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Aneurysm, Brain (cont.)

Medical Treatment

Ruptured brain aneurysm
- Doctors locate the aneurysm with cerebral angiography and then surgically clip it.
- Doctors generally perform the clipping within 72 hours because an aneurysm has a 30% risk of rebleeding. This risk peaks at 7 days and carries with it a 60% risk of poor outcome or death.
- For people with severe symptoms such as a coma, doctors often delay surgery and instead use other options.
- Options include interventional radiologic procedures such as placing a coil inside the blood vessel during the cerebral angiography. You can think of the coil as a clip placed within the aneurysm, rather than on the outside.
- Either the surgical clip or placing a coil effectively removes the aneurysm from your blood circulation system and eliminates the risk of rebleeding.
- Clipping also allows the doctor to more aggressively manage the associated spasm of your arteries that is likely to follow.
- Virtually all people with a brain aneurysm will receive nimodipine (Nimotop), a calcium channel blocker that helps prevent the blood vessel spasm that regularly accompanies ruptured aneurysms.
  - Additional methods of treating vessel spasm include inducing high blood pressure with fluids and medications in an effort to increase blood flow through areas of spasm and narrowing.
  - Doctors will use a special ultrasound exam, a transcranial Doppler ultrasound, to assess the degree of spasm and help guide treatment.
- Additional treatments that may be required depend on the severity of your symptoms and information obtained by diagnostic studies. These may include the following:
  - A drainage device may be placed through your skull to allow drainage of fluid and decrease pressure within your brain.
  - Antiseizure medications may prevent seizures that frequently accompany ruptured aneurysms.
  - Glucocorticoids, anti-inflammatory steroids, occasionally used to help control swelling in the brain, remain controversial because no proven benefit has been shown.
  - Antifibrinolytic agents may be used to stabilize the clot within an aneurysm in people who cannot undergo a clipping procedure. Increasing numbers of people develop delayed strokes, so doctors now use antifibrinolytic agents infrequently.
Unruptured brain aneurysm
- The best treatment would be to prevent rupture of an aneurysm once it is discovered.
- Larger aneurysms are more likely to bleed than smaller ones.
- Currently there is no reliable method of determining which aneurysms will rupture. For this reason doctors offer a variety of opinions on how to treat an intact aneurysm once it is discovered.
- Treatment most likely will be a surgical clipping procedure or placement of a coil in the aneurysm similar to those in a ruptured aneurysm.