Aneurysm

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Diagnosing and Treating an Aneurysm

In some patients without symptoms, an aneurysm may be detected on a scan that was done for another reason – this is called an incidental finding, and it often comes as a shock to the patient.  The patient should be referred to a neurological surgeon to confirm the diagnosis and for further evaluation.

In other cases, a patient reporting symptoms of an aneurysm may undergo one of these diagnostic tests at the direction of a primary care practitioner or a neurologist:

  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT)
  • Magnetic resonance angiography (MRA)
  • Computed tomography angiography (CTA)
  • Four-vessel cerebral angiography (angiogram)
  • Cerebral blood flow studies
  • Spinal angiography


These images may be used to detect whether an aneurysm is present. If an aneurysm is found, the imaging tests can help determine its location, size, and shape, all of which contribute to the risk of rupture. Based on that degree of risk, the neurosurgeon and the patient will discuss the options for treatment.

If there is little risk of rupture in a healthy, asymptomatic patient, the neurosurgeon may recommend a medical approach rather than a surgical one. In the nonsurgical approach, the aneurysm will be monitored while the patient undergoes medical treatment for one of the contributing factors (such as hypertension or high cholesterol), or commits to the lifestyle changes necessary to reduce risk (such as quitting smoking or breaking an addiction to drugs or alcohol).

If the aneurysm appears to be at risk for rupture, however, the neurosurgeon will likely recommend a surgical approach. The greatest risk factors for rupture are:

  • The size of the aneurysm. An aneurysm of 7mm or greater is at greater risk for rupture than a smaller one.
  • The location of the aneurysm. An aneurysm that is located toward the front of the brain (anterior), is less prone to rupture than one located toward the back of the brain (posterior).

 
The neurosurgeon will also consider the age and overall health of the patient, as well as medical and family history, before making a recommendation. Because the consequences of a ruptured aneurysm are so severe — stroke, coma, and even death — most patients at risk for a rupture will be referred for surgery. 

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Reviewed by: Jared Knopman, M.D.
Last reviewed/last updated: January 2015
Illustrations by Thom Graves, CMI