Presentation varies with the type of aneurysm involved. Most patients with AAA are asymptomatic but come to medical attention by finding of a pulsatile mass on physical examination, as the result of other abdominal imaging studies, or through ultrasound screening programs for AAA [8]. Patients suffering from cerebral aneurysms may present with headache, nosebleed, visual symptoms, facial pain, altered levels of consciousness which may or may not be accompanied with seizures and autonomic disturbances.

• Pain

  Call your provider if you develop a lump on your body, whether or not it is painful and throbbing. With an aortic aneurysm, go to the emergency room or call 911 if you have pain in your belly or back that is very bad or does not go away. [nlm.nih.gov]

  Some people with abdominal aneurysms report abdominal pain, lower back pain, or a pulsating sensation in the abdomen. [medicalnewstoday.com]

• Disability

  They understood that nearly 50% of all brain bleed patients become disabled for life and wanted to change this grave reality,” Pandey says. [healthblog.uofmhealth.org]

  Brain damage from a burst aneurysm can cause disability or death. A the University of Maryland Medical Center, our neurosurgeons surgically repair aneurysms frequently. [umms.org]

  Severe bleeding can cause brain damage and permanent disability. What are the symptoms of a cerebral aneurysm? Symptoms of a cerebral aneurysm may include chronic headaches, vertigo, and nausea. [web.archive.org]

  A ruptured brain aneurysm requires emergency medical treatment as the likelihood of death or disability is high. Ten to 20 percent of those who have a subarachnoid hemorrhage will die before getting to a hospital. [my.clevelandclinic.org]

• Inflammation

  To help diagnose an aortic aneurysm, your doctor may need to perform CT or ultrasound tests to find out whether your symptoms may be caused by other medical conditions, including: Appendicitis, inflammation of the appendix Cholecystitis, inflammation [nhlbi.nih.gov]

  He underwent curative excision biopsy, which showed perivascular inflammation. He was diagnosed as a case of left superficial temporal artery aneurysm. [ncbi.nlm.nih.gov]

  Our group investigates the role of inflammation and infection as possible causes of cerebral aneurysms. [hus.fi]

  Pathophysiology Inflammation and proteolytic degeneration of connective tissue proteins → Loss of structural integrity of the aortic wall → Widening of the vessel Perforation of the vascular wall causing bleeding into the surrounding tissue → Formation [amboss.com]

• Surgical Procedure

  Intraoperative proximal test occlusion is useful to decide on the surgical procedure of revascularization in patients with unclippable internal carotid aneurysm. [ncbi.nlm.nih.gov]

  There are two types of surgical procedures: open surgery and endovascular surgery. Open Surgical Repair of the Aorta: A procedure known as open thoracic aortic repair is done under general anesthesia. [umm.edu]

  Recommended specialists Brain Aneurysm - Further information Brain aneurysm repair is a surgical procedure used to treat a bulging blood vessel in the brain, which may burst open (rupture). [leading-medicine-guide.com]

• Severe Pain

  SUDDEN, SEVERE ABDOMINAL OR BACK PAIN If you have a family history of AAA and feel sudden, severe pain in your abdomen or back, seek immediate care. These symptoms may signal that you have developed an AAA, possibly one in process of rupturing. [vascular.org]

  A ruptured aneurysm usually produces sudden and severe pain, and depending on the location and amount of bleeding, shock, loss of consciousness and death. Emergency surgery is necessary to stop the bleeding. [healthcentral.com]

  This can lead to severe pain and massive internal bleeding, or hemorrhage. Causes It is not known what exactly causes an abdominal aneurysm in some people. [medtronic.com]

  Emboli can move with the blood flow until they block an artery in the lower leg or foot, causing sudden onset of severe pain, numbness, and coolness of the foot, which may also appear pale. [merckmanuals.com]

  This is a medical emergency and you should call 999 immediately if you or someone with you has any of these symptoms: a sudden severe pain in the abdomen, back or lower back area feeling cold, clammy, sweaty, faint and breathless loss of consciousness [bhf.org.uk]

