An aneurysm is a bulging, weak area in the wall of an artery that supplies blood to the brain. It is most commonly located in large arteries at the base of the brain. While aneurysms can develop throughout the body, those located in the neck and head are especially dangerous due to their potential to rupture and cause life-threatening bleeding.
What are the symptoms of a neck aneurysm?
In many cases, aneurysms in the neck cause no symptoms until they either become very large or rupture. Some potential warning signs and symptoms include:
- A pulsing lump in the neck
- Pain above or behind the eye
- Numbness and paralysis on one side of the face
- Dilated pupils
- Drooping eyelid
- Vision changes or double vision
- Dizziness
- Ringing in the ears
However, it’s important to note that many of these symptoms can occur with other medical conditions as well. The only way to definitively diagnose a neck aneurysm is through diagnostic imaging tests.
What does a neck aneurysm feel like?
In some cases, a person may be able to feel a neck aneurysm forming. The most distinctive symptom is a pulsing lump or bulge in the neck. This occurs as blood pumps through the weakened aneurysm, causing it to expand.
The lump may feel rubbery or solid. Typically, it does not cause pain, unless it is exceptionally large or presses on nearby nerves. Some people describe feeling as if something is stuck in their throat. The lump may visibly pulsate with each heartbeat.
If a cerebral aneurysm in the base of the brain grows large enough, it can press against cranial nerves located at the brain stem. This can sometimes cause numbness or tingling on one side of the face or head. In severe cases, it can mimic a stroke and cause facial drooping or paralysis on one side.
However, it is rare for most cerebral aneurysms to cause symptoms until they rupture. Even large aneurysms in the brain may go unnoticed for years before finally rupturing.
Detecting aneurysms before rupture
Because aneurysms are often silent until rupture, health experts recommend screening for those at high risk. Some key risk factors include:
- Older age, especially over 60
- High blood pressure
- Smoking
- Drug or alcohol abuse
- Atherosclerosis
- Family history of aneurysms
- Presence of an abnormal bulge in a blood vessel
People with a family history of brain aneurysms or connective tissue disorders like polycystic kidney disease have an increased risk and should consult their doctor about screening.
If an aneurysm is suspected, the following imaging tests may be performed to confirm diagnosis and determine treatment:
- CT scan: This uses X-rays and computers to create cross-sectional images of the head and neck. It can detect bleeding and larger aneurysms.
- MRI: Magnetic resonance imaging produces detailed images of soft tissues and blood vessels. It provides a 3D view of aneurysms.
- Cerebral angiogram: In this procedure, a catheter is inserted into the groin and threaded through arteries leading to the brain. Contrast dye is injected to highlight blood vessels on X-ray.
- CT angiogram: This is a minimally invasive version of a cerebral angiogram. Contrast dye is injected into the bloodstream and a CT scan produces detailed images.
Treating aneurysms before rupture
The risk of aneurysm rupture greatly increases if the bulge exceeds 5 to 10 mm in diameter. Treatment aims to prevent rupture and fatal bleeding. Options may include:
- Surgical clipping: The aneurysm is accessed through an incision in the skull. A tiny metal clamp is placed around its base to seal it off.
- Endovascular coiling: Tiny platinum coils are guided through the blood vessels into the aneurysm, triggering blood clotting within the bulge.
- Flow diverter stenting: A mesh tube is placed within the artery leading to the aneurysm to divert blood flow away from it.
- Medication: Blood pressure lowering drugs may help prevent enlargement and rupture.
Which option is best depends on the aneurysm size, location, and other factors. Aneurysms requiring urgent treatment include those that:
- Are rapidly growing
- Have a high risk of imminent rupture
- Are causing stroke-like symptoms
- Are leaking blood
Outlook for unruptured aneurysms
The prognosis for an unruptured aneurysm depends heavily on its size, rate of growth, and underlying risk factors. Very small aneurysms (less than 3 mm) have a very low annual risk of rupture of around 0% to 2%. For larger aneurysms exceeding 7 mm, the annual risk is between 2% to 6%, with the risk increasing as the bulge gets bigger.
With preventive treatment, the prognosis for unruptured aneurysms is generally good, with a low risk of post-treatment complications. Ruptured aneurysms have a far worse prognosis, with mortality rates as high as 40%. This highlights the importance of detecting and proactively treating aneurysms before they rupture.
Conclusion
Aneurysms in the neck and cerebral arteries feeding the brain can be life-threatening if they grow and rupture. While many smaller aneurysms cause no symptoms, larger bulges may sometimes be detected as a pulsing neck mass. Diagnostic imaging tests like CT angiography and MRI are needed to confirm aneurysms.
People at high risk due to family history or other factors should consider screening. Prompt preventive treatment can seal off aneurysms before rupture. Ruptured aneurysms require emergency care to stop bleeding into the brain that can rapidly cause stroke, coma, and death.
Detecting and treating aneurysms before they rupture offers the best chance of preventing a catastrophic brain bleed. Anyone experiencing troubling symptoms such as sudden severe headache, neck pain, vision changes, or fainting should seek urgent medical care to rule out a ruptured aneurysm.
References
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