Aneurysm

Medical malpractice in the treatment of brain aneurysms can happen when the physicians and nurses don’t follow rigorous standards in the care of the patient.  This page of our website pulls together resources so patients and families can understand more about what aneurysm is and how it’s treated.

Before we get to the basics: One important issue that families need to be aware of is the potential for turf wars and conflicts of interest by doctors who are vying for their business. Because aneurysms are treated both by neurosurgeons and by interventional radiologists, the treatment that might be appropriate for you could fall in the domain of a doctor OTHER THAN the one who is proposing to operate on you.  That’s why it’s vital for patients pursuing treatment of unruptured aneurysms to take their time and seek multiple opinions from different specialties of physicians.

Read a true aneurysm malpractice story for more lessons that might save a life.

Now, here’s a basic education in brain aneurysms.

From the National Institute of Neurological Disorders and Stroke (NINDS):

A brain (cerebral) aneurysm is a bulging or ballooning out of part of the wall of an artery in the brain. The disorder may result from congenital defects or from other conditions such as high blood pressure, atherosclerosis (the build-up of fatty deposits in the arteries), or head trauma. Cerebral aneurysms can occur at any age, although they are more common in adults than in children and are slightly more common in women than in men. The signs and symptoms of an unruptured cerebral aneurysm will partly depend on its size and rate of growth. For example, a small, unchanging aneurysm will generally produce no symptoms, whereas a larger aneurysm that is steadily growing may produce symptoms such as loss of feeling in the face or problems with the eyes. Immediately before an aneurysm ruptures, an individual may experience such symptoms as a sudden and usually severe headache, nausea, vision impairment, vomiting, and loss of consciousness. Rupture of a cerebral aneurysm usually results in bleeding in the brain, causing a hemorrhagic stroke. Or blood can leak into the area surrounding the brain and develop into an intracranial hematoma (a blood clot within the skull). Rebleeding, hydrocephalus (the excessive accumulation of cerebrospinal fluid), vasospasm (spasm of the blood vessels), or additional aneurysms may also occur.

The following information is from the Brain Aneurysm Foundation:

Although people with unruptured brain aneurysms may have headaches, this is often not associated with the actual aneurysm. Most people with unruptured brain aneurysms are completely free of symptoms, while others may experience some or all of the following symptoms, which suggest an aneurysm:

• Cranial Nerve Palsy
• Dilated Pupils
• Double Vision
• Pain Above and Behind Eye
• Localized Headache

People who suffer a ruptured brain aneurysm (subarachnoid hemorrhage) will often have warning signs. The following warning signs precede about 40% of major ruptures:

• Localized Headache
• Nausea & Vomiting
• Stiff Neck
• Blurred or Double Vision
• Sensitivity to Light (photophobia)
• Loss of Sensation

Brain aneurysms are detected, and their size and location determined, by one or more of a variety of imaging tests. These include:

• CT scan of the brain. A CT scan (Computed Tomography) uses x-rays and a computer to create cross-sectional pictures of the brain. It is good at showing abnormal pools of blood, such as from a burst aneurysm, but is not as sensitive as some other methods.
• CT Angiogram (CTA). This combines a CT scan with injection of contrast dye into a vein. The dye travels to the brain and highlights arteries.
• MRI scan of the brain (Magnetic Resonance Imaging). This uses magnetic waves instead of x-rays and creates a more detailed image than CT scan.
• MRA (Magnetic Resonance Angiography). This scan combines a regular MRI with the contrast dye, which is injected into a major vein. Like the CTA, this dye travels to the brain arteries, and images are created using an MRI. This creates a more enhanced image.
• Angiogram or arteriogram. In this technique, contrast dye is injected directly into an artery in the neck and X-ray pictures are taken as the dye travels into the arteries in the brain. This produces the most detailed images of arteries of the techniques currently used, but also has some risks that the other procedures do not.

When an aneurysm is discovered before it has burst, it can be treated with “clipping,” in which a neurosurgeon inserts a tiny device like a paper clip to seal off the aneurysm, or it can sometimes be treated by “coiling.”