• Dyspnea

  A 69-year-old man, with multiple known comorbidities such as coronary heart disease, chronic obstructive pulmonary disease, and stage 4 chronic kidney disease, presented with acute chest pain and dyspnea. [ncbi.nlm.nih.gov]

• Vomiting

  A leaking aneurysm may cause severe headache, vomiting, neck stiffness, confusion, lethargy, and other neurologic symptoms. How does the doctor treat a cerebral aneurysm? A cerebral aneurysm is usually treated with medications and surgery. [web.archive.org]

  However, sometimes as an aneurysm grows, you may have symptoms including: Severe headaches Vision changes Pain behind the eye Nausea and/or vomiting If an aneurysm begins to bleed or ruptures, it can be life-threatening. [premierhealth.com]

  Sudden and severe headache, often described as “the worst headache of my life” Nausea/vomiting Stiff neck Blurred or double vision Sensitivity to light Seizure Drooping eyelid A dilated pupil Pain above and behind the eye Loss of consciousness Confusion [bafound.org]

  CASE PRESENTATION: A 60-year-old man with sudden onset of severe headache, nausea, and vomiting was admitted to our hospital. [ncbi.nlm.nih.gov]

• Abdominal Pain

  Some people with abdominal aneurysms report abdominal pain, lower back pain, or a pulsating sensation in the abdomen. [medicalnewstoday.com]

  This condition can cause significant abdominal pain and back pain and may lead to the artery’s leak or rupture, at which point it becomes a life-threatening emergency. [spine-health.com]

  The symptoms of a thoracic aortic aneurysm include: Chest or back pain Coughing Dysphasia, or difficulty swallowing The symptoms of an abdominal aneurysm include: Abdominal pain A pulsing sensation in the stomach If an aortic aneurysm tears and causes [columbiasurgery.org]

• Thrombosis

  […] and mass effect Resolved CCA 27 F Worsening of cranial nerve palsy Aneurysm thrombosis and mass effect Resolved COA 22 S Worsening of cranial nerve palsy Aneurysm thrombosis and mass effect Resolved CCA 10 S Parent artery occlusion Poor SFD deployment [ncbi.nlm.nih.gov]

• Back Pain

  This condition can cause significant abdominal pain and back pain and may lead to the artery’s leak or rupture, at which point it becomes a life-threatening emergency. [spine-health.com]

  Sometimes mistaken for a heart attack, an abdominal aortic rupture can be characterized by chest and jaw pain, stabbing abdominal or back pain, fainting, difficulty breathing, and weakness on one side of the body. [pennmedicine.org]

  SUDDEN, SEVERE ABDOMINAL OR BACK PAIN If you have a family history of AAA and feel sudden, severe pain in your abdomen or back, seek immediate care. These symptoms may signal that you have developed an AAA, possibly one in process of rupturing. [vascular.org]

  Some people with abdominal aneurysms report abdominal pain, lower back pain, or a pulsating sensation in the abdomen. [medicalnewstoday.com]

  Severe and sudden abdominal pain Severe chest and back pain Dramatic decrease in blood pressure back to top Types of Aortic Aneurysms The type of aortic aneurysm you have depends on where it is located. [heart.ucla.edu]

• Fear

  What you need to know about these uncommon but much-feared blood vessel abnormalities. Published: January, 2019 Each year, tens of thousands of people discover they have a bulging blood vessel in their brain, chest, or abdomen. [health.harvard.edu]

  They can strike fear in the healthiest of adults because of their reputation for bursting suddenly – and fatally. An aneurysm is a weakening or bulging of an artery wall. [pennmedicine.org]

  Dissecting them is difficult and messy, and there is always the fear that the aneurysm will rupture again while I am doing this. [lithub.com]

  This insight into the mystery of life, coupled though it be with fear, also has given rise to religion. [nytimes.com]

