A sudden, severe headache unlike any you have had before is an emergency. Call an ambulance now. This may be a ruptured aneurysm. It is treated in hours at the nearest hospital — do not drive yourself, do not wait, and do not contact us first.
A weakened, ballooning segment of artery in the brain, or a tangle of abnormal vessels connecting arteries directly to veins. Both can bleed, and both are frequently found before they do.
Most unruptured aneurysms are discovered by accident on a scan, and a substantial proportion never need treating. A ruptured one is a different matter entirely, and it is treated where you are.
An aneurysm is a weak point in an artery wall that balloons outward under pressure, usually at a branching point in the circle of arteries at the base of the brain. Most cause no symptoms at all and are found incidentally on scans done for other reasons.
The danger is rupture. Bleeding into the space around the brain — subarachnoid haemorrhage — is a catastrophic event with high mortality, and the risk of a second bleed is highest in the first days. This is why a ruptured aneurysm must be secured urgently, wherever the patient happens to be.
An arteriovenous malformation is different. It is a tangle of abnormal vessels in which arteries connect directly to veins without the normal capillary bed between them. It may present with bleeding, with seizures, or with headache, and it is often diagnosed in younger patients.
For unruptured aneurysms, the treatment decision is a balance. Small aneurysms in low-risk locations may carry an annual rupture risk lower than the risk of treating them, in which case observation with blood pressure control and stopping smoking is the correct answer. Larger ones, irregular ones, and those in higher-risk positions tip the other way.
Subarachnoid haemorrhage carries its highest risk of a second, often fatal, bleed within the first days. Securing the aneurysm is measured in hours to a couple of days, and arranging international travel takes longer than that even at best. Whatever the difference in cost or reputation between hospitals, an aneurysm secured tomorrow near you is better medicine than a better hospital next week. Contact us afterwards — we can help with rehabilitation, with a second aneurysm found on the scans, or with an AVM identified during the workup.
CT detects bleeding; angiography defines the aneurysm.
For an unruptured aneurysm, the treatment decision turns on three things: maximum diameter in millimetres, exact location, and shape — whether it is smooth or has a daughter sac or irregular bleb. Send the CT or catheter angiogram report with those details, and the images if you can, along with your blood pressure readings and whether you smoke.
For unruptured aneurysms, not treating is frequently the right answer.
Regular imaging surveillance combined with strict blood pressure control and stopping smoking, which are the two measures that most reduce rupture risk. For small aneurysms in low-risk locations, the annual risk of rupture can be lower than the risk of treatment, making this the safer course.
Platinum coils are delivered through a catheter from the groin to fill the aneurysm from inside, so blood no longer enters it. No opening of the skull, shorter hospital stay and quicker recovery. Wide-necked aneurysms may need a stent or balloon to hold the coils, which commits you to antiplatelet medication.
A titanium clip is placed across the neck of the aneurysm through an open operation. It is durable, with a lower rate of later recurrence than coiling, and remains preferable for certain shapes and locations — particularly wide-necked aneurysms and some at the middle cerebral artery.
Options are surgical removal, embolisation to block feeding vessels, stereotactic radiosurgery which obliterates the malformation over two to three years, or a combination. Grading systems weigh size, location and venous drainage. For some unruptured AVMs, particularly larger ones in critical areas, observation may carry less risk than intervention.
This is the whole question. Ruptured means urgent treatment locally. Unruptured means a considered decision with time to plan.
Larger aneurysms, irregular ones with daughter sacs, and those in the posterior circulation carry higher rupture risk and are more likely to warrant treatment.
Neck width, branch vessels and access determine which is technically appropriate. A centre offering only one of the two cannot give you a neutral recommendation.
Choose a centre where both clipping and coiling are available and discussed jointly by a neurosurgeon and a neurointerventionist. Where only one is offered, that is the treatment you will be advised to have.
A new cranial nerve palsy with an aneurysm may indicate it is enlarging and warns of impending rupture. That needs urgent local assessment rather than a planned trip.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Possibly not. The decision balances the annual risk of rupture against the risk of treatment, and for small, regularly shaped aneurysms in lower-risk locations the balance often favours observation with blood pressure control and stopping smoking. Send the size, location and shape and we will tell you which side of that balance you are on.
Neither in general; the anatomy decides. Coiling avoids opening the skull with a quicker recovery but has a somewhat higher rate of later recurrence requiring re-treatment. Clipping is more durable and preferable for certain shapes and locations. The important thing is being assessed at a centre that offers both.
No. A ruptured aneurysm must be secured within hours to a couple of days because the risk of a second bleed is highest early, and arranging travel takes longer than that. Have it treated at the nearest capable hospital. We can genuinely help afterwards — with rehabilitation, or with any further aneurysm found on the scans.
Screening is generally recommended where two or more first-degree relatives have had an aneurysm or subarachnoid haemorrhage, and in certain inherited conditions such as polycystic kidney disease. For a single affected relative, routine screening is usually not advised. MR angiography is used, avoiding radiation.
Two things, and both matter considerably. Control your blood pressure rigorously, and stop smoking completely — smoking is a strong independent risk factor for both aneurysm formation and rupture. Avoiding heavy straining and stimulant drugs is also sensible. None of this removes the risk, but it meaningfully lowers it.
An arteriovenous malformation is a tangle of abnormal vessels connecting arteries directly to veins, and it is treated differently. Options include surgical removal, embolisation, radiosurgery which works over two to three years, or a combination. For some unruptured AVMs the risk of treatment exceeds the risk of leaving them, and observation is reasonable.
Send the angiogram report with the aneurysm's size in millimetres, its exact location and its shape. Those three determine whether treatment is needed at all.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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