Brain Aneurysms

• Affect approximately 2-5% of the Australian population
• Most common in adults aged 35-60 years
• Women are 1.5 times more likely to develop aneurysms than men
• Many aneurysms never rupture and can be managed safely
• Early detection and expert management significantly improve outcomes
• Modern treatment options include both surgical and minimally invasive approaches

At Cura Medical Specialists, we understand the profound concern and anxiety that comes with a brain aneurysm diagnosis, whether discovered incidentally or following symptoms. Our experienced neurovascular team, led by Dr. Emma Harrison and Dr. Najwa Khalil, provides comprehensive, compassionate care using the latest diagnostic techniques and treatment approaches available in Sydney.

A brain aneurysm, also known as a brain aneurysm or intracranial aneurysm, is a weakness in the wall of a blood vessel in the brain that causes it to bulge outward, creating a balloon-like sac. These abnormal dilations typically occur at points where blood vessels branch, particularly in the circle of Willis—the network of arteries at the base of the brain that supplies blood to the entire brain.

The wall of a normal artery has three layers: the inner layer (intima), middle muscular layer (media), and outer layer (adventitia). In an aneurysm, one or more of these layers becomes weakened, causing the vessel wall to balloon outward under the pressure of blood flow. This weakening can be present from birth (congenital) or develop over time due to various factors.

Most brain aneurysms are small—typically less than 10 millimetres in diameter—and may never cause problems. However, larger aneurysms or those that continue to grow pose a risk of rupture, which can lead to life-threatening bleeding in the brain called a subarachnoid haemorrhage. Understanding the type, size, and location of an aneurysm is crucial for determining the most appropriate management approach.

Unruptured brain aneurysms often produce no symptoms and are frequently discovered incidentally during brain imaging performed for other reasons. However, some aneurysms, particularly larger ones, may cause symptoms by pressing on nearby brain structures or nerves.

Symptoms of an unruptured aneurysm may include:

• Sudden, severe headache unlike any previously experienced
• Pain above or behind the eye
• Vision changes, including double vision or loss of peripheral vision
• Numbness or weakness on one side of the face
• Difficulty speaking or understanding speech
• Sudden dizziness or loss of balance
• Neck stiffness

Warning signs of a ruptured aneurysm (medical emergency):

• Sudden, explosive headache often described as "the worst headache of my life"
• Nausea and vomiting
• Stiff neck
• Sensitivity to light (photophobia)
• Sudden confusion or decreased consciousness
• Seizures
• Weakness or numbness in arms or legs
• Difficulty speaking or understanding speech

Seek immediate emergency care if you experience: Any sudden, severe headache, especially if accompanied by neck stiffness, nausea, vomiting, or changes in consciousness. A ruptured aneurysm is a life-threatening emergency requiring immediate medical attention. Call 000 immediately or go to the nearest hospital emergency department.

Brain aneurysms develop through a complex interplay of genetic, environmental, and lifestyle factors. While the exact cause isn't always clear, research has identified several key risk factors that contribute to aneurysm formation and growth.

Non-modifiable risk factors:

• Family history: Having a first-degree relative with a brain aneurysm increases your risk by 3-5 times
• Genetic conditions: Including polycystic kidney disease, Ehlers-Danlos syndrome, and Marfan syndrome
• Gender: Women are more likely to develop aneurysms, particularly after menopause
• Age: Risk increases with age, peaking between 35-60 years
• Race: Higher prevalence in certain ethnic groups, including Aboriginal and Torres Strait Islander peoples

Modifiable risk factors:

• High blood pressure: The most significant modifiable risk factor
• Smoking: Increases aneurysm risk by 3-10 times and accelerates growth
• Excessive alcohol consumption: Heavy drinking can weaken blood vessel walls
• Drug use: Particularly cocaine and amphetamines, which cause sudden blood pressure spikes
• Infections: Rare, but certain infections can weaken arterial walls

Other contributing factors:

• Head trauma or injury
• Arteriovenous malformations (AVMs)
• Previous history of aneurysm rupture
• Hormonal factors, including pregnancy and oral contraceptive use

Understanding these risk factors helps our team at Cura Medical Specialists develop personalised prevention strategies and determine appropriate screening recommendations for patients and their families.

