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Our team of neurosurgeons, interventional neuroradiologists, neurologists, and radiation specialists offer the latest advanced treatments and diagnostics for brain aneurysms. With careful monitoring and treatment, we can even stop many aneurysm ruptures before they happen.

What Is a Brain Aneurysm?

A brain aneurysm (also called a cerebral aneurysm) is a weak, bulging area in an artery in the brain. Aneurysms can form anywhere in the brain, but they most often appear at the base of the skull.

When an aneurysm ruptures, or bursts, it is a medical emergency. A ruptured aneurysm can lead to bleeding in the brain, which is called a subarachnoid hemorrhage. This brain bleed can lead to brain damage, stroke, or even death.

The neurovascular team at the Brigham and Women’s Hospital’s Center for Cerebrovascular Diseases provides a multidisciplinary approach to patient care that combines neurosurgery, neurology, and interventional neuroradiology.

How Rare Are Brain Aneurysms?

About 1 out of every 50 people has an unruptured brain aneurysm. Many do not know it because they do not have symptoms. Around 30,000 Americans experience a ruptured brain aneurysm each year.

What Does a Brain Aneurysm Look Like?

Brain aneurysms are bulges on an artery. Saccular aneurysms are the most common type. They are rounded and appear at a branch point or on one side of an artery. These aneurysms are known as berry aneurysms because of their round shape. Fusiform and mycotic aneurysms look more like ballooning of the entire vessel.

Types of Brain Aneurysms

The three main types of brain aneurysm are:

• Saccular aneurysms: The most common type of aneurysm is also called a berry aneurysm because of its rounded shape. Saccular aneurysms are blood-filled sacs found at a branch point or on one side of an artery, usually in a large vessel at the base of the skull.
• Fusiform aneurysms: These aneurysms cause bulging on all sides of an artery.
• Mycotic aneurysms: Bacterial, fungal, or viral infections can weaken arteries in the brain. This damage can lead to mycotic aneurysms. They often appear on the smaller vessels of the brain rather than those at the base of the skull.

Symptoms of a Brain Aneurysm

Brain aneurysms typically cause no symptoms unless they rupture. Knowing the signs of an aneurysm rupture can be lifesaving.

Unruptured Aneurysm Symptoms

Most unruptured brain aneurysms do not cause any symptoms. Large unruptured aneurysms may press on a nerve or other parts of the brain. In those cases, you may notice these symptoms:

• Drooping of one eyelid
• Vision changes
• Weakness or numbness

Ruptured Aneurysm Symptoms

A ruptured brain aneurysm often causes a sudden, severe headache that is different in quality from a usual headache. Many people describe it as the worst headache of their life.

Call 911 if you experience a sudden and severe headache or any of these symptoms:

• Confusion
• Light sensitivity
• Nausea or vomiting
• Stiff neck
• Double vision
• Drooping eyelid

What Causes Brain Aneurysms?

Brain aneurysms form when the walls of an artery in the brain become thin or weak. Several factors can contribute to this weakening, including smoking and family history.

Brain Aneurysm Risk Factors

Women are more likely to get an aneurysm than men, as are people ages 30–60. Black and Latino individuals are twice as likely to have an aneurysm as white individuals. Other risk factors that make you more likely to get an aneurysm include:

• Connective tissue disorders like polycystic kidney disease, , or Ehlers-Danlos syndrome
• Family history of aneurysms (parent, sibling, or child)
• Smoking
• High blood pressure

How to Prevent Brain Aneurysms

We do not always know what causes a brain aneurysm, so it can be difficult to prevent one. However, you can take important steps to lower your risk.

People with connective tissue disorders or a family history of aneurysms should see a neurosurgeon or neurovascular specialist. Regular monitoring can help determine when treatment is needed. Talk to your primary care doctor if you’re concerned about your risk for brain aneurysms.

The best way to prevent brain aneurysms is to make lifestyle changes that also reduce your risk for other health conditions. Some steps you can take include:

• Quit smoking
• Control high blood pressure

How Do You Prevent a Brain Aneurysm From Rupturing?

You can reduce your risk of a ruptured aneurysm by managing your risk factors. Steps you might need to take include lowering your blood pressure, stopping smoking, controlling diabetes, and losing weight.

We can also treat unruptured aneurysms with medication and monitor for any changes in their appearance or blood flow.

Diagnosing Brain Aneurysms

Advanced imaging and other diagnostic tools help us find brain aneurysms and determine treatment options. These tests can identify both unruptured and ruptured aneurysms and guide treatment plans.

