What Is the Recovery Outlook for a Ruptured Brain Aneurysm?

If you or a loved one has experienced a ruptured brain aneurysm, you understand the gravity of this condition. A ruptured or burst brain aneurysm is a rare but life-threatening medical event, affecting approximately 30,000 people in the United States each year.

Depending on the severity of the rupture, the individual’s health status, and the availability of immediate emergency medical assistance, some patients can recover and resume their normal lives. However, many others may remain significantly debilitated and require prolonged rehabilitation for maximal recovery.

In this article, we discuss the prognosis and recovery process after a ruptured aneurysm. This can be one of the most challenging and devastating conditions for both patients and loved ones.

Individuals with unruptured brain aneurysms may remain asymptomatic for their entire lives. In many cases, these aneurysms go unnoticed until discovered incidentally during medical examinations for unrelated issues. Conversely, a ruptured brain aneurysm is a severe medical emergency that could potentially lead to death or permanent disability.

When a brain aneurysm ruptures, blood spills into the surrounding space around the brain. This is often associated with a severe headache, typically described as the "worst headache of life". Other symptoms you may have at the time of rupture include:

• Nausea and vomiting
• Stiff neck
• Drooping eyelid on the affected side of the face
• Disturbances in vision such as double vision or blurred vision
• Sensitivity to light
• Seizure
• Confusion
• Loss of consciousness

When a brain aneurysm ruptures, the ensuing bleed typically lasts for only a few seconds. However, within these brief initial moments, significant consequences can unfold. While blood is indispensable for sustaining life, its escape from blood vessels can inflict damage on surrounding brain tissue.

Furthermore, this blood leakage prevents the delivery of oxygen and nutrients to its intended destination. This can potentially lead to the death of brain cells in a condition known as hemorrhagic stroke.

If the bleeding remains uncontrolled, it can lead to a loss of consciousness or even death. On average, 74% of individuals who suffer a ruptured aneurysm survive the initial 24 hours. However, among these survivors, 25% may encounter life-threatening complications within the next 6 months.

Recovering from a ruptured brain aneurysm can be a long and arduous journey. Some of the primary complications of concern include the following:

When the brain experiences bleeding, fluctuations in sodium levels can occur, potentially harming brain cells. Both low and high levels of sodium in the blood can adversely affect brain cells: low levels may dehydrate them, while high levels may cause them to swell.

Even after initial bleeding is controlled, the weakened wall of the aneurysm may continue to deteriorate over time, increasing the likelihood of rebleeding. Additionally, repeated rupture or recurrence of the aneurysm can occur even after treatment.

When a brain aneurysm ruptures, blood is released into the subarachnoid space surrounding the brain. This blood can block the flow of cerebrospinal fluid (CSF), leading to a condition known as hydrocephalus. If left untreated, this can increase the pressure within the skull and lead to complications such as brain herniation and further neurologic damage.

When blood spills into the space surrounding the brain, it can trigger inflammation and other biochemical changes that cause the blood vessels to constrict or spasm (vasospasm). As a result, the flow of blood through these vessels is restricted, leading to reduced blood flow to parts of the brain. This can cause an ischemic stroke.

When the brain aneurysm bursts, there are typically two main ways that the rupture can be repaired.

A common way to treat a ruptured brain aneurysm is to insert a surgical clip. The surgeon temporarily removes a window of bone from your skull via craniotomy and finds then places a metal clip around the aneurysm. The window of bone is then replaced. This procedure cuts off the blood flow to the aneurysm and prevents further leaks. 

This method is an alternative to surgical clipping. Although it is considered less invasive, there is a higher chance that the aneurysm could grow again or require another treatment. Instead of opening the skull, the doctor reaches the target blood vessel by inserting a thin, flexible tube (catheter) into a blood vessel in the groin or wrist area.

The catheter is advanced up to the vessel affected by the aneurysm, and small platinum coils are delivered to the aneurysm. Once the aneurysm is filled, the coils take the shape of the aneurysm and can stop the blood flow to it. Other tools such as flow diverter stents or a mesh basket may be used to functionally remove the aneurysm from the blood circulation.

After a ruptured aneurysm and repair has occurred, patients may experience a prolonged hospital stay to monitor and manage potential complications, such as vasospasm. Additionally, if a devastating bleed has occurred, returning home right away may not be the best option.

Some patients may be referred to a rehabilitation hospital as part of the recovery process. Others may need ongoing medical care and assistance that cannot be provided at home, and a skilled nursing facility (SNF) may be recommended. In cases of severe disability, long-term care facilities may be discussed.

Following treatment, some patients may undergo regular follow-up appointments and periodic imaging scans over the course of several months, years, or indefinitely. These measures help to ensure the effectiveness of treatment and enable early detection of any signs of aneurysm recurrence or re-rupture.

Throughout this observation period, patients are also monitored for potential complications, and their healthcare provider will discuss lifestyle modifications aimed at reducing the risk of recurrence.  

While life expectancy is not typically affected after aneurysm treatment, survival can depend on the severity of the initial injury and rupture. While a brain aneurysm is not a death sentence and many individuals can live their entire lives going undiagnosed, a ruptured aneurysm can be a significantly debilitating event. Rehabilitation to help with regaining functions such as speech or mobility may be recommended to maximize recovery.

• The first 24 hours after an aneurysm rupture is critical in terms of survival.
• Clipping of an aneurysm is advantageous in terms of lesser recurrence and rebleeding rates compared to coiling.
• Coiling of an aneurysm is more minimally invasive and associated with quicker recovery times.
• Some complications that can occur after a ruptured aneurysm include changes in sodium levels, hydrocephalus, and vasospasm.

• National Institute of Neurological Disorders and Stroke
• American Association of Neurological Surgeons (AANS): Cerebrovascular Disease
• Brain Aneurysm Foundation
• American Association of Neurological Surgeons (AANS): Cerebral Aneurysm
• American Brain Foundation (ABF)