At Cura Medical Specialists, we employ state-of-the-art diagnostic technology and comprehensive assessment protocols to accurately diagnose and evaluate cerebral aneurysms. Our neurovascular specialists, Dr. Emma Harrison and Dr. Najwa Khalil, utilise their extensive experience to interpret complex imaging and develop individualised management plans.

Initial consultation and assessment: Our detailed neurological examination includes assessment of vision, speech, coordination, reflexes, and cognitive function. We carefully review your medical history, family history, and any symptoms you may be experiencing. This comprehensive evaluation helps determine the urgency of further testing and guides our diagnostic approach.

Advanced imaging techniques:

• CT Angiography (CTA): A rapid, non-invasive scan that provides detailed images of blood vessels using contrast dye. CTA is often the first-line imaging for suspected aneurysms and can quickly identify the presence, location, and size of aneurysms.
• Magnetic Resonance Angiography (MRA): Uses magnetic fields and radio waves to create detailed images of blood vessels without radiation exposure. MRA is particularly useful for follow-up monitoring of known aneurysms.
• Digital Subtraction Angiography (DSA): The gold standard for aneurysm diagnosis, providing the most detailed images of cerebral blood vessels. This minimally invasive procedure involves inserting a thin catheter through a blood vessel in the groin and injecting contrast dye directly into the brain's arteries.

Specialist interpretation and planning: Our neurovascular team carefully analyses all imaging results, considering factors such as aneurysm size, shape, location, and relationship to surrounding brain structures. We assess rupture risk using established scoring systems and discuss findings in our multidisciplinary team meetings to ensure optimal treatment recommendations.

Follow-up imaging protocols: For unruptured aneurysms requiring monitoring, we establish individualised surveillance schedules based on aneurysm characteristics and patient factors. Regular follow-up imaging allows us to detect any changes in aneurysm size or shape that might influence treatment decisions.

Treatment decisions for cerebral aneurysms depend on multiple factors, including aneurysm size, location, shape, patient age, overall health, and individual risk factors. At Cura Medical Specialists, we offer the full spectrum of treatment options, from careful monitoring to advanced surgical and endovascular interventions.

Conservative management and monitoring: Many small, unruptured aneurysms can be safely monitored with regular imaging studies. Our surveillance protocols include lifestyle modification recommendations, blood pressure management, and scheduled follow-up appointments. This approach is often appropriate for small aneurysms (less than 7mm) in patients without high-risk features.

Medical management:

• Blood pressure control: Maintaining optimal blood pressure reduces stress on aneurysm walls and decreases rupture risk
• Smoking cessation support: We provide comprehensive resources and referrals to help patients quit smoking
• Lifestyle modifications: Including dietary guidance, exercise recommendations, and stress management techniques
• Medication management: Careful review of medications that might affect bleeding risk or blood pressure

Endovascular treatment:

• Coiling (endovascular embolisation): A minimally invasive procedure where platinum coils are placed inside the aneurysm through a catheter, promoting clotting and sealing off the aneurysm from normal blood flow
• Flow diverters: Advanced stent-like devices that redirect blood flow away from the aneurysm, promoting healing of the vessel wall
• Balloon-assisted coiling: Used for wide-necked aneurysms where standard coiling techniques may not be sufficient

Surgical treatment:

• Microsurgical clipping: A traditional but highly effective procedure where a small metal clip is placed across the neck of the aneurysm to prevent blood flow into the aneurysm sac
• Bypass surgery: Rarely needed, but may be considered for complex aneurysms where other treatments aren't suitable

Our team works closely with leading neurosurgical centres in Sydney to ensure patients have access to the most appropriate treatment option for their specific situation.

At Cura Medical Specialists, we understand that facing a cerebral aneurysm diagnosis can be overwhelming. Our approach combines cutting-edge medical expertise with compassionate, patient-centred care to provide you with the best possible outcomes and peace of mind.

