What is a brain aneurysm? A brain aneurysm is an abnormal, outward bulging of an artery in the brain caused by weakness in the arterial wall  Aneurysms can occur at any age, but aneurysms are usually detected in patients between the ages of 40 and 60 years. In addition, aneurysms are more prevalent among women (60%), and approximately 20% of patients have two or more aneurysms. Most individuals do not experience any symptoms from an aneurysm and only realize that they have one once it ruptures. Cerebral aneurysms can rupture and cause a serious stroke of death, and cause bleeding into the brain or the space closely surrounding the brain called the subarachnoid space.   What causes aneurysms? There are various causes for brain aneurysms. Some people may be genetically prone to aneurysms. Your physician will be interested in your family history. Smoking, high blood pressure, alcohol, and underlying diseases can increase the risk for developing a brain aneurysm What are the symptoms of brain aneurysms? Many people will not experience symptoms at all. Some aneurysms can go unnoticed for a lifetime. However, some aneurysm patients will experience the following symptoms:   •Limited eye movement • Dilated pupils • Double vision • Pain above and behind eye • Localized headache What is a Ruptured Aneurysm? Rupture of a cerebral aneurysm is considered a medical emergency, and 25% of patients suffering a ruptured aneurysm will die before reaching a hospital. When an aneurysm ruptures, blood will spill from the artery into the subarachnoid space surrounding the brain. The rupture can lead to stroke, vasospasm (constriction of the brain arteries) and increased pressure on the brain. Over half will die within the first 30 days after the hemorrhage. Sometimes patients describing “the worst headache in my life” are actually experiencing one of the symptoms related to a ruptured brain aneurysm. Other symptoms include: •Nausea and vomiting • Stiff neck or neck pain • Blurred vision or double vision • Pain above and behind the eye • Dilated pupils • Sensitivity to light • Loss of sensation   How are brain aneurysms diagnosed? Asymptomatic unruptured aneurysms can be diagnosed and located by MRI (magnetic Resonance Imaging) or by CT imaging. A cerebral angiogram can be performed to confirm the presence and boundaries of the aneurysm. A 3 Dimensional angiogram can be performed to help deterine an approch for treatement ruptured aneurysms, a CT scan will be performed. A lumbar puncture or spinal tap can also detect the presence of blood indicating the rupture of an aneurysm.   How big are aneurysms? Aneurysm Size Ranges: SMALL  Up to 10 mm LARGE  10 - 25 mm GIANT    Larger than 25 mm How are brain aneurysms treated? With the increase in imaging technology, more unruptured aneurysms are being detected more often. Although the aneurysm is unruptured, there is cause for concern and a treatment will most likely be warranted. Your physician will evaluate a number of factors when suggesting a course of treatment.  •Risk of hemorrhage – what is the probability of the    aneurysm rupturing? • Size and location • Age and health of patient • Family history • Surgical risks Depending on your aneurysm, the physician may recommend Surgical Clipping, Endovascular Coiling, or observation and medical management. Surgical Clipping Surgical clipping has been the traditional method for treatment of brain aneurysms. This method requires a neurosurgeon to perform a craniotomy (removal of part of the skull) to access the brain and blood vessels. The surgeon blocks blood flow to the aneurysm by applying a metal clip to its base, redirecting the blood flow away from the aneurysm. Then the wound is sealed again and closed.   Endovascular Coil Therapy Endovascular Coiling Therapy is a less invasive treatment method that produces better outcomes than surgical clipping in certain patients. Endovascular coil therapy is a minimally invasive procedure that accesses the treatment area from within the blood vessel. A catheter (small tube) is inserted into the patient’s femoral artery and advanced through the body until the aneurysm is accessed from the inside. Small, soft platinum coils are inserted through the catheter into the aneurysm. The coils are packed into the aneurysm to block the flow of blood into the aneurysm. By blocking the flow, the pressure on the aneurysm is reduced. Over time, new tissue will grow at the opening of the aneurysm and blood flow will be diverted away from the aneurysm. There are different types of coils available. Some coils have a coating that hydrates and packs the aneurysm while others have a bioactive coating to accelerate a tissue response. The procedure is performed in under the guidance of fluoroscopic X-rays. The fluoroscopy allows the physician to visualize the vasculature and properly place the coils.