When A Brain Aneurysm Ruptures


What To Know About A Rupture

Where Do Aneurysm Ruptures Occur?

Most aneurysms are located on arteries which supply the brain in an area called the “subarachnoid space”.  Therefore, when a Brain Aneurysm ruptures it results in bleeding in and around the brain, and is referred to as a “Subarachnoid Hemorrhage”.  Commonly, bleeding also extends into the brain itself.  The most classic symptom of Brain Aneurysm rupture or beginning to leak or rupture (sentinel bleed) is "Worst Headache Of Life" better known as “W.H.O.L.”.  It is often described as a headache that brings someone to their knees or like being struck by lightening. The headache is caused by sudden rise in intracranial pressure as the brain is suddenly exposed to the arterial blood pressure.  The rising intracranial pressure also has the effect of decreasing the perfusion to the brain, which causes many patients to expire immediately or to lose consciousness.  Other symptoms of high intracranial pressure include vomiting, lethargy, and weakness.


Consequences of Aneurysm Rupture

The outcome of a Brain Aneurysm rupture can depend on a variety of factors- for example the extent of bleeding, the location of the Brain Aneurysm, age and general health of the patient, and subsequent medical care. Unfortunately, many patients die before reaching the hospital, and almost 50% will not survive the first two weeks, even under best available care. Of the survivors, many will be permanently disabled. Only a portion will return to their pre-rupture level of function and employment. Why such grim statistics? Because the brain is a complex and sensitive organ, designed for performance in the protected environment of the skull, under carefully controlled conditions. It has a low tolerance for the kind of insult caused by subarachnoid hemorrhage. It is simply not built to withstand high pressure, interruptions in cerebral perfusion or direct damage produced by bleeding for any extended length of time. Most damage caused by aneurysm rupture is sustained in the first minutes of the event. Even flawless subsequent care – and such care is extremely complicated and very often subject to setbacks and additional complications even in the best of centers – can only prevent future bleeding and help mitigate the harmful effects of the initial rupture.

Will the Aneurysm Rupture?

That is the key question facing a patient with an unruptured aneurysm. We have no crystal ball to predict which one will rupture and when.  The best advice we can give is based on studies which followed patients with different aneurysms for many years without treatment-either because of patient preference or because treatment was felt to be ineffective or too risky.  What we learned-and continue learning from these studies is that the risk of rupture depends primarily on the size and location of the aneurysm, along with additional variables such as aneurysm shape, possible symptoms, family history, etc. playing a role as well. Undoubtedly, there are other factors yet unknown, and many are being investigated.  For the time being, we can only speak in terms of probabilities.  One can never say that a given aneurysm will never rupture or will rupture for sure.