Aneurysm
(Brain Aneurysm · Aortic Aneurysm)
In this condition factsheet:
The Facts on Aneurysm
An aneurysm is a weak point in a blood vessel wall, most commonly in an artery. Blood pressure tends to push the weakened section of an arterial wall outward, forming a balloon-like projection. This condition by itself isn't especially harmful if it remains relatively small, but the artery is prone to rupture. A ruptured aneurysm breaks the artery and allows uncontrolled bleeding to occur, which can be fatal.
Aneurysms can form in different places. The most common type of aneurysm is an abdominal aortic aneurysm (AAA). The aorta is the body's largest artery, carrying blood from the heart to every organ except the lungs. It leaves the heart flowing upwards in the chest, makes a U-bend, and flows down the spine from the chest to the abdomen. Several branches leave the aorta in the abdomen, going to the kidneys, liver, and intestines. These branch points are prime sites for aneurysms.
Other locations for aneurysms are:
- the blood vessels within the brain – the most common type of cerebral (brain) aneurysm is called a berry aneurysm
- thoracic aortic aneurysm (the thorax is in the chest) – of the thoracic aneurysms, the most common subtype is the aneurysm of the ascending aorta (between the heart and the U-bend)
Aneurysms tend to occur in older Caucasian men; women are less at risk. By age 80, over 5% of Caucasian men have developed an aneurysm. People of African descent rarely develop aneurysms.
Abdominal aortic aneurysms occur in 4% to 8% of men 65 and older, and in 0.5% to 1.5% of women 65 and older. They rarely occur in people under the age of 55. Unfortunately, 80% to 90% of people who experience a ruptured abdominal aortic aneurysm die from it.
Causes of Aneurysm
A person's risk of developing an aneurysm may be inherited. Ascending aortic aneurysms and berry aneurysms are especially likely to run in families. The men of an affected family are more likely to develop aneurysms than are the women. Scientists haven't yet identified the responsible genes in humans, though they have identified some in mice.
Most ascending aortic aneurysms are a result of aging associated with heart disease risk factors. Some aneurysms are a result of genetic diseases such as Marfan's syndrome. People with Marfan's syndrome are unusually tall with long extremities. Abraham Lincoln is thought to have had this syndrome. They also have a weakness in the aortic wall, just where the aorta leaves the top of the heart.
Two other types of aneurysms are mycotic and atherosclerotic aneurysms. Mycotic aneurysms are caused by a bacterial or fungal infection. Almost any such organism can damage the arteries, but the infection must be very deep and severe. The bacteria salmonella and syphilis both seem to have a special liking for arterial walls.
Atherosclerotic aneurysms are linked to the process that causes coronary artery disease, which is the buildup of fatty deposits on the inner wall of the arteries. This can result in weakening of the vessel wall. However, the correlation is still not fully understood, since someone with severe atherosclerosis may not develop an aneurysm if they are not already genetically predisposed.
Risk factors for heart disease, such as high blood pressure, high cholesterol, inactivity, smoking, and obesity, are also risk factors for aneurysms. Severe aneurysms are probably due to a combination of genes and poor cardiovascular health. Occasionally, aneurysms develop where stab or gunshot wounds have perforated an artery.
Symptoms and Complications of Aneurysm
Aneurysms often cause no pain. They're sometimes detected accidentally in body scans. The most likely way you will notice a cerebral, thoracic, or abdominal aneurysm is if it grows big enough to press against nerve-bearing tissue or has ruptured resulting in significant bleeding. Unfortunately, this means the aneurysm has grown recently, so the warning comes late. Fast-growing aneurysms are the ones most likely to rupture. Even large aneurysms often cause no symptoms.
Cerebral (brain) aneurysms occasionally cause some of these symptoms as they start to swell:
- double vision
- facial pain
- loss of vision
- severe headaches from minor bleeding
- squinting
- tremors or uncontrollable movement of an eye or eyelid
With thoracic aneurysms, symptoms are rare but may include:
- chest pain, upper back pain, or both
- coughing up of blood
- difficulty swallowing
- hoarseness
- Horner's syndrome – drooping eyelid, absence of sweating on one side of the face
- wheezing
Abdominal aneurysms are more likely to cause symptoms that:
- give a pulsing sensation in the abdomen
- cause upper abdominal pain, severe lower back pain, or both
The symptom of a ruptured abdominal aneurysm is intense pain and tenderness in the stomach or lower back area. Ruptured thoracic aneurysms cause excruciating pain in the upper chest that spreads to the back and sometimes down the trunk. Blood loss and failure of vital organs such as the kidneys can lead to fatal consequences in cases of thoracic and abdominal aneurysms. Ruptured cerebral aneurysms cause a hemorrhagic stroke, with all of its symptoms.
