Unruptured Brain Aneurysm: Know the Symptoms and When to Seek Care

By Morgan deBlecourt
February 01, 2024
A female patient sits on an exam table and talks to a female doctor

A ruptured brain aneurysm can be deadly, but most people don’t realize they have a brain aneurysm until it’s too late. That’s because unruptured brain aneurysms rarely cause symptoms. Fortunately, some warning signs can signal when you should seek care. Duke Health neurosurgeon Andrew B. Cutler, MD, a specialist in identifying and treating brain aneurysms, explains what they are and when you should see a doctor.

Brain Aneurysm: Unruptured vs. Ruptured

A brain aneurysm is a weakened or bulging portion of an artery in the brain. Most unruptured brain aneurysms are stable and not life-threatening. However, when a brain aneurysm ruptures, it leaks blood around the brain. This is called a subarachnoid hemorrhage, a type of stroke that can be devastating and deadly. If you have an unruptured brain aneurysm, surgery may be recommended to prevent a rupture. A team of brain aneurysm specialists can help you determine if, when, and what type of surgery is right for you. 

Unruptured Brain Aneurysm Warning Signs

According to Dr. Cutler, most unruptured brain aneurysms are discovered during an imaging scan for an unrelated issue. That’s because brain aneurysms are often “silent,” meaning they don’t cause any symptoms.

When unruptured brain aneurysms do cause symptoms, they include:

  • Droopy eyelids
  • Pain around the eyes
  • Pupil dilation 
  • Vision changes
  • Facial weakness or numbness

Chronic headaches or migraines are rarely related to an unruptured brain aneurysm, Dr. Cutler said. However, a sudden and intense headache that may be described as the worst headache of your life could signal a leaky or ruptured brain aneurysm. This requires emergency medical attention. 

Unruptured Brain Aneurysm Effects on Behavior

Unlike tumors inside the brain -- which often grow to three or four centimeters in diameter and compress areas of the brain that control behavior -- aneurysms are smaller, usually less than a centimeter wide, and form on the outside of the brain. It’s rare for an unruptured brain aneurysm to cause behavior changes like confusion or mood swings, unless it’s growing very large, very quickly, said Dr. Cutler.

When to See a Brain Aneurysm Specialist

If you’ve been experiencing symptoms of a brain aneurysm, talk to your doctor about getting an MRI or CT angiogram and ask for a referral to a neurologist or neurosurgeon who specializes in treating brain aneurysms. “This is especially true if you smoke or have high cholesterol or high blood pressure, since these are major risk factors,” Dr. Cutler said. “If you have a family history of aneurysm or if you or a family member has a connective tissue disorder, which makes blood vessels weaker than normal, you should be screened for a brain aneurysm.”

Qualified, experienced brain aneurysms specialists at Duke offer appointments in Raleigh and Durham. If you discover you do have a brain aneurysm, Duke offers the full range of treatment options, from less-invasive catheter-based approaches to complex open surgery. “Because of our breadth of expertise, we can help you navigate the treatment options and ultimately choose what is best for you,” Dr. Cutler said.

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