Brain Aneurysm (cont.)

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What are the signs and symptoms of brain aneurysm?

The headache associated with a leaking aneurysm is severe. Blood is very irritating to the brain and surrounding membranes and causes significant pain. Patients may describe the "worst headache of their life," and the health care practitioner needs to have an appreciation that a brain aneurysm may be the potential cause of this type of pain. The headache may be associated with nausea, vomiting, and change in vision. A subarachnoid hemorrhage also causes pain and stiffness of the neck because the meninges become inflamed. However, the "worst headache of their life" complaint needs to be matched with physical findings to be considered a risk factor for a leaking aneurysm.

How is brain aneurysm diagnosed?

The diagnosis of brain aneurysm begins with a high index of suspicion by the health care practitioner. The history of the headache, an acute onset of the headache, associated with a stiff neck and an ill-appearing patient on physical examination, typically lead the health care practitioner to consider the diagnosis and order a CT (computerized tomography) scan of the head. If the CT scan is performed within 72 hours of the onset of the headache, it will detect 93% to 100% of all aneurysms. In the few cases that are not recognized by CT, the health care practitioner may consider performing a lumbar puncture (LP, or spinal tap) to identify blood in the cerebrospinal fluid that runs in the subarachnoid space. Some hospitals will consider CT angiography of the brain instead of the LP.

If the CT or the LP reveals the presence of blood, angiography is performed to identify where the aneurysm is located and to plan treatment. Angiography, where a catheter is threaded into the arteries of the brain and dye is injected while pictures are taken, can demonstrate the anatomy of the arteries and uncover the presence and location of an aneurysm. CT angiography or MR angiography may be performed without threading catheters into the brain as is the case with a formal angiogram. There is some controversy as to which type of angiogram is best to assess the patient, and the kind chosen depends upon the patient's situation and condition.

Though the symptoms may suggest a brain aneurysm, other diagnoses may need to be considered. Migraine headache, meningitis, tumor, and stroke all may cause neurologic symptoms. Based on the patient's presentation, the health care practitioner will need to decide which tests and studies to use in addition to brain imaging to establish the correct diagnosis.

Medically Reviewed by a Doctor on 2/8/2016

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