Expert neurovascular team: Dr. Emma Harrison and Dr. Najwa Khalil lead our cerebrovascular program, bringing decades of combined experience in managing complex aneurysm cases. Their expertise in both diagnostic interpretation and treatment planning ensures you receive world-class care close to home in Sydney's Inner West.

Comprehensive, multidisciplinary approach: Our team collaborates closely with neurosurgeons, interventional radiologists, and other specialists to ensure you have access to the full range of treatment options. We participate in regular multidisciplinary meetings where complex cases are discussed to determine the optimal management approach for each patient.

State-of-the-art diagnostic capabilities: We utilise the latest imaging technology and have established relationships with premier imaging centres across Sydney. Our specialists are trained in interpreting the most advanced imaging techniques, ensuring accurate diagnosis and optimal treatment planning.

Personalised treatment planning: We recognise that every aneurysm and every patient is unique. Our treatment recommendations are tailored to your specific situation, taking into account not only medical factors but also your lifestyle, concerns, and preferences.

Convenient Inner West location: Located in Drummoyne with excellent transport links and ample parking, our practice is easily accessible for patients throughout Sydney. Our modern facilities provide a comfortable, welcoming environment for consultations and follow-up care.

Ongoing support and monitoring: Whether you require surgical treatment or ongoing monitoring, we provide comprehensive follow-up care. Our team is available to address concerns, answer questions, and ensure you feel supported throughout your care journey.

Strong hospital affiliations: We maintain close working relationships with leading private and public hospitals across Sydney, ensuring seamless care coordination if hospitalisation or specialised procedures are required.

Receiving a diagnosis of brain aneurysm can be life-changing, but with proper management and support, many people with aneurysms live full, active lives. Our team at Cura Medical Specialists is committed to helping you understand your condition and develop strategies for living confidently with your diagnosis.

Understanding your individual risk: Not all aneurysms are the same, and rupture risk varies significantly based on size, location, and other factors. We provide clear, personalised information about your specific situation, helping you understand what your diagnosis means for your daily life and long-term health.

Lifestyle modifications for aneurysm management:

• Blood pressure management: Maintaining healthy blood pressure through diet, exercise, and medication compliance is crucial
• Smoking cessation: If you smoke, quitting is the single most important step you can take to reduce your risk
• Exercise guidelines: Most people with unruptured aneurysms can exercise safely, though we may recommend avoiding extremely strenuous activities or contact sports
• Stress management: Learning techniques to manage stress can help control blood pressure and improve overall wellbeing

Managing anxiety and emotional health: It's normal to feel anxious about having an aneurysm. We provide resources for psychological support and can refer you to counsellors who specialise in helping people cope with serious medical conditions. Many patients find support groups helpful for connecting with others who understand their experience.

Family planning considerations: For women of childbearing age, we provide guidance about pregnancy considerations and work with obstetric specialists to ensure safe pregnancy management when appropriate.

Regular monitoring and follow-up: Adhering to your follow-up schedule is important for tracking any changes in your aneurysm. We make this process as convenient as possible and are always available to address concerns between appointments.

Emergency preparedness: We ensure you and your family understand warning signs that require immediate medical attention and have a clear action plan for emergency situations.

Will my aneurysm definitely rupture? Most brain aneurysms never rupture. The annual rupture risk for small aneurysms (less than 7mm) is typically less than 1%. Factors such as size, location, shape, and your individual risk factors all influence rupture probability. Our specialists will provide you with personalised risk assessment based on your specific situation.

Can I still exercise with an unruptured aneurysm? Most people with unruptured aneurysms can exercise safely. We generally recommend avoiding activities that cause sudden, extreme increases in blood pressure, such as very heavy weightlifting or high-intensity contact sports. However, regular moderate exercise is beneficial for overall cardiovascular health and blood pressure control.

Should my family members be screened for aneurysms? Family screening is recommended when you have a first-degree relative (parent, sibling, or child) with a cerebral aneurysm, particularly if multiple family members are affected. We can provide guidance about appropriate screening protocols and timing for family members.

