A brain aneurysm is a serious condition that could cause a stroke. You’ll need prompt treatment. Surgery is the first-line treatment option, but there are less invasive procedures.

A brain aneurysm is a bulged agea area that can form at weak or thin points in your arteries. Aneurysms can develop all over the body, and smaller ones aren’t a major cause for concern. However, an aneurysm in an artery in your brain that bleeds can cause a stroke and requires emergency medical treatment.

This article will explore the emergency treatments you’ll need if you have a ruptured cerebral aneurysm. It will also cover other treatments that doctors may offer for smaller, less critical aneurysms in your brain.

Learn more about brain aneurysms.

For smaller aneurysms that have a low risk of rupture, a doctor may monitor them over time. However, even small aneurysms can rupture without warning.

If you have a large aneurysm that’s causing symptoms by putting pressure on nearby nerves or structures, your doctor may recommend removal. If your aneurysm ruptures, treatment is usually immediate and aggressive.

Getting surgery to place metal coils or deliver medications that can close the ruptured vessel and stop the bleeding is the first-line treatment for cerebral aneurysms. Open surgery used to be the only option, but, as technology has progressed, less invasive methods have emerged and even proven superior to traditional surgery.

In endovascular embolization, for example, a doctor inserts a thin catheter into a large artery far away from the rupture — usually in the groin — to place a stent or coil and deliver medications for treatment.

This treatment has come a long way in recent years, and it’s become the first choice in treating brain aneurysms. As a less invasive option, it offers better outcomes with fewer complications for most people with cerebral aneurysms.

Without treatment, a ruptured aneurysm will cause blood to leak from the artery where the weak spot developed into your brain tissue. This is known as a cerebral hemorrhage or hemorrhagic stroke.

Even if the bleeding stops, additional complications can develop from a brain bleed, including:

  • reoccurring bleeding at the site of the aneurysm
  • changes in levels of electrolytes like sodium
  • increased fluid buildup in the brain (hydrocephalus)
  • spasms or seizures

Only about half of people who have a ruptured brain aneurysm survive. For people who do survive the rupture, some sort of neurologic damage usually occurs.

The only time a doctor may not offer aggressive treatment for a ruptured aneurysm is when other health conditions or circumstances would guarantee an adverse outcome. People who are already very unwell or who are showing little neurologic function after the rupture may not survive or see improvement with surgery.

In these cases, any treatments offered are less invasive but also not curative.

Smaller aneurysms don’t usually cause symptoms, and they may go unnoticed unless a doctor performs imaging of the brain for another purpose.

If you’ve been experiencing headaches or vision changes, or if you experience a sudden neurological change that prompts your healthcare team to check for an aneurysm, they may run the following tests:

When to treat even a small aneurysm is debated, as even small aneurysms can rupture without warning.

If you’re not a good candidate for open surgery or endovascular embolization, or if you have a low risk aneurysm, a doctor will offer treatments and testing to watch the progression of the aneurysm and to try to prevent rupture.

Serial imaging, or regular CT or MRI scans, to check the size and progression of the aneurysm is common. In addition, a doctor may recommend making some diet and lifestyle changes and better managing any chronic health conditions that could increase the risk of rupture, such as high blood pressure.

Your healthcare team might recommend the following nonsurgical options if you’re at risk of a cerebral aneurysm rupture:

  • quitting smoking
  • eating a healthy diet
  • getting regular exercise
  • avoiding stimulants
  • taking medications to keep control of your blood pressure
  • taking antiseizure medications
  • taking calcium-channel blockers to reduce the risk of vasospasms
  • getting shunts to divert cerebrospinal fluid and reduce pressure in the brain
  • trying rehabilitation programs
  • getting physical therapy

Learn about how to prevent a cerebral aneurysm.

Small brain aneurysms that aren’t causing symptoms have a good outlook unless they rupture. Since there’s no telling when that can happen, your healthcare team may suggest treatment or close monitoring of the aneurysm.

Studies suggest that aneurysms under 24 millimeters in diameter have up to a 14.5% chance of rupturing within 5 years of discovery. The risk of rupture increases to 40% or more in aneurysms measuring 25 millimeters or more.

Some things that can increase the risk of an existing aneurysm rupturing include:

  • your family history or genetics
  • your age
  • your overall health
  • the type, size, and location of the aneurysm
  • uncontrolled high blood pressure
  • cigarette smoking
  • the use of stimulant drugs, like caffeine or cocaine

In one study, nearly 20% of people who developed bleeding in the brain as a result of a ruptured cerebral aneurysm died soon after the event. Nearly 30% were still alive after 5 years, and about 64% of survivors were living without any disability 5 years after treatment.

Overall, people who have endovascular embolization seem to have better outcomes with fewer complications than those who have open surgery.

Learn more about life after a brain aneurysm.

Doctors typically treat even small brain aneurysms with at least a minimally invasive surgical procedure because they can rupture without warning and have severe consequences, such as stroke or death. Not everyone is a candidate for surgery, however.

Without treatment, a ruptured aneurysm has a poor outlook, but an unruptured aneurysm that a doctor finds when testing for something else can exist without any symptoms at all.

If you have a ruptured aneurysm, your healthcare team will likely offer emergency medical treatment to give you the best chance of survival. The effects of the acute rupture and your overall health will play a significant role in your long-term outlook and recovery after a brain aneurysm.