By Dr. Jared Cooper, Neurosurgeon, White Plains Hospital

When people hear the words “brain aneurysm,” they often assume it means that a blood vessel in the brain has ruptured but that’s a common misconception.

A brain aneurysm is an outpouching in an artery of the brain, due to a weakness in the blood vessel wall. While an aneurysm can rupture, many never do. In fact, an estimated 1 in 50 people in the U.S.—about 6.8 million Americans—are currently living with an unruptured brain aneurysm.

“The distinction between a ruptured and unruptured aneurysm is important because they are very different clinical situations,” says Dr. Jared Cooper, a neurosurgeon at White Plains Hospital. “A ruptured aneurysm is a medical emergency. Unruptured aneurysms, however, often do not cause symptoms and, depending on the individual patient and the type of aneurysm, may be treated or simply monitored.”

When an Aneurysm Ruptures

A ruptured brain aneurysm occurs when the weakened area of the artery breaks open and bleeding occurs around the brain.

The hallmark symptom is typically a sudden onset, extremely severe headache, often described as a “thunderclap” headache or the “worst headache of my life.” Other symptoms may include:

• Nausea or vomiting
• Confusion
• Weakness
• Seizure
• Loss of consciousness

“The sudden onset is one of the most important things to recognize,” Dr. Cooper says. “People who experience migraines generally recognize their typical headache pattern. Headaches from an aneurysm rupture generally do not gradually  worsen. They are sudden, severe, and often dramatically different from any headache the person has experienced before.”

If you suspect a ruptured brain aneurysm, call 911.

An Unruptured Aneurysm Is a Different Story

Most unruptured aneurysms do not cause symptoms and are often discovered incidentally when a person undergoes brain imaging for another reason. Less frequently, larger aneurysms may cause compression of nearby cranial nerves or other brain structures that can cause symptoms, such as blurred or double vision, a drooping eyelid, a dilated pupil, pain above or behind the eye, weakness, or numbness.

Still, finding an unruptured aneurysm, however, does not automatically mean a person needs treatment.

“We look at the whole picture,” Dr. Cooper explains. “The aneurysm’s size, location and shape are important, as are the patient’s age, health, and individual risk factors. “All of those things help us understand the risk an aneurysm may pose and determine the safest approach for that patient.”

Risk factors considered can include high blood pressure, diabetes, chronic tobacco or alcohol use, family history, and certain inherited conditions.

Treatment Is Highly Individualized

All ruptured aneurysms require emergency treatment. Today, they are most commonly treated using minimally invasive endovascular techniques such as coiling, although surgical clipping and other approaches may be appropriate depending on the aneurysm and the patient.

For unruptured aneurysms that do require treatment, physicians have an expanding range of options, including coiling, stent-assisted or balloon-assisted coiling, flow-diverting stents, intrasaccular devices and, in select cases, surgical clipping.

The most important takeaway, Dr. Cooper says, is not to think of every brain aneurysm in the same way.

“Learning that you have an aneurysm can understandably be frightening,” he says. “With the imaging and treatment options available today, we can carefully evaluate each aneurysm and determine the approach that is safest for that individual patient.”

White Plains Hospital offers the full range of advanced care for brain aneurysms, from monitoring and evaluation, to minimally invasive endovascular procedures, and open microsurgical treatment when needed.

Dr. Jared Cooper is a neurosurgeon and neuro-endovascular surgeon with White Plains Hospital Physician Associates (WPHPA), with offices in our WPHPA Neurosurgery & Neuro-Endovascular Surgery location in White Plains. To make an appointment, call 914.849.7593.

This story originally appeared on Health Matters, a White Plains Hospital publication.