• Neck Swelling

  back or chest Coughing and/or hoarseness Trouble breathing or swallowing Neck swelling Clammy skin Nausea and vomiting Rapid heart rate General sense that something is wrong Abdominal Aneurysm Symptoms Before rupturing, abdominal aneurysms can cause [medstarheartinstitute.org]

• Headache

  When a brain aneurysm ruptures, there is a sudden severe headache that some people say is the "worst headache of my life." The risk of coma or death after a rupture is high. The health care provider will perform a physical exam. [nlm.nih.gov]

  This may cause a severe headache that a person may describe as "the worst headache of my life." It may be called a thunderclap or sentinel headache. [account.allinahealth.org]

  And, over two years later, her relentless headaches have only recently stopped. "Headaches so bad that previously I would have gone home from work," Ms Cordery said. "That was what I was living with every single day." [abc.net.au]

• Seizure

  Common AVM symptoms include: Seizures An AVM in the brain may act as an irritant, resulting in abnormal electrical activity. Seizures can develop as a result of this hyperactivity. [stfranciscare.org]

  Possible Complications Complications of aneurysm in the brain may include: Increased pressure inside the skull Loss of movement in one or more parts of the body Loss of sensation of any part of the face or body Seizures Stroke Subarachnoid hemorrhage [account.allinahealth.org]

  […] medications to treat seizures related to a stroke Rehabilitation is an important part of your treatment, especially if your aneurysm caused a stroke. [premierhealth.com]

  Stroke Subarachnoid hemorrhage When to Contact a Medical Professional Go to the emergency room or call the local emergency number (such as 911) if you have a sudden or severe headache, especially if you also have nausea, vomiting, seizures, or any other [ufhealth.org]

  Seizures — An electrical disturbance in the brain causes involuntary movements or behavior or loss of consciousness. [templehealth.org]

• Confusion

  A leaking aneurysm may cause severe headache, vomiting, neck stiffness, confusion, lethargy, and other neurologic symptoms. How does the doctor treat a cerebral aneurysm? A cerebral aneurysm is usually treated with medications and surgery. [web.archive.org]

  Sudden and severe headache, often described as “the worst headache of my life” Nausea/vomiting Stiff neck Blurred or double vision Sensitivity to light Seizure Drooping eyelid A dilated pupil Pain above and behind the eye Loss of consciousness Confusion [bafound.org]

  Untreated brain aneurysm ruptures lead to confusion, unconsciousness, coma and seizures. Ultimately, ruptured aneurysms lead to death, which is why immediate treatment is critical. [templehealth.org]

  such as the ability to raise only one arm or close only one eye Seizures Confusion Brain Aneurysm Treatment Treatment for brain aneurysms depends on whether the aneurysm is ruptured or unruptured. [spinalcord.com]

• Dizziness

  If an aneurysm expands quickly or ruptures, symptoms may develop suddenly and include: Pain Clammy skin Dizziness Nausea and vomiting Rapid heart rate Shock Low blood pressure Your doctor can use an angiogram, CT scan or ultrasound test to diagnose an [heart.org]

  […] severe headache that is different from previous headaches Loss of consciousness Stiff neck Sudden blurred or double vision Sudden pain above or behind the eye or difficulty seeing Sudden change in mental status or awareness Sudden trouble walking or dizziness [chistlukeshealth.org]

  The expanded aneurysm may press on nerves and cause double vision, dizziness, or headaches. Some aneurysms may cause ringing in the ears. If an aneurysm ruptures, pain, low blood pressure, a rapid heart rate, and lightheadedness may occur. [nlm.nih.gov]

• Stupor

  Other symptoms of an aneurysm rupture may include: Confusion, no energy, sleepiness, or stupor Eyelid drooping Headaches with nausea or vomiting Muscle weakness or difficulty moving any part of the body Numbness or decreased sensation in any part of the [account.allinahealth.org]

  Other symptoms of an aneurysm rupture may include: Confusion, no energy, sleepiness, stupor, or coma Eyelid drooping Headaches with nausea or vomiting Muscle weakness or difficulty moving any part of the body Numbness or decreased sensation in any part [ufhealth.org]

