Top Takeaways

• While similar, strokes and aneurysms are different medical health problems.
• The best way to prevent strokes and aneurysms is to quit smoking, control blood pressure, take medications as prescribed, and adopt a healthy lifestyle.
• Unruptured aneurysms may not have any symptoms. It is when the aneurysm ruptures that symptoms suddenly show up. 
• Strokes and ruptured aneurysms are life-threatening medical emergencies that require immediate medical attention. 

 

Definition

 

Stroke

A stroke, or brain attack, happens when the blood supply to part of the brain is blocked. The longer the blockage, the more serious the damage. Brain damage can lead to some loss of memory and muscle control. 

 The two most common types of strokes are:

1. Ischemic stroke: when a blood clot blocks the blood supply to the brain.
2. Hemorrhagic stroke: when a blood vessel in the brain bursts and bleeds.

 

Aneurysm

An aneurysm is an abnormality or weakness in the wall of a blood vessel in the body. This abnormality can be congenital (a person is born with it) or can happen over time as a person gets older and other factors.

While aneurysms may occur anywhere in the body, they most commonly occur in the brain and the heart’s aorta. This weakness causes the blood vessel to bulge, or balloon, and sometimes rupture. A brain aneurysm, or cerebral aneurysm, is a weakness in an artery in the brain. This article will focus on brain aneurysms.

Aneurysms can be unruptured, where the weak blood vessel is still intact, and ruptured, where the blood vessel bursts. Ruptured brain aneurysms can lead to hemorrhagic stroke, which can cause a subarachnoid hemorrhage (bleeding in the space between the skull and the brain).

 

Difference

The main difference between a stroke and an aneurysm is that while all strokes are medical emergencies, only ruptured aneurysms are medical emergencies.

When properly diagnosed, monitored, and sometimes treated, small unruptured aneurysms may not turn into life-threatening medical emergencies.

 

Risk Factors

Risk factors can be modifiable (can be controlled) and non-modifiable (cannot be controlled):

 

Stroke

Modifiable Risk Factors 

• Smoking
• Excessive alcohol use
• Drug use, especially cocaine
• Obesity and physical inactivity 
• High blood pressure (hypertension)
• High cholesterol levels, especially if the person has atherosclerosis (hardening of arteries due to the buildup of plaque)
• Diabetes 
• Heart disease, including atrial fibrillation (irregular heartbeat)
• Arterial disease, including carotid arterial disease (CAD) and peripheral arterial disease (PAD)
• Sickle cell anemia and other blood disorders 

 

Non-Modifiable Risk Factors 

• Age: Stroke risk increases with age
• Ethnicity: Stroke risk is higher in African Americans
• Gender: Stroke risk is higher in men. However, since women live longer and stroke risk increases with age, women have more strokes than men!
• Family history: If a person’s grandparent, parent, or sibling suffered from a stroke, especially if they were younger than 65 years, that person’s risk of stroke is higher
• Prior stroke: stroke risk is higher for a person who has already had a stroke
• Prior heart attack: stroke risk is higher in people who have had a heart attack

 

Aneurysm

Modifiable Risk Factors 

• Smoking
• High blood pressure
• Excessive alcohol use
• Drug use, especially cocaine

 

Non-Modifiable Risk Factors 

• Age: adults over the age of 40 are at an increased risk for brain aneurysms
• Ethnicity: risk of subarachnoid hemorrhage caused by a ruptured brain aneurysm is higher in African Americans.
• Gender: risk of subarachnoid hemorrhage caused by a ruptured brain aneurysm is higher in women
• Family history: If a person’s grandparent, parent, or sibling suffered from a brain aneurysm, that person’s risk is higher
• Prior aneurysm: risk is higher for a person who has already had an aneurysm
• Infection or congenital abnormality in the brain’s artery wall
• Severe head trauma
• Arteriovenous malformations (AVM)
• Polycystic kidney disease

 

Strokes and ruptured aneurysms can have devastating complications that lead to long-term disability and even death. Patients can lower their risk by changing the modifiable risk factors, including taking the recommended medications and lifestyle modifications, such as quitting smoking, exercising, not using drugs, drinking less alcohol, and eating healthier.