What's the difference between surgical clipping and coiling? Both are effective treatments, but they use different approaches. Surgical clipping involves opening the skull and placing a small metal clip across the aneurysm neck, while coiling is performed through blood vessels using a catheter inserted through the groin. The choice depends on aneurysm characteristics, location, and individual patient factors.

How often will I need follow-up imaging? Follow-up schedules vary based on aneurysm characteristics and treatment approach. Unruptured aneurysms under monitoring typically require imaging every 6-12 months initially, then less frequently if stable. Treated aneurysms also require periodic imaging to ensure the treatment remains effective.

Understanding when to seek medical attention is crucial for anyone with a diagnosed brain aneurysm or those at risk. While most aneurysms never cause problems, recognising warning signs can be life-saving.

Seek immediate emergency care (call 000) if you experience:

• Sudden, severe headache that's different from any you've had before
• Headache with neck stiffness, fever, or sensitivity to light
• Sudden changes in vision or double vision
• Sudden weakness or numbness in face, arms, or legs
• Difficulty speaking or understanding speech
• Sudden loss of balance or coordination
• Loss of consciousness or confusion
• Seizures

Contact our practice promptly for:

• New or worsening headaches, especially if they're more frequent or severe
• Changes in vision that develop gradually
• Persistent neck pain or stiffness
• New neurological symptoms such as dizziness, difficulty concentrating, or memory problems
• Concerns about your medication or treatment plan

Routine follow-up appointments: Maintain regular scheduled appointments even if you feel well. Many important changes in aneurysms can only be detected through imaging studies, not symptoms.

Emergency contact information: Outside business hours, if you have urgent concerns related to your aneurysm, contact your GP or present to the nearest hospital emergency department. For life-threatening symptoms, always call 000 immediately.

Don't let concerns about a possible brain aneurysm go unaddressed. Whether you're experiencing symptoms, have a family history of aneurysms, or need expert management of a known aneurysm, our experienced neurovascular team is here to help.

Why choose Cura Medical Specialists for your aneurysm care:

• Leading neurovascular specialists Dr. Emma Harrison, Dr. Najwa Khalil, Dr. Timothy Ang, and Dr. Hugh Stephen Winters
• Comprehensive diagnostic capabilities using state-of-the-art imaging
• Personalised treatment plans tailored to your individual needs
• Convenient Drummoyne location with excellent parking
• Collaborative care with Sydney's top neurosurgical centres
• Ongoing support and monitoring throughout your care journey

How to book your consultation: Phone: (02) 7906 8356 - Our friendly reception team can schedule your appointment and answer any questions about your visit.

Online booking: Visit our secure patient portal for convenient 24/7 appointment scheduling.

What to bring to your appointment:

• Referral letter from your GP or other doctor
• Previous brain imaging (scans, reports) if available
• List of current medications and allergies
• Medicare card and private health insurance details
• Any questions or concerns you'd like to discuss

Consultation process: Your initial consultation will include a comprehensive neurological examination, review of your medical history, and discussion of appropriate diagnostic tests or treatment options. We allow adequate time for questions and ensure you leave with a clear understanding of your condition and next steps.

Early consultation and expert management can make a significant difference in outcomes for cerebral aneurysm patients. Our team is committed to providing you with the expert care, support, and peace of mind you deserve.

Managing a brain aneurysm diagnosis involves not just medical treatment but also emotional support and practical resources. We've compiled comprehensive Australian resources to help you and your family navigate this journey.

Professional support organisations:

• Brain Foundation Australia: Provides information, support, and advocacy for people with neurological conditions. Offers free resources and support programs.
• Stroke Foundation: While focused on stroke, many resources are relevant for aneurysm patients, particularly regarding risk factor management and recovery.

Remember, you're not alone in managing your cerebral aneurysm. Our team at Cura Medical Specialists is here to support you every step of the way, and these additional resources can provide valuable supplementary support for you and your family.