  […] the higher is the grade (2): Asymptomatic, mild headache, slight nuchal rigidity (neck stiffness) Moderate to severe headache, nuchal rigidity, cranial nerve palsy, no other neurological deficit Drowsiness / confusion, mild focal neurologic deficit Stupor [aans.org]

  […] aneurysm Grade 1 - Asymptomatic or minimal headache and slight nuchal rigidity Grade 2 - Moderate-to-severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy Grade 3 - Drowsiness, confusion, or mild focal deficit Grade 4 - Stupor [emedicine.medscape.com]

Laboratory tests

• Complete blood count
• Prothrombin time and complete blood profile
• Serum electrolytes
• Arterial blood gases
• Liver function tests

Imaging 

Imaging studies include angiography, CT scan, MRI, Doppler ultrasound and echocardiography. For cerebral aneurysm, imaging tests like transcranial doppler ulrasonography, lumbar puncture and cervical spine imaging may be conducted.

Test results

On the basis of tests and imaging studies, the site of the aneurysm may be localized and often, the underlying cause may also be identified.

Medication

Medication include the use of calcium channel blockers, anticonvulsants if needed, and beta blockers. At least one clinical study showed that people who took beta blockers had a slower rate of growth of their AAA compared with people who took a placebo (0.36 versus 0.68 cm per year) [9].

Surgery

Surgical intervention includes insertion of a surgical clip in the neck of the aneurysm. Endovascular coiling of the aneurysm can also be performed, often yielding better results.

It has been suggested that patients with untreated large ascending or descending thoracic aneurysms are more likely to die of complications associated with their aneurysms than from any other cause [6]. Re-rupture, particularly in subarachnoid hemorrhage (SAH) associated with cerebral aneurysm (CA), is associated with a mortality that is estimated to be 70 percent and aneurysm repair is the only effective treatment to prevent this occurrence [7]. Overall, aneurysm is a progressive condition with mortality rates directly proportional to size of the dilation.

Aneurysms have many causes. They can be due to congenital diseases, particularly those that damage the connective tissue, such as Marfan syndrome, Ehlers Danlos syndrome or Loeys-Dietz syndrome. Tilson et al described the potential for an autoimmune basis for the development of abdominal aortic aneurysms (AAA) involving the DRB1 major histocompatibility locus [2].

Conditions causing a disbalance in synthesis and degradation of collagen, such as increased matrix metalloproteinase (MMP) production by macrophages, decreased tissue inhibitor of metalloproteinase (TIMP) expression also contribute to aneurysm formation. Lastly, factors based on lifestyle such as hypertension, obesity, atherosclerosis, and high cholesterol, may also lead to the development of aneurysms. Indeed, hypertension and atherosclerosis are the two most important predisposing factors to aneurysms.

Incidence

The incidence of aneurysms varies depending upon the type and gender. For example, AAA occur 8.2% in males in the UK but females only have an incidence of 0.6-1.4%.

Age

In males the peak age of aneurysms is 80 years but the incidence peaks from 50 years of age. Females have a slightly delayed onset, with incidence rising sharply after the 6th decade of life.

Sex

Aneurysms are more common in males, with an approximate ratio of 2:1. However, the risk of rupture of large aneurysms (≥5.0 cm) is significantly greater in women than men (18 versus 12 percent) [3].

Race

Aneurysms are much more common in Caucasians than people belonging to African-American and other races.

Aneurysms develop due to damage to vessel walls either due to factors acting directly on the vessel walls and weakening them, such as atherosclerotic plaques, nonenzymatic glycosylation of vessels in diabetes mellitus, and hypertension, or due to congenital defects in connective tissue structure and formation. Ischemia also contributes to the pathogenesis. Some common aneurysms are described below:

Abdominal aortic aneurysm

The United States National Lung, Heart and Blood Institute supported a research program that identified the following as mechanisms important in the development of AAA [4]: Proteolytic degradation of aortic wall connective tissue which is followed by inflammation and immune responses. Two other factors include biochemical stress and molecular genetics.