Surgical Clipping

A surgical approach requires the patient to be placed under general anesthesia. Clipping requires a craniotomy, a surgical procedure in which a section of the skull cap, or bone plate, is removed so that the surgeon can access the aneurysm and place a tiny metal clip across the neck. This is done to stop blood flow into the aneurysm, and to prevent rebleeding and further damage. After clipping the aneurysm, the bone plate is wired back into place and the wound is closed. Historically, surgery has been the most common treatment for aneurysms.

Coiling

Detachable platinum coils are used in the endovascular treatment of intracranial brain aneurysms. In this less-invasive approach, physicians rely on fluoroscopic imaging (real-time X-ray) to visualize the patient’s vascular system and treat the disease from inside the blood vessel.

• Detachable Platinum Coils – Background: With the emergence of microcatheter and micro-coil technologies during the late 1980s, physician-inventor Guido Guglielmi, M.D. saw the potential for the endovascular deployment of micro-coils in brain aneurysms. Within two years, this pioneer helped develop the first detachable platinum coil. In 1995, the FDA allowed the marketing of detachable platinum coils for the treatment of high-risk aneurysms.
• What is a detachable platinum coil? Platinum coils are used to occlude (fill) intracranial aneurysms, significantly reducing the incidence of aneurysm rupture or re-rupture. The coils are typically constructed of platinum to allow it to conform to the aneurysm shape and make it radiopaque (visible via X-ray). The coil is attached to a delivery wire and fed through a microcatheter into the aneurysm. The delivery wire allows the physician to reposition or withdraw the coil to ensure ideal placement. Once properly positioned within the aneurysm, the coil is detached from the delivery wire using an electrolytic detachment process.

Here is a description from the American Society of Interventional and Therapeutic Neuroradiology:

The treatment of an aneurysm is often determined by its size. Traditional surgery is performed by a neurosurgeon, however, the patient may also have the option to select endovascular treatment or “coiling,” a less invasive option with fewer risks.

As in other endovascular treatments of conditions such as stroke or angioplasty, a catheter is inserted in the groin area and threaded through the vessels to the site of the aneurysm. Detachable platinum coils are then dispensed through the catheter and placed carefully inside the aneurysm. The number of coils used depends on the size of the aneurysm.

As an aneurysm is really a “ballooning” in a weakened area of a vessel wall, the goal of “coiling” is to pack the aneurysm tightly to close off blood flow into the aneurysm thereby preventing its rupture. Occasionally, it is necessary to add more coils at a later time to complete treatment.

Certain aneurysms may be treated by blocking the artery from which the aneurysm arises using coils or detachable balloons. Additional new methods of aneurysm treatment are in development.

Hospitalization time varies from patient to patient. A 1 or 2-day hospitalization may be possible for certain patients who have not had a hemorrhage, but patients who have had a recent brain hemorrhage from a ruptured aneurysm may expect to be hospitalized at least 10-14 days minimum. A follow-up x-ray, MR scan, or an angiogram may be performed to evaluate the position of the coils.

Patients may be placed on a blood thinner such as aspirin after the procedure, which may be continued after discharge.

Read real-life patient narratives of their aneurysm treatment.

If appropriate standards are not followed, patients can suffer serious injury from the procedures used to try to heal aneurysms and other blood vessel malformations in the brain. Legal action including lawsuits may be appropriate if qualified physicians in the field determine that standards were not adhered to.

Standards of care for the treatment of aneurysms in the brain which have burst open can be found at the American Heart Association Guidelines For Management of Aneurysmal Subarachnoid Hemorrhage.

Boston Scientific’s treatment of Brain Aneurysms using embolic coils.

Additional Information

• Anatomy of a Brain Injury Lawsuit.
• CT Scans Showing Brain Damage Caused by a Surgeon.
• Brain Injury Lawsuits: Track Record of Patrick Malone & Associates, P.C.

Legal options

Good medical care can often minimize or prevent a significant brain injury from one of these medical conditions. Or there can be other ways in which the brain injury could have been prevented. So a lawsuit can be appropriate in some circumstances, depending on what an investigation by a qualified lawyer finds.

Learn more about your legal options

Legal Consultation

The lawyers at Patrick Malone & Associates provide free and confidential consultations to help sort out your legal options. Contact Us or call 1-202-742-1500 or toll free at 1-888-625-6635 for a free case evaluation.

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