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Neurology (Expert Forum)
In a fog about diagnosis of small aneurysm
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
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In a fog about diagnosis of small aneurysm
by TJM24, Jul 03, 2009 09:07AM
I'm a 36 yr old male. Work out 4 days a week. I got an MRA last week for some bad headaches I'd had over the weekend (turned out to be migraine). As an incidental finding on the MRA, my PCP called and said I had a 3 mm aneurysm on the anterior communicating artery. He was very dismissive of this and said this is a very tiny one, asymptomatic and likely has been with me most of my life. He said he wanted to recheck it periodically and that I should not worry. Easier said than done. I've been a wreck, worrying that I have a ticking bomb in my head and everytime I take a jog or play some indoor soccer I'm thinking its either going to grow or possibly rupture. I've stopped weightlifting (I did moderate not very heavy weights) and I've given up my weekly cigar. I don't drink and I take atenolol for borderline hypertension. I've had nobody in my family going back several generations ever die of stroke or have an aneurys rupture. My doc senses my anxiety over this and has told me to see a neurosurgeon here in Cincinnati to have an expert evaluate it. He still absolutely thinks surgery is not adivsed at this time and that periodic observation is the wisest choice. I'm quite worried that a neuro"surgeon" is going to want to operate. My other concern is that watching and waiting may require me to stop all cardio exercise and sport which is my main stress relief and joy in life. Based on the info I've provided what is your take on this type of small aneurysm finding and your take on what should be done (watch and wait or operate?), limitations on actitivies? Thank you.
-Jason
-Jason
Doctor's Answer
by Lama Chahine, MD, Jul 07, 2009 02:10PM
, Jul 07, 2009 02:10PM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, Iand review your imaging, I can not make specific recommendations regarding management of your aneurysm. However I will try to provide you with some useful information.
It sounds like you have an asymptomatic intracranial aneurysm: an aneurysm in one of the brain vessels that was found incidentally, and not thought to be causing symptoms. In general, when an aneurysm is found and the size determined on MRA, sometimes (depending on the quality of the MRA and the appearance of the aneurysm on it) another confirmatory test such as a CT angiogram or cerebral angiogram may need to be done to confirm the presence of the aneurysm, confirm its size, and to exclude the presence of additional aneurysms too small to be seen on MRA.
In general, the risk of rupture of intracranial aneurysm depends on several factors including most importantly the aneurysm size. Other factors include the location, underlying medical conditions (such as high blood pressure but also other medical conditions), and very importantly smoking and drug use, particularly cocaine use. In general, an aneurysm that is 3 mm in size has a low risk of rupture (in some studies, aneurysms that size have less than a 0.05% risk of rupture per year). The management in such cases is re-imaging at regular intervals (once or twice every year). Control of blood pressure is essential, with goal of <130/85 on average (the lower the better).
In general, aerobic exercising is good for overall blood vessel health, and keeps blood pressure down, and there are no specific limitations that need to be placed on people with small asymptomatic intracranial aneurysms. However, I recommend you discuss with the neurosurgeon if there any specific vigorous exercises that should be avoided.
There are in general 2 types of treatments for aneurysms: clipping, a surgical procedure in which the skull is opened (craniotomy) and the aneurysm is surgically ligated, and coiling, an endovascular procedure in which an angiogram is done through a vessel in the groin, and coils are placed in the aneurysm in order to make it close off. Each of these procedures have its indications and complications, and it is best to discuss these with the neurosurgeon. In selecting a neurosurgeon, the most important thing is to select someone experienced, and a vascular neurosurgeon at a high-volume center is most appropriate for management of intracranial aneurysms.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history, Iand review your imaging, I can not make specific recommendations regarding management of your aneurysm. However I will try to provide you with some useful information.
It sounds like you have an asymptomatic intracranial aneurysm: an aneurysm in one of the brain vessels that was found incidentally, and not thought to be causing symptoms. In general, when an aneurysm is found and the size determined on MRA, sometimes (depending on the quality of the MRA and the appearance of the aneurysm on it) another confirmatory test such as a CT angiogram or cerebral angiogram may need to be done to confirm the presence of the aneurysm, confirm its size, and to exclude the presence of additional aneurysms too small to be seen on MRA.
In general, the risk of rupture of intracranial aneurysm depends on several factors including most importantly the aneurysm size. Other factors include the location, underlying medical conditions (such as high blood pressure but also other medical conditions), and very importantly smoking and drug use, particularly cocaine use. In general, an aneurysm that is 3 mm in size has a low risk of rupture (in some studies, aneurysms that size have less than a 0.05% risk of rupture per year). The management in such cases is re-imaging at regular intervals (once or twice every year). Control of blood pressure is essential, with goal of <130/85 on average (the lower the better).
In general, aerobic exercising is good for overall blood vessel health, and keeps blood pressure down, and there are no specific limitations that need to be placed on people with small asymptomatic intracranial aneurysms. However, I recommend you discuss with the neurosurgeon if there any specific vigorous exercises that should be avoided.
There are in general 2 types of treatments for aneurysms: clipping, a surgical procedure in which the skull is opened (craniotomy) and the aneurysm is surgically ligated, and coiling, an endovascular procedure in which an angiogram is done through a vessel in the groin, and coils are placed in the aneurysm in order to make it close off. Each of these procedures have its indications and complications, and it is best to discuss these with the neurosurgeon. In selecting a neurosurgeon, the most important thing is to select someone experienced, and a vascular neurosurgeon at a high-volume center is most appropriate for management of intracranial aneurysms.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Thanks,