Thoracic aortic aneurysm 

Thoracic aortic aneurysms are most commonly associated with hypertension, although other causes such as Marfan syndrome and Loeys-Dietz syndrome are increasingly recognized [5]. They may encroach on mediastinal structures leading to respiratory distress, difficulty in swallowing due to compression of esophagus, cough and hoarseness of voice due to irritation of recurrent laryngeal nerves, and sometimes secondary cardiac disease.

Control and limiting of predisposing factors such as obesity and hypertension are of prime importance in preventive therapy. Particular care should be taken by diabetic patients to keep both blood sugar levels and cholesterol levels in normal limits.

An aneurysm may be defined as a localized abnormal dilation of a blood vessel or the heart [1]. It can arise anywhere in the body with varying presentations. Aneurysms can be both congenital and acquired. They can be classified on the basis of shape and size of the dilation into 2 main types.

• Saccular aneurysms are outpouchings of the vessel wall that are spherical and sac-like in shape. Their size ranges from 5-20cm in diameter. They often contain thrombi. On imaging, they appear as lump-like dilations.
• Fusiform aneurysms are somewhat less dilated in diameter but are longer in length. They are diffuse, circumferential dilations that involve a long vascular segment and appear as longitudinal arc-like swellings on imaging. Lumps are less pronounced. Their diameter may be the same as, or, slightly less than that of saccular aneurysms but they vary greatly in length. Fusiform aneurysms commonly involve extensive areas of the aortic arch and other portions of the vascular channel such as portions of the iliac arteries and parts of the abdominal and thoracic aorta.

Definition

An aneurysm is defined as a segmental, full-thickness dilation of a blood vessel 50 percent greater than its normal diameter [10].

Cause

They can be present from birth or develop later in life due to various reasons such as hypertension, obesity, high cholesterol, diabetes and weakening of vessel wall due to old age.

Signs and symptoms

Most aneurysms are asymptomatic, coming to notice usually during routine examinations. Rupture of an aneurysm, however, is a medical emergency and presents as sharp pain and subsequent collapse. Cerebral aneurysms may preset with symptoms of headache, visual disturbances, seizures and facial pain.

Treatment

Treatment is supportive unless there is a high chance of rupture, in which case surgical intervention is imperative.

1. Robbins and Cotran, Pathologic Basis of Disease. 8th ed. Pa: Saunders Elsevier. Ch 11 p 506-9, 2010. 
2. Tilson MD, Ozsvath KJ, Hirose H, Xia S. A genetic basis for autoimmune manifestations in the abdominal aortic aneurysm resides in the MHC class II locus DR-beta-1. Ann N Y Acad Sci. Nov 18 1996;800:208-15. 
3. Norman PE, Powell JT. Abdominal aortic aneurysm: the prognosis in women is worse than in men. Circulation 2007; 115:2865. 
4. Wassef M, Baxter BT, Chisholm RL, Dalman RL, Fillinger MF, Heinecke J, et al. Pathogenesis of abdominal aortic aneurysms: a multidisciplinary research program supported by the National Heart, Lung, and Blood Institute. J Vasc Surg. Oct 2001;34(4):730-8.
5. Homme J et al: Surgical Pathology of the ascending aorta: a clinicopathologic study of 513 cases. Am J Surg Pathol 30:11559, 2006. 
6. Griepp RB, Ergin MA, Lansman SL, et al. The natural history of thoracic aortic aneurysms. Semin Thorac Cardiovasc Surg 1991; 3:258.
7. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 2012; 43:1711.
8. Shreibati JB, Baker LC, Hlatky MA, Mell MW. Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on abdominal ultrasonography use among Medicare beneficiaries. Arch Intern Med 2012; 172:1456. 
9. Gadowski GR, Pilcher DB, Ricci MA. Abdominal aortic aneurysm expansion rate: effect of size and beta-adrenergic blockade. J Vasc Surg 1994; 19:727. 
10. Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 1991; 13:452.