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Aneurysm, Brain (cont.)

Outlook

Most aneurysms show no symptoms until they rupture. The single most important predictor of the outcome of the subarachnoid hemorrhage is your physical condition when you arrive at the hospital.

Once an aneurysm has ruptured, recovery depends on the degree of bleeding and associated problems.
- Rebleeding
- Increased pressure within your brain
- Subsequent artery spasms and narrowing of the arteries of your brain
Doctors direct treatment at the time your rupture is diagnosed toward preventing these complications.
Once you are diagnosed with an unruptured aneurysm the main question is what to do about it.
- Most experts agree that for aneurysms smaller than 10 mm (0.4 in), if you have no history of bleeding into your brain, the risks of surgery outweigh the potential benefits.
  - Factors that would favor surgery are high blood pressure that is poorly controlled and symptoms related to compression of nerve tissue by the aneurysm.
  - Factors weighing against surgery include location of the aneurysm in a surgically difficult area and co-existing illnesses that would increase your risk of surgery.
- A promising treatment for brain aneurysms involves placing a metallic coil inside the aneurysm. The coil causes a clot to form inside, and the clot blocks the aneurysm from your circulation system.
  - This markedly decreases the chance of rupture.
  - The risks of the procedure are much lower than for surgery, but the long-term outcomes are not yet known.
  - Current experience indicates that this technique works best for smaller aneurysms. It may, in fact, cause an increased risk of rupture when used in very large aneurysms.