Experts at the Center for Endovascular Surgery specialize in evaluating brain aneurysm symptoms and treating patients who present with unruptured and ruptured brain aneurysms.

A brain aneurysm (sometimes called cerebral aneurysm) is an abnormal bulging or ballooning portion of a weakened blood vessel that is located in the brain. The larger the bulging becomes, the more likely the brain aneurysm will bleed into and around the brain. When brain aneurysms bleed they cause sudden death in half of the patients. Those that survive only remain functionally intact less than half of the time. Brain aneurysm bleeds cause strokes that can seriously impair speech, motor and sensory function.

Factors that increase the risk for brain aneurysms and associated symptoms include:

• Age
• Family or personal history of brain aneurysms
• Certain conditions such as polycystic kidney disease and connective tissue disorders
• Smoking

High blood pressure, high cholesterol and alcohol abuse may increase risk as well, but studies are less conclusive.

Most people with unruptured brain aneurysms experience little to no brain aneurysm symptoms. In some instances, people experience brain aneurysm symptoms before rupture, including:

• A "warning" headache that may occur several days or weeks before the rupture
• A dilated pupil in one eye
• Problems with vision or eye movement
• Pain above or behind the eye, or in the temple, back of the head or neck

Brain aneurysm symptoms more typically occur when an aneurysm ruptures. This is considered an emergency situation and requires immediate emergency care. The first wave of symptoms of a ruptured brain aneurysm typically include:

• A very severe headache. Even if a patient is prone to headaches or migraines, this headache will feel very different from the normal pattern
• Neck stiffness
• Nausea
• Vomiting
• Sensitivity to light

The above brain aneurysm symptoms are often immediately followed by:

• Confusion or change in mental state or consciousness
• Coma
• In some cases, seizures

If the physicians at the Center for Endovascular Surgery suspect a brain aneurysm that is not ruptured, they will perform a thorough personal and family history and a medical examination. Based on the patient's brain aneurysm symptoms, the Center's physicians will also perform tests to see if they can detect the brain aneurysm or detect a low level of blood leakage in the brain, which can precede a rupture. These tests might include:

• A lumbar puncture spinal tap to see if the spinal fluid has traces of blood or is yellow (signs of bleeding in the brain)
• Cerebral angiography. X-rays are taken of the brain after a dye is injected into it through a catheter threaded through the groin. Aneurysms are often seen on this x-ray.
• Magnetic resonance angiography: This test can detect unruptured aneurysms and screen high-risk patients. Similar to cerebral angiography, images are taken of the brain after a dye is injected into it through a catheter threaded through the groin.

When patients present with brain aneurysm symptoms, the Center's physicians work to secure the aneurysm within 24 hours of presentation so as to prevent a second bleed. Risks of re-bleed are highest in the post-bleed period. Patients undergo emergency angiography followed by endovascular coiling or surgical clipping.

The Center's physicians work closely with the emergency departments of Beth Israel Medical Center in Manhattan, Beth Israel's Kings Highway Division in Brooklyn, and St. Luke's-Roosevelt Hospital Center to stabilize the patient. Patients are evaluated and transferred to Roosevelt Hospital's Neuroscience Intensive Care Unit as rapidly as possible. Close monitoring of the patient is combined with support for the patient and their loved ones, so as to explain the plan of action.

Physicians at the Center for Endovascular Surgery strive to treat patients in the safest and least invasive way. The treatment of choice, if possible, is to treat the aneurysm without "opening the head." In fact, greater than 70% of all aneurysms treated at the Center are treated without open surgery, using minimally invasive approaches such as endovascular coiling. The Center has one of the highest percentages in the nation for use of endovascular coiling and has significant experience with this technique. When aneurysms and brain aneurysm symptoms cannot be treated using endovascular techniques, the surgical team performs open surgery to secure the aneurysm to prevent re-rupture.

Patients with ruptured brain aneurysms often require placement of a ventricular drain to divert spinal fluid, which can build up in the brain following brain aneurysm hemorrhage. Patients are additionally treated with a combination of medical therapies including calcium channel blockers to prevent vasospasm, a narrowing of cerebral blood vessels, which can occur after a brain aneurysm bleed. Vasospasm can lead to stroke. Blood volume therapy is also used to increase the circulating blood volume, which can also act to prevent these types of strokes. Infrequently, patients are additionally managed with medications to elevate blood pressure following aneurysm treatment, to overcome vasospasm in patients manifesting stroke signs and symptoms of vasospasm-related stroke.

Every effort is also made to treat patients with unruptured aneurysms and their symptoms without "opening the head." Patients with unruptured aneurysms do not require prolonged stays in the Neuroscience Intensive Care Unit and are not treated with the medical modalities mentioned above. These patients often return to home within a few days after treatment.