Can an Unruptured Brain Aneurysm Rupture?

From the moment a suspected aneurysm is discovered, the question arises: can an unruptured brain aneurysm rupture and how can we prevent it?

Neurologists often suggest medical intervention when an aneurysm is detected, even if it is unruptured. This is due to the high risk of rupture and the potential severe consequences of such a rupture.

In my own case, a “suspicious shadow” was observed during a CT scan in the emergency room (ER). A subsequent intracerebral angiogram revealed an unruptured aneurysm in my internal carotid artery, with a ‘nipple’ projection that increased the likelihood of rupture. In consultation with my neurologist, I opted for a coiling procedure, scheduled to take place six months after the initial bleed.

Understanding Aneurysms and Their Risks

A brain aneurysm is a weakened area in the wall of a brain artery that causes the formation of a sac-like bulge. When this bulge becomes large enough to burst, it can result in a stroke or brain hemorrhage, leading to serious health complications, disability, or even death.

The presence of a ‘nipple’ projection in an aneurysm can significantly increase the likelihood of rupture. This projection can cause mechanical stress and instability in the aneurysm, making it more prone to bursting.

Medical Interventions to Prevent Aneurysm Rupture

After the diagnosis of an unruptured aneurysm, the primary goal is to prevent its rupture. The medical procedure recommended in such cases is the aneurysm coiling, which is a minimally invasive surgery to block blood flow into the aneurysm and prevent its further growth or rupture.

The coiling procedure involves inserting a small, soft catheter into an artery in the leg, guiding it to the brain, and then filling the aneurysm with small platinum coils. The coils prompt a blood clot to form inside the aneurysm, effectively sealing it off from the blood flow and preventing rupture.

Case Study: My Experience with Coiling

Upon being informed of the “suspicious shadow” on my CT scan, I was referred for an intracerebral angiogram. The angiogram confirmed the presence of an unruptured, large aneurysm near my internal carotid artery with a ‘nipple’ projection.

My neurologist emphasized the increased risk of rupture due to the ‘nipple’ and recommended a coiling procedure six months later, to allow the brain to recover from the initial bleed.

The coiling process itself was a fascinating yet daunting experience. Despite the pre-procedure anxiety, the actual procedure took about three hours. A small incision was made in my leg, and a catheter was guided into a blood vessel and through the arteries to the brain.

The recovery period was minimal, requiring only one night in the hospital for observation. This was a stark contrast to the initial hemorrhagic stroke that had left me in the ICU for two weeks. The relief after the procedure was palpable: the ‘ticking time bomb’ of the aneurysm was removed.

Conclusion

While the thought of an unruptured aneurysm is terrifying, modern medical interventions like coiling can effectively reduce the risk of rupture and improve outcomes. It is crucial to consult with a neurologist if an aneurysm is detected, and to follow their recommendations to ensure the best possible outcome.