Aneurysm, Brain Health (cont.)

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Brain Aneurysm Other Exams and Tests

The physical exam will focus on the neurologic status of the patient and usually includes the following:

  • evaluation of the pupils to see if they are round and reactive;
  • assessment of the cranial nerves that help the face, mouth, and tongue move and feel;
  • evaluation of the eyes via a fundoscopic exam;
  • examination of the back of the eyes with a light to view the optic nerve (It is the one nerve that leaves the brain that can be directly visualized and may give clues as to whether there is increased pressure within the brain.);
  • assessment of the movement, sensation, and reflexes of the extremities; and
  • assessment of balance and coordination.

The doctor will also check for neck stiffness and meningismus, a condition that features meningitis-like symptoms without inflammation of the meninges (the membranes that cover the brain and spinal cord). When blood leaks from a cerebral aneurysm, it enters the subarachnoid space and causes the tissues that surround the brain to become inflamed. This causes involuntary stiffness of the neck. The patient does not complain about soreness when moving the neck; instead, the stiffness makes it difficult for the doctor to flex or bend the neck because it is being held rigid by the surrounding muscles.

Patients often describe the symptoms of a leaking brain aneurysm and subarachnoid hemorrhage as “the worst headache of their life”. While this compliant is of concern, the decision to pursue that diagnosis requires that the findings of the physical examination be consistent with an ill appearing patient who is at risk for brain aneurysm.

A CT scan of the head without contrast is the first test to look for leaking blood in the brain. The CT is 95% sensitive for detecting a leaking aneurysm, although it cannot tell exactly where the bleeding comes from.

If the suspicion remains high that a brain aneurysm is present, the next test to be performed is a lumbar puncture (LP). With the patient either lying on their side or sitting up, a small needle is inserted through the skin in the lower part of the back between the vertebrae of the lumbar spine and into the subarachnoid space. A few drops of cerebrospinal fluid (CSF) is withdrawn and analyzed in the laboratory. The CSF surrounds the spinal cord and brain and provides them with nutrients. The CSF normally contains no red or white blood cells. If the analysis shows a significant numbers of red blood cells, it may indicate that bleeding has occurred and that the aneurysm has leaked, even though the bleeding could not be seen on a CT scan. The fluid is also checked for white blood cells and bacteria to exclude meningitis and encephalitis as potential causes of the symptoms.

Angiography is the definitive test to make the diagnosis of a leaking brain aneurysm. A small tube is threaded into the arteries of the neck and dye is injected to outline the arteries of the brain to look for abnormalities in the anatomy, including a brain aneurysm. Other tests may be needed to help stabilize and assess the patient.

EKGs and monitors may help look for changing heart rhythms. Increased pressure in the brain can cause changes in the blood pressure, heart rate, heart rhythm, and alterations in the electrical conduction of the heart. Routine blood tests are often done to check for anemia, blood clotting, electrolyte levels, and kidney function. An EEG may be done if the patient has a seizure, which is sometimes a complication of a bleeding brain aneurysm.

While most cerebral aneurysms are due to weakness of a blood vessel wall in the brain, others may be due to an infection or cancer (rarely). Should that be the case, other tests might be necessary.


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