Diagnosis

There are special imaging techniques that can detect an aneurysm of the brain. Two non-invasive tests which show the blood vessels in the brain are called computed tomography angiography (CTA) and magnetic resonance angiography (MRA).  Both of these tests are considered screening tests. However, before any treatment is considered, a cerebral angiogram is usually performed to determine the best treatment option(s).

A cerebral angiogram is an invasive test where the patient lies on an X-ray table and the physician inserts a small tube (catheter) through a blood vessel in the groin. The catheter is guided into each of the blood vessels in the brain, contrast dye is injected and pictures are taken of all the blood vessels in the brain. This test is the most reliable way to detect all types and sizes of cerebral aneurysms.

Although small aneurysms may not cause symptoms, they may be detected due to incidental imaging or screening for another reason e.g. hitting one’s head during a fall. However, as an aneurysm enlarges, it can cause headaches and produce pressure on normal brain tissue and / or nerves leading to vision problems, numbness or weakness of an arm or leg, difficulty with memory or speech, seizures or other neurological problems.

No two patients are the same and no two aneurysms are the same. Therefore the doctor will evaluate both the short term and long term risks in order to make a recommendation. The recommendations may be for either no treatment, (but rather monitoring the patient), open craniotomy or, endovascular treatment. If treatment is required then a discussion with the physician should include which technique is best in their given situation. If a procedure is suggested, the discussion should include the risk of treatment as well as an understanding of the procedure.

Established treatment of a cerebral aneurysm involves exclusion of the lesion from the cerebral circulation either by surgical clipping or by endovascular coiling. Recent technological advances have led to the development of new treatments e.g. intracranial stents, liquid embolics and flow diversion devices.