms that result from an infection in the arterial wall are called mycotic aneurysms.

Cancer-related aneurysms are often associated with tumors of the head and neck.

What are the symptoms?

Most cerebral aneurysms do not show symptoms until they either become very large or burst. Small, unchanging aneurysms generally will not produce symptoms, whereas a larger aneurysm that is steadily growing may press on tissues and nerves. Symptoms may include pain above and behind the eye; numbness, weakness, or paralysis on one side of the face; dilated pupils; and vision changes. When an aneurysm hemorrhages, an individual may experience a sudden and extremely severe headache, double vision, nausea, vomiting, stiff neck, and/or loss of consciousness. Adults usually describe the headache as “the worst headache of my life” and it is generally different in severity and intensity from other headaches people may experience. Children may express their pain differently. “Sentinel” or warning headaches may result from an aneurysm that leaks for days to weeks prior to rupture. Only a minority of individuals have a sentinel headache prior to aneurysm rupture. If your child complains of head pain or cries with pain, or if you notice any changes in facial expression or eye movement, it is very important to contact your doctor immediately. If your child is experiencing an aneurysm, emergency surgery may just save a life.

Other signs that a cerebral aneurysm has burst include nausea and vomiting associated with a severe headache, a drooping eyelid, sensitivity to light, and change in mental status or level of awareness. Some individuals may have seizures. Individuals may lose consciousness briefly or go into prolonged coma. Again, if your child is experiencing this “worst headache,” especially when it is combined with any other symptoms, you should seek immediate medical attention.

Testing and diagnosis

Most cerebral aneurysms go unnoticed until they rupture or are detected by brain imaging that may have been obtained for another condition. If your child does have an aneurysm, several diagnostic methods are available to provide information about the aneurysm and the best form of treatment.

In addition, the doctor will ask you and, when possible, your child to describe the symptoms, when they started and how long they lasted. The doctor will also examine your child and take a complete medical history, including a family medical history.

How are they treated?

Not all cerebral aneurysms burst.  If your child is diagnosed with very small aneurysms, they may be monitored to detect any growth or onset of symptoms and to ensure aggressive treatment of coexisting medical problems and risk factors.

It is important to note that, like your child, each case is unique, and considerations for treating an unruptured aneurysm include the type, size, and location of the aneurysm; risk of rupture; the  age and health of your child, as well as any recent  head injuries, diseases or disorders, personal and family medical history and, of course, risk of treatment. Your neurology team will discuss all options and risks with you prior to treatment.

Two surgical options are available for treating cerebral aneurysms and when it comes to performing them, you can trust that our specialists are among the best in the nation. However it is important to note that any surgery, and especially brain surgery, can carry some risk to your child (such as possible damage to other blood vessels, the potential for aneurysm recurrence and rebleeding, and the risk of post-operative stroke).

Endovascular embolization is an alternative to surgery. Once your child has been anesthetized, the doctor inserts a hollow plastic tube (a catheter) into an artery (usually in the groin) and threads it, using angiography, through the body to the site of the aneurysm. Using a guide wire, detachable coils (spirals of platinum wire) are passed through the catheter and released into the aneurysm. The coils fill the aneurysm, block it from circulation, and cause the blood to clot, which effectively destroys the aneurysm. The procedure may need to be performed more than once during your child’s lifetime.

After treatment, your child will remain in the medical center until the bleeding stops. In addition, underlying conditions, such as high blood pressure, will be treated. Any other treatments your doctor recommends will be based on your child’s symptoms and may include anticonvulsants to prevent seizures and analgesics to treat headache. Vasospasm can be treated with calcium channel-blocking drugs and sedatives may be ordered if your child is restless to help keep him or her as still as possible during the recovery stage.

Several months following the rupture, a shunt may be surgically inserted into a ventricle if the buildup of cerebrospinal fluid is causing harmful pressure on surrounding tissue in your child’s brain. Depending on the type and severity of your child’s aneurysm, rehabilitative, speech, and occupational therapy may be needed to help him or her regain lost function and learn to cope with any permanent disability. Your neurology team will work with you and your family to determine the best course of action to restore your child’s quality of life, now and in the future.

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If your child has been diagnosed, you probably have lots of questions. Call our offices at: 682-885-2500 to schedule an appointment, refer a patient or speak to our staff.

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