A brain aneurysm is also known as spontaneous cerebral hemorrhage, hypertensive parenchymal hemorrhage, or hemorrhagic stroke. Approximately 13.5 percent of all strokes are hemorrhagic. Risk factors include hypertension (high blood pressure), congenital blood vessel malformation (aneurysm) and arteriolosclerosis (arterial plaque buildup). Other risk factors include diabetes, menopause, cigarette smoking, liver disease associated with alcohol consumption, and caffeine consumption.
Typical Signs
Brain aneurysms are usually characterized by a sudden, severe headache which is sometimes described as the worst headache of one's life. One may also have imbalance, staggering gait, neck pain, nausea or vomiting. Vision changes may include sensitivity to bright lights (photophobia) or double vision (diplopia). Some may have loss of consciousness, vertigo or confusion. If the areas of the brain which control muscle movements are effected, then a focal neurological deficit (inability to move arms, legs, face) may be present. Seizures are present in about 20 percent of cases within the first 24 hours of the bleeding.
Typical History
Most people do not have any symptoms prior to an aneurysm rupture. Headache is usually abrupt and occurs 60 percent of the time. In some cases the headache is not able to be distinguished from that of a migraine headache. Extreme physical exertion or trauma may precede an aneurysm.
Physical Exam Findings
A health care professional may find an altered level of consciousness or coma, quadriplegia (inability to move all extremities), or hemiplegia (inability to move extremities on one side). The heart and breathing rates may be slow. There may be deviation of the eyes, abnormal pupils (one larger than the other or one not responding to light) or other focal neurologic deficits dependent on the site of the aneurysm.
References
- Mayo Clinic Procedings 2005 Mar; 80 (3): 420
