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Aneurysm, Brain (cont.)

Exams and Tests

If the doctor suspects a ruptured aneurysm, you will have a complete physical exam, with particular attention to the neurologic exam.

The doctor will be very concerned about your level of consciousness and the presence or absence of localized nerve problems.
The doctor will seek a quick focused history from you, or from family members if you are unable to give information.
The doctor quickly will try to determine the likelihood that you have a ruptured aneurysm as opposed to other causes of headache or alterations of consciousness.
Your physical examination and the history of the event will guide further diagnostic testing.
Any time you become unstable, such as changes in blood pressure, decreasing level of alertness, or difficulty breathing, the doctor may perform life-saving maneuvers. Such maneuvers might include placing a tube down your throat to protect your airway and provide adequate breathing.
If you have no symptoms, the doctor may include in your workup many of the following tests, although the tests may be performed on an outpatient basis.
- A CT scan of your brain: A CT scan will detect acute bleeding from a ruptured aneurysm about 90% of the time.
  - Aside from the bleeding, CT scans are able to detect some complications of a ruptured aneurysm such as swelling of the brain.
  - A plain CT scan is not a good test to use to detect aneurysms that have not ruptured.
- A lumbar puncture (spinal tap): If the CT scan shows no evidence of bleeding in your brain, the doctor may perform a lumbar puncture.
  - This procedure involves placing a needle into your spinal canal in the low back, below the level at which the spinal cord ends.
  - The doctor will collect spinal fluid and send it to the lab to look for the presence of blood.
  - If blood is present, particularly if the spinal fluid is yellow, you have bleeding in the brain and the workup proceeds further.
- Cerebral angiography: The doctor likely will perform this test next.
  - The doctor places a catheter into your groin while you are under local anesthesia. It is threaded up toward your brain and then injects an x-ray contrast dye into your arteries.
  - The doctor will take several x-rays to be reviewed by neurosurgeon and a radiologist.
  - These x-rays help the neurosurgeon locate the aneurysm and determine how to manage it.
  - They also will show the presence of other aneurysms.
- Magnetic resonance angiography: Like an MRI, this test is very useful for detecting unruptured aneurysms and for screening high-risk patients.
  - It is noninvasive and virtually risk-free.
  - Doctors consider the test inadequate for planning surgery.
- Helical CT angiography: This test is a recent addition to the diagnostic possibilities.
  - It does involve administering x-ray contrast dye and is not risk-free.
  - It has the potential to aid in surgical planning in that it demonstrates the relation of the aneurysm to bony structures of the skull base.