Berry Aneurysm

Content of This Page

 1- Introduction

2- Causes

3- Symptoms

4- Investigations & Lab Results

5- Complications

6- Treatment

Introduction

A Berry Aneurysm, also known as a saccular aneurysm, is a small, rounded outpouching that occurs on the walls of cerebral arteries, typically at branching points in the circle of Willis. These aneurysms resemble a berry hanging on a stem, hence the name. Berry aneurysms are the most common type of intracranial aneurysm and can remain asymptomatic for years. However, if they rupture, they cause a subarachnoid hemorrhage, a serious and potentially life-threatening type of stroke characterized by bleeding into the space surrounding the brain.

© image from www.researchgate.net

Causes

  • Congenital weakness in the arterial wall: Defects in the internal elastic lamina and media layers make vessel walls prone to bulging.

  • Hypertension: High blood pressure increases stress on artery walls, promoting aneurysm formation.

  • Atherosclerosis: Plaque buildup can weaken vessel walls.

  • Genetic factors and connective tissue disorders: Conditions like polycystic kidney disease, Ehlers-Danlos syndrome, and Marfan syndrome increase risk.

  • Smoking: Damages blood vessels and accelerates aneurysm development.

  • Age and sex: More common in adults over 40 and slightly more frequent in females.

  • Trauma or infection: Rarely, vessel injury or infections can contribute.

Ruptured Berry Aneurysm (Subarachnoid Hemorrhage) © image from www.researchgate.net

Symptoms

-Symptoms of Unruptured Berry Aneurysm

  • Often asymptomatic and found incidentally.

  • If large, may cause pressure effects on nearby structures:

    • Headache

    • Cranial nerve palsies (e.g., third nerve palsy causing double vision and drooping eyelid)

    • Visual disturbances

    • Pain above or behind the eye

-Symptoms of Ruptured Berry Aneurysm (Subarachnoid Hemorrhage)

  • Sudden, severe “thunderclap” headache — often described as the worst headache of life.

  • Neck stiffness (meningismus) due to meningeal irritation.

  • Nausea and vomiting.

  • Photophobia (sensitivity to light).

  • Loss of consciousness or altered mental status.

  • Focal neurological deficits (weakness, speech problems) depending on bleeding location.

  • Seizures (less common).

Investigations & Lab Results

1. Imaging Studies

  • Computed Tomography (CT) Scan of the Head

    • First-line imaging if rupture is suspected (subarachnoid hemorrhage).

    • Detects acute bleeding in the subarachnoid space.

  • CT Angiography (CTA)

    • Non-invasive imaging to visualize cerebral blood vessels and identify aneurysms.

  • Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA)

    • Helpful for detecting unruptured aneurysms and assessing surrounding brain tissue.

  • Digital Subtraction Angiography (DSA)

    • Gold standard for detailed visualization of aneurysm size, shape, and location.

    • Often used before surgical or endovascular treatment.

2. Laboratory Tests

  • Complete Blood Count (CBC)

    • To check for anemia or infection.

  • Coagulation Profile (PT/INR, aPTT)

    • Important prior to any surgical intervention.

  • Electrolytes and Renal Function Tests

    • Assess overall medical status before treatment.

  • Other Tests

    • May include cardiac evaluation if embolic sources are suspected.

Complications

  • Rupture leading to subarachnoid hemorrhage (SAH):

    • Life-threatening bleeding into the space around the brain causing sudden severe headache, loss of consciousness, and high mortality.

  • Rebleeding:

    • Increased risk of another rupture soon after the first bleed, worsening outcomes.

  • Hydrocephalus:

    • Accumulation of cerebrospinal fluid due to blockage of its pathways by blood, causing increased intracranial pressure.

  • Vasospasm:

    • Narrowing of cerebral arteries after SAH, leading to delayed ischemic stroke.

  • Seizures:

    • Resulting from brain irritation or injury.

  • Permanent neurological deficits:

    • Including paralysis, cognitive impairment, or cranial nerve palsies.

  • Death:

    • Due to severe hemorrhage or complications.

Treatment

1. Unruptured Berry Aneurysm

  • Observation and Monitoring:

    • Small, asymptomatic aneurysms may be monitored regularly with imaging if risk of rupture is low.

  • Risk Factor Control:

    • Manage hypertension, stop smoking, and control other vascular risk factors.

  • Elective Intervention:

    • Considered for aneurysms larger than 7 mm, those causing symptoms, or with high-risk features.

2. Ruptured Berry Aneurysm (Subarachnoid Hemorrhage)

  • Emergency Care:

    • Stabilize airway, breathing, circulation.

    • Control blood pressure to reduce rebleeding risk.

  • Definitive Treatment to Secure the Aneurysm:

    • Surgical Clipping:

      • Open brain surgery to place a clip at the aneurysm neck to prevent bleeding.

    • Endovascular Coiling:

      • Minimally invasive procedure where coils are inserted via catheter to fill and seal the aneurysm.

  • Supportive Care and Complication Management:

    • Prevent and treat vasospasm (e.g., nimodipine).

    • Manage hydrocephalus (e.g., ventricular drain).

    • Control seizures and provide intensive neurocritical care.

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