Cerebral aneurysms is usually the disease of the blood vessels of the brain, in which there is a weakness in the wall of the artery resulting in abnormal small saccular focal dilatation.

The etiology is not known, but they may occur at points of pressure differences where the artery bifurcates, resulting in the weakness in the walls, and with time gradually they enlarge and dilate. The other cause may be congenital wall weakness. There are few genetic diseases, which predispose to aneurysm formation. So, if there is a person who have two close relatives suffered from aneurysm, it is recommended to perform a surveillance imaging.

Aneurysms are present around 5% of the population, among which 15-20% may have multiple aneurysms.

Risk factors include

• Old age
• Smoking
• Hypertension
• Atherosclerosis
• Drug use
• Head injury
• Heavy alcohol consumption

Presentation:

They may either be identified as:

• Ruptured Aneurysm
• Unruptured Aneurysm

Ruptured Aneurysms: These patients usually present with headaches. A headache which is very severe in intensity, as they have never ever experienced before. We call it a” thunder clap headache”. Later, the patient may become drowsy and even comatose, if the bleeding is persistent and did not stop. Such patients should be urgently admitted and treated as an emergency because the chances of rebleed is very high.

Unruptured Aneurysms: It’s a big debatable topic. There are many schools of thoughts regarding the treatment of such aneurysms. The international study for unruptured intracranial aneurysm (IUSIA) has done a research study to evaluate this. According to them, aneurysm less than 7 mm size have a low rate of rupture. Rupture rate also vary depending from which artery the aneurysm is arising. So, we should always keep this in our mind that any aneurysm can rupture at any time and accordingly, the whole scenario should be discussed with the patient about the risk factors of rupture and prophylactic surgery. Young patient with smaller size aneurysms with history of smoking are more at risk for rupture then a healthy old person with the same size aneurysm.

Surgery is the only definitive treatment for aneurysm. It can be done

• Open procedure: In this we do a craniotomy and reach the concerned vessel and clip the aneurysm using metallic clips.

• Endovascular procedure: In this, through the artery in the groin we reach the concerned vessel endovascularly, and put small metal coils in the aneurysm.

Post coiling DSA of Ica Aneurysm

Both the procedures have their own benefits and side effects, but are equally effective in the treatment of aneurysms according to the international subarachnoid aneurysm trail (ISAT)