Unruptured aneurysms

In most cases, an unruptured aneurysm will cause no symptoms unless it becomes big or, in the case of a intracranial aneurysm, begins to press against tissues or nerves inside the brain.

Unruptured aortic aneurysm

Symptoms of an unruptured aortic aneurysm include:

• a vibrating sensation in your abdomen, usually near your navel (belly button), that is usually only noticeable when you touch it,
• chronic (long-lasting) back pain, and
• chronic abdominal pain.

Unruptured intracranial aneurysm

Symptoms of an unruptured intracranial aneurysm include:

• visual disturbances, such as loss of vision or double vision,
• difficulties moving one of your eyes,
• pain on one side of your face or around your eye,
• paralysis of some of your facial muscles,
• headaches, and
• seizures (fits).

Ruptured aortic aneurysm

If your aortic aneurysm ruptures, you will experience a sudden and severe pain in the middle or side of your abdomen. In men, the pain can also radiate down into the scrotum.

Other symptoms include:

• dizziness,
• sweaty and clammy skin,
• rapid heartbeat (tachycardia),
• shortness of breath,
• feeling faint, and
• loss of consciousness.

Ruptured intracranial aneurysm

Symptoms of a ruptured intracranial aneurysm usually begin with a sudden and severe headache, which has been described as like being hit on the head, resulting in a blinding pain that is unlike anything ever experienced before.

Other symptoms include:

• stiff neck,
• sickness and vomiting,
• slurred speech,
• sensitivity to light (photophobia),
• blurred or double vision,
• mental confusion, and
• loss of consciousness.

Causes of an aneurysm

Aortic aneurysms
The aorta is the largest blood vessel in the body, and is responsible for moving oxygen-rich blood away from your heart and lungs to the rest of the body.

The aorta is a hollow tube, about the width of a hosepipe. The wall of the aorta is made up of elastic fibres that are a mixture of proteins and collagen (a tough, flexible type of protein).

In cases of aortic aneurysm, the normal mixture of elastic fibres and collagen becomes disrupted, leading to a weakening in part of the aortic wall. The large amount of blood that passes through the aorta will place pressure on the weak spot in the wall, causing it to bulge outwards to form an aneurysm.

Risk factors for an aortic aneurysm

It is not known exactly what causes the aortic wall to weaken. However, a number of factors, many of which are interlinked, have been related to an increased risk of developing an abdominal aortic aneurysm. These are explained below.

1. Atherosclerosis: this is a condition where blood vessels, such as the aorta, become harder and narrower. It can be caused by high-cholesterol, smoking and high blood pressure (hypertension).
2. Smoking: people who smoke tobacco are four times more likely to develop an aortic aneurysm compared to non-smokers. This may be due to smoking’s link with atherosclerosis, but there may also be substances in tobacco smoke that directly weaken the aortic wall.
3. High blood pressure: if the blood is pumped through the aorta at a higher pressure than normal, it may weaken the aortic wall.
4. Family history: research has found that someone with a first-degree relative, such as a parent, brother, or sister, who has an aortic aneurysm, will have a 20% chance of developing the condition themselves, compared to a 1 to 3% risk in a person with no family history of aneurysm.

Intracranial aneurysm
The brain requires a large supply of blood due to its size and complexity (the brain uses 25% of all the blood in the human body).

The supply of blood is delivered to the brain by two main blood vessels that run up the neck and into the brain. These blood vessels divide into smaller and smaller vessels in the same way that a trunk of a tree divides into branches and twigs.

Most aneurysms develop at the points where the blood vessels divide and branch off because these are the sections where the vessel walls are weakest.

Risk factors for an intracranial aneurysm

In some cases, intracranial aneurysms are caused by pre-existing (present from birth) weaknesses in the blood vessels.

Anything that alters the normal flow of blood through the brain can also be a risk factor for an intracranial aneurysm. Common risk factors include:

• atherosclerosis (narrowing of the arteries),
• smoking,
• high blood pressure (hypertension), and
• severe head injury.

Family history can be a risk factor. Having a first-degree relative with a history of intracranial aneurysm means that it is twice as likely that you will develop an intracranial aneurysm compared to someone with no family history of the condition. However, the increased risk is still small, estimated at 4.2%.

Cocaine abuse is another risk factor for intracranial aneurysms. Cocaine can inflame the walls of the blood vessels and raise your blood pressure. The combination of both of these factors increases your risk of developing an intracranial aneurysm.

There are also a number of health conditions that can increase your risk of developing an intracranial aneurysm. These include:

1. polycystic kidney disease: a genetic disorder that affects the kidneys and causes chronic high blood pressure, and
2. Marfan syndrome: a genetic disorder where the fibres that make up the blood vessels are not properly formed.

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