A brain aneurysm is a weakness in the wall of a cerebral artery or vein causing an area of localized dilation or ballooning. Although many brain aneurysms are asymptomatic and do not cause any problems, brain aneurysms can grow in size and begin to bleed or rupture. When this occurs, patients begin experiencing symptoms including severe headaches, neck pain, vision loss, imbalance, dizziness, emotional changes, lack of concentration, and other neurological problems. If not treated in a timely manner, a symptomatic brain aneurysm can rupture causing permanent brain injury or death.What Causes A Brain Aneurysm?
An aneurysm occurs when there is a weakness in the wall of a blood vessel. The repeated trauma of blood flowing against the vessel wall presses against the point of weakness and causes the aneurysm to enlarge. Overtime, this pressure creates a blood filled sac along the wall of the blood vessel. Although aneurysms can occur anywhere in the vasculature of the brain, they most commonly form in the arteries of the Circle of Willis. The arteries are inherently weaker and thus are more susceptible to aneurysms.Who is at Risk for Developing a Brain Aneurysm?
Certain genetic factors and lifestyle choices put an individual at higher risk for developing a brain aneurysm. Typical lifestyle choices that make a person more susceptible are as follows:
- Untreated hypertension (high blood pressure)
- Excessive alcohol consumption
- Drug use (usually cocaine)
Genetic conditions associated with brain aneurysms include the following:
- Family history (people who have a family history of aneurysms are more likely to have an aneurysm than those who don’t)
- Previous aneurysm
- Gender (female)
- Race (African American)
- Genetic disorders (i.e. autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfarn syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, and hereditary hemorrhagic telangiectasia)
- Gene disorders affecting the vasculature (i.e. genetic defects with perlecan, elastin, collagen type 1 A2, endothelial nitric oxide synthase, endothelin receptor A and cyclin dependent kinase inhibitor)
A brain aneurysm is diagnosed based upon signs and symptoms, neurologic evaluation, and diagnostic studies.
a. Signs and Symptoms
As stated above, most brain aneurysms are asymptomatic. When a brain aneurysm becomes symptomatic it usually represents an emergent condition and the symptoms are sudden and severe. For instance, it is not uncommon for an individual with a brain aneurysm to present to the emergency room with the “worst headache of their life.” Typically, these individuals have accompanying neurological findings in addition to a headache including but not limited to vision loss, blurry vision, fuzzy vision, floaters, loss of coordination, loss of balance, dizziness, memory loss, emotional changes, depression, difficulty speaking, and lack of concentration.
It is worth noting that not every person with a brain aneurysm has the same symptoms. An individual may have a combination of several symptoms. Typically, a physician will be looking for one or more neurological finding in addition to a sudden and severe headache.
b. Neurological Examination
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This also includes an evaluation of the individual’s medical history. An individual with a brain aneurysm may have positive findings during a neurological examination. However, the absence of positive findings during a neurological examination does not rule out an aneurysm. The presence of positive findings merely raises a suspicion for a brain aneurysm.
If a brain aneurysm is present, a neurological examination may reveal changes in the individual’s mental status, impaired cranial nerves, impaired motor function, impaired sensation, impaired coordination, and/or impaired deep tendon reflexes.
c. Diagnostic Studies
Diagnostic studies represent the gold standard for diagnosing brain aneurysms. Most hospitals and emergency rooms have Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) available. However, the best way of identifying a brain aneurysm is Computed Tomography Angiogram (CTA), Magnetic Resonance Angiogram (MRA), or Cerebral Angiogram. Each of these methods uses radiographs and the injection of a contrast dye to obtain actual imagines of the blood vessels in the brain. This allows the radiologist to obtain a very clear picture of the size and position of the aneurysm.How is a Brain Aneurysm Treated?
Treatment for a brain aneurysm usually depends on whether the aneurysm has completely ruptured. If it has completely ruptured, emergency surgery is usually required including evacuation of the hematoma, reducing intracranial pressure (usually through the placement of a shunt), and restoration of the vasculature.