Tests we use to diagnose brain aneurysms include:

• Magnetic resonance angiography (MRA): This is a type of MRI that takes images of blood vessels. It does not involve the use of contrast dye.
• Computed tomography angiography (CTA): This is a type of CT scan that uses contrast dye to produce images of the blood vessels.
• Cerebral angiography: This test uses a long, thin tube called a catheter, which is gently inserted into an artery in your wrist or groin. A special dye is then injected to make the blood vessels in your brain show up clearly on an X-ray. Although this procedure is more invasive than other imaging tests like an MRA or CTA, it can provide more detailed information.
• Cerebrospinal fluid analysis (CSF): This test involves collecting a small sample of spinal fluid. A doctor uses a small needle to gently insert into the spinal canal in a procedure called a lumbar puncture (or spinal tap). It can help show if an aneurysm has ruptured, but it cannot detect whether an aneurysm is present.

When to Seek a Diagnosis for a Brain Aneurysm

Understanding the signs and risk factors for an aneurysm is crucial for proper diagnosis and treatment. If you have a strong family history of aneurysms (two close relatives with brain aneurysms), your doctor may recommend a screening test like an MRA to check for an aneurysm. It’s important to get care at a center that specializes in treating brain aneurysms.

When To Call 911

A ruptured aneurysm is a medical emergency. The first sign is a sudden and severe headache that is often described as the worst headache of your life. Call 911 for that type of headache or these other symptoms:

• Confusion
• Light sensitivity
• Nausea or vomiting
• Stiff neck
• Double vision
• Drooping eyelid

When To Call Your Doctor

It is possible to not have any symptoms with an unruptured aneurysm. Call your doctor if you notice:

• Drooping of one eyelid
• Vision changes
• Weakness or numbness

Brain Aneurysm Screening and Monitoring

Unruptured aneurysms do not always need treatment. In many cases, we use imaging to monitor low-risk aneurysms or screen people who are more likely to develop an aneurysm.

Your doctor may recommend regular screenings for brain aneurysm because of:

• Family history: People who have two close family members (parent, sibling, or child) with an aneurysm are at higher risk themselves.
• Connective tissue disorders: Conditions like polycystic kidney disease, Ehlers-Danlos syndrome or Marfan syndrome increase your likelihood of developing an aneurysm. These conditions can weaken the walls of your blood vessels, making them more vulnerable to an aneurysm.

Brain Aneurysm Treatments

Time and precision are critical when treating a ruptured brain aneurysm. An unruptured aneurysm, on the other hand, can often be treated on a planned, non-emergency basis. The goal of brain aneurysm treatment is to prevent or stop a brain bleed and protect your brain from long-term damage. At Mass General Brigham, we offer a wide range of treatments for all types of brain aneurysms.

Your treatment plan depends on factors like your overall health, the type and size of the aneurysm, and your age. In many cases, we can use minimally invasive endovascular procedures that avoid the need for open brain surgery. If your aneurysm does not require treatment right away, we will monitor it closely.

Brain aneurysm treatments we offer include:

• Endovascular coil embolization: This is a minimally invasive procedure that uses a thin, flexible tube (catheter) to reach the blood vessels in the brain. Through the catheter, a soft metal coil is placed inside the aneurysm to block blood flow and help prevent rupture. In some cases, small mesh tubes called stents are used to help hold the coil in place. Sometimes, a mesh-like device called an endosaccular device is used instead of a coil.
• Flow diversion: Some aneurysms can be treated using a device called a flow diverter. It’s similar to a stent but has smaller mesh openings. The flow diverter gently redirects blood away from the aneurysm. Over time, this helps the aneurysm seal off and heal.
• Microsurgical clipping: This is a type of open surgery. The surgeon makes a small opening in the skull and places a tiny titanium clip at the base of the aneurysm to stop blood flow. This helps prevent the aneurysm from growing or rupturing.
• Microsurgical bypass: Large or complex aneurysms may require a bypass procedure. During this procedure, we take a blood vessel from another part of the body and use it to create a new route around the aneurysm. This technique allows blood flow to be cut off from the aneurysm without directly clipping the aneurysm.
• Clinical trials and new therapies: Our researchers are leading the study of new therapies and devices to treat brain aneurysms. This research and innovative clinical trials allow us to offer promising new treatments before they are widely available.

Brain Aneurysm Recovery and Rehabilitation

Brain damage from an aneurysm can affect many parts of your life—from how you move and speak to how you think and process information. At Mass General Brigham, we offer comprehensive rehabilitation services to help you recover, adjust to any changes, and relearn skills. Services we provide include:

• Cognitive assessments: A neuropsychologist can evaluate your cognitive function and identify affected areas, including memory, attention, problem-solving abilities, and language.
• Physical therapy: Physical therapists help you improve or regain strength, balance, coordination, and mobility. Physical therapy can also help you manage limitations and adjust to changes in your body after an aneurysm.
• Speech therapy: Speech therapy addresses communication challenges, including problems with speaking, understanding, reading, and writing. Speech therapists also address swallowing challenges so you can safely eat and drink.
• Occupational therapy: Occupational therapy focuses on increasing your independence after an aneurysm. Occupational therapists help you regain skills needed for daily life, such as dressing, bathing, and household chores.