Can an aneurysm start out small/asymptomatic?

[Curious1alwys, BSN, RN]

Ok, I know an aneurysm is a is an abnormal widening or ballooning of a section of a blood vessel. I know when one ruptures you get all kinds of neurological symptoms if it is in the brain, most notably "the worst headache of my life". But can they present atypically?

I am curious because my mother had a strange episode. She is late 50's, heavy smoker, drinker, hyperlipidemic, is on antihypertensives for high BP. Family hx heart disease, CHF, CAD, TIA, diabetes, etc. Anyhow, she was straining during a bowel movement and felt a powerful, painful popping sensation in her head, around occipital area, kindof behind an ear. At the time she even thought she was having an aneurysm and really thought she was going to lose consciousness (so it was powerful enough to scare her). For the next week or so she started feeling "under the weather" as she describes it with some head pain and pain radiating into her neck. She went to the doctor (after I really got after her lol) and he said she had bronchitis, gave antibiotics, and said she had a pulled muscle behind her ear. He gave her a muscle relaxant for that. Told her if she didn't feel better with a couple of weeks to come back. Well, she has been applying heat to the site and she says that heat makes it hurt more but that applying pressure with her hand to the site alleviates the pain. I told her maybe she should go to the ER, they could do a CT scan since her doctor ordered no imaging studies. She thinks I am blowing it out of proportion because she said her doc said that if it was an aneurysm she would not be able to talk. I know that could be one of the symptoms but not the only one.

I am trying to get her to go back to her doctor or go to the ER. What I am wondering though is have any of you soon aneurysm/bleeding in the brain/etc that started slow and the patient wasn't that affected? Can it start that way and do I have reason to be concerned. She is totally blowing me off.:uhoh21: I am a new grad so of course I have no clue. I am not asking for medical advice what I am asking is should I be worried about this?? Thanks!

[birdgardner]

My mother survived a burst cerebral aneurysm when she was 49, and I only just had her pre-disposing condition ruled out this summer, so I take an interest in this.

My thinking is that it could possibly be an aneurysm that got bigger suddenly but didn't burst, or some other arterial pathology, and that she should seek follow-up, either at the ER or with a vascular specialist.

You could have a weak spot in the artery that expands suddenly with increased pressure, but is still confined to one layer of the artery, so the whole thing doesn't give.

Straining or orgasm is associated with aneurysm rupture, and I don't see how you put your neck muscles into straining but you sure increase your BP.

Good luck to you, and I hope you can persuade your mother to go for follow-up.

[P_RN, ADN, RN]

My uncle had on of the first aneurysm repairs in SC. Waaay back in the 60s. Asymptomatic until his toes turned blue. 4 cm abdominal aortic one. Lost both legs. So yes it can be asymptomatic. Unexplained headache needs explaining. What if it isn't an aneurysm? Could be nothing, could be SOME thing.

[Curious1alwys, BSN, RN]

Yeah, I know. There is no way to tell. I just think her doctor telling her "it isn't an aneurysm because she can still talk" is sort of dumb. I mean we all know that is not the only presentation. I'll give her a call tomorrow and work on her some more. Thanks!

[dkweaver]

My mother, my aunt (her sister) and a niece have all had aneurysms. None had any symptoms other than a head ache. My mother survived hers my aunt didn't had a stroke on the table. My cousin just with in the past 2 years has had 5 aneurysms repaired.

So definitely have her get this checked out.

My sister and I go every 2 years for MRI's just to be safe. Although we can't find any medical evidence that aneurysms are genetic we do believe our family has a predisposition.

[BluntForceTrauma]

If I were you, I would encourage your mother to get at least a CT scan.....MRI maybe.

We had a patient who had fallen off of a horse. About a week later, he suffered from headaches constantly. His PCP sent him home w/ a prescription for pain meds and told him nothing was wrong. But his head continued to hurt....So finally he went to the ER, and was found to have bleeding in the brain....so much that he had to have an evacuation of a massive SAH and SDH......

Better to be safe than sorry.

[flightnurse2b, LPN]

i had a patient come in the ER once with severe lower back pain. hours later, she coded and died from AAA. pts with berry aneurysms can live with migraines or sinus pressure until they rupture. you never know with aneurysms... they are sneaky as heck sometimes. your mom needs to go to her PCP or the ER as soon as possible to find out whats going on!

[Elvish, BSN, DNP, RN, NP]

When I worked in med-surg (a hundred years ago as a newbie), we had quite a few folks who'd gone in for some other abdominal studies only to come diagnosed with a whompin' AAA. Of course they won a ticket to the OR and usually came out grateful for said abdominal study!

Had one older gentleman once (wasting and numerous other health issues apart from his AAA) who was so thin you could see his AAA pulsing. He was a DNR. Nice fellow, died about a week after I took care of him. But AAA was completely asymptomatic.

[kukukajoo, LPN]

A friend of mine evidently had some prenatal brain vessels that did not dissolve and created a tangle and an aneursim. Her symptom was pain and only because it was pressing on a nerve!! She had this for years and it just kept getting bigger and bigger. She did have surgery that was uneventful, good considering it was at her brain stem!

BUT.. She then had a one in a million allergic reaction to the cement used to put her skull disc back in place. It caused all kinds of problems and a very bad infection, as well as the stuff getting rejected and shattering and coming out of her skull in little pieces like glass. The resulting problems have caused several surgeries and issues too numerous to get into here.

She is high fuctioning but not at a level she was before, but at least she is alive. We thought we were going to lose her more than once....

[Elvish, BSN, DNP, RN, NP]

Wow, what a story, kukukajoo.

[kukukajoo, LPN]

This happened to her in her mid twenties. She went on to marry the most wonderful and understanding man and has a beautiful 2 year old daughter!

[Pat_Pat RN]

One of our ER docs had an aortic aneursym for 7 years before he had surgery for it. It was very near his heart, I'm not sure exactly where. But the point it, he had one for 7 years, and did not have a bad outcome.