If the aneurysm has not completely ruptured but is symptomatic and/or bleeding, the doctor may be able to treatment the aneurysm through surgical clipping or endovascular coiling. In certain circumstances, a gamma knife procedure may also be used; however, this heavily depends upon the size and location of the aneurysm.
Surgical clipping involves placing a metal clip around the base of the aneurysm. This effectively cuts off the blood supply to the aneurysm preventing further growth and rupture.
Endovascular coiling refers to the insertion of platinum coils into the aneurysm. Once in the aneurysm, the coils expand and initiate a thrombotic reaction within the aneurysm. This may prevent further growth of the aneurysm.When is the failure to diagnose or treat a brain aneurysm medical malpractice?
If you are reading this article, this may be the key question: what type of cases are viable medical negligence claims?
Medical malpractice can occur if the physician fails to recognize the signs and symptoms, fails to conduct a proper physical and neurological examination, fails to refer the patient to a neurologist and/or neurosurgeon, fails to order the correct diagnostic studies, fails to timely diagnose the condition, and/or fails to properly treat the condition.
A brain aneurysm represents a very serious medical condition. Once an aneurysm begins to grow and becomes symptomatic, time is of the essence.
Many individuals present to the emergency room within a day or two with a sudden and severe headache. Because headaches are relatively common, many physicians fail to diagnose this condition and tell the patient they simply have a migraine or a tension headache. However, migraines and tension headaches present differently than headaches caused by a brain aneurysm. Usually, patients with migraines have a history of headaches and tension headaches are not commonly associated with vision loss.
Moreover, the vision loss associated with a migraine is usually a brief aura prior to the beginning of the headache. This is distinguishable from a patient with the sudden onset of a severe headache with no prior history of headaches and persistent vision loss. For these reasons, a competent physician should be able to distinguish between a migraine, a tension headache, and a headache caused by a brain aneurysm.Sample Settlements and Verdicts
Below are some sample verdicts in Maryland from around the country in brain aneurysm cases. These verdicts are interesting and illustrative for attorneys trying to get a handle on how a jury might value these claims when they believe the doctor made a mistake.
But the predictive value of these verdicts is limited. It foolhardy to believe that the outcome of one case is predictive of the result in another even in cases that sound similar. Why? Every case is unique and different and each case presents its own special opportunities and challenges.
- 2013, Illinois Settlement: $3,250,000. A woman presented to the hospital complaining of unusually severe headaches. She was given pain medication and discharged. She returned several more times over the course of the next several days complaining of worsening symptoms. Each times she was given pain medication and discharged. Several days later, she presented to a different hospital and was diagnosed with a ruptured brain aneurysm. She died six days later. After several days of trial, the doctors and hospital settled the case.
- 2009, New York Verdict: $2,150,000. A 45 year old woman presented to the emergency room complaining of a sudden headache and loss of vision in her right eye. She was seen by two residents who failed to correctly diagnose her condition. She was discharged and told to return the following day for a CT scan. Although the woman returned the following day for a CT scan, she was told to return two days later to receive the results. During that time, she died from a brain aneurysm. After a three week trial, the jury returned a verdict of $2,150,000.
- 2002, Maryland Verdict: $2,050,000. A 45 year old female presented to the hospital with a severe headache, light sensitivity, and transient right leg numbness. The emergency physician diagnosed her with a sinus headache and discharged her. She was found unresponsive in her home two days later. Upon returning to the hospital, a CT scan revealed a massive bleed on the right side of her brain. She subsequently died. After deliberating for 1 hour, the Baltimore city jury returned a verdict for $2,050,000.
- 1993, Maryland Award: $1,656,833. A 57 year old man presented to the hospital and saw a neurologist over a two week period complaining of severe headaches and progressively worsening neurologic symptoms. The man was discharged after the radiologist negligent failed to identify the aneurysm and after the neurologist failed to rule out an aneurysm. He died a day and half later when the aneurysm ruptured in his brain. An arbitration panel awarded the man $1,656,833.
If you think you have a potential wrongful death malpractice claim for someone you loved because a doctor failed to diagnose a aneurysm, call 800-553-8082 or get a free no obligation case evaluation.More Information on Malpractice Claims