 

Symptoms and Warning Signs

Some symptoms and warning signs are common in strokes and aneurysms, while others are unique to each condition. 

 

Stroke

Some of the most common symptoms and warning signs of a stroke include:

• Drooping and numbness in one side of the face or body
• Weakness and inability to lift arm
• Slurred speech or difficulty speaking
• Confusion
• Double vision and other vision problems
• Difficulty with balance and coordination
• Sudden, severe headache

 

Both the American Heart Association and the American Stroke Association recommend using the acronym F.A.S.T. to remember how to spot signs of a stroke. F.A.S.T. stands for: 

 

F: Face drooping

A: Arm weakness

S: Speech problems

T: Time to call 911

 

Aneurysm

Symptoms and warning signs depend on the size of the aneurysm and whether it is intact, leaking, or ruptured:

 

A small, unruptured aneurysm often doesn’t have any noticeable symptoms or warning signs.

A large, unruptured aneurysm often has the following symptoms: 

•   Weakness and numbness in one or both limbs
•   Difficulty speaking
•   Confusion
•   Double vision and other vision problems
•   Difficulty with balance and coordination
•   Pain around one eye
•   Enlarged pupil in one eye

 

Leaking aneurysm: The most noticeable symptom of a leaking aneurysm is a sudden and severe headache. A small leak often leads to a large leak and eventually a ruptured aneurysm.

 

Ruptured aneurysm:

•   A sudden, extremely severe headache often described as the worst headache in a person’s life
•   Stiff neck 
•   Nausea and vomiting 
•   Seizure 
•   Loss of consciousness 
•   Sensitivity to light

 

If you suspect that a loved one is having a stroke or a brain aneurysm, call 911 or seek immediate medical attention.

 

Diagnosis

Healthcare professionals will diagnose strokes and aneurysms based on symptoms, personal medical history, medications, family history, and other factors. Some of the tools used to diagnose strokes and aneurysms include:

 

Computed Tomography scan (CT scan)

A CT scan, or CAT scan, is a non-invasive tool that uses X-rays and computer technology to show images of the areas of the brain affected by a stroke or aneurysm, including any bleeding in or around the brain.

 

Magnetic Resonance Imaging (MRI)

An MRI is a non-invasive tool that uses a magnetic field and radio-frequency waves to show detailed images of the brain, including soft brain tissue.

 

Your loved one’s doctor will decide whether they need a CT scan, MRI, or other imaging tests.

 

Treatment

Treatment will depend on the type of stroke or brain aneurysm, severity, medical history, age, and other factors. The following is a general overview of treatments available for strokes and brain aneurysms:

 

Stroke

Different types of strokes require different treatment protocols.

 

Ischemic stroke

Doctors may give your loved one a tissue plasminogen activator, or tPA, to break up a clot. Later, doctors may also prescribe blood thinners, statins, blood pressure medications, and other medications to prevent future strokes.

Neurosurgeons may also perform a thrombectomy, which is a surgery that places a catheter from the groin up to the blocked blood vessel in the brain. The neurosurgeon then pulls out the clot from the blood vessel using a stent retriever.

 

Hemorrhagic stroke

Treatment depends on the type and location of the hemorrhagic stroke. A combination of medications and surgery may be needed to control the bleeding in the brain and reduce the pressure caused by that bleeding.    

 

Aneurysm

Unruptured aneurysm

Doctors may prescribe medications to prevent future rupture of the aneurysm. Doctors may also recommend regular imaging tests to ensure that the aneurysm is not getting any bigger. Although not common, some patients with a high risk for aneurysm rupture may also be eligible for surgery.

 

Ruptured aneurysm

A ruptured aneurysm needs emergency surgery. The two most common procedures used for ruptured brain aneurysms are surgical clipping and endovascular coiling.

Surgical clipping is an open surgery where the neurosurgeon opens a section of the skull to find the aneurysm, then places a small metal clip at the bottom of the aneurysm to close off the blood flow into it and prevent further bulging or leaking.

Endovascular coiling is less invasive than surgical clipping, where the surgeon reaches the brain by inserting a catheter from the groin or wrist into the artery in the brain. The surgeon then inserts a platinum coil to destroy the aneurysm.

  

Caregivers can speak with their loved one's healthcare provider to learn more about the best treatment course.