An aneurysm is a weakened, bulging area within a blood vessel wall. This abnormal ballooning can occur in arteries throughout the body, including the neck. If left unaddressed, an aneurysm’s thin wall may rupture, leading to internal bleeding. While often asymptomatic, a ruptured aneurysm can be life-threatening.
Understanding Neck Aneurysms
Neck aneurysms involve arteries in the neck, most commonly the carotid and vertebral arteries. Carotid arteries, on either side of the neck, deliver oxygen-rich blood to the brain, face, and head. Vertebral arteries ascend through the spinal column, supplying blood to the upper spinal cord, brainstem, cerebellum, and the posterior brain.
Aneurysms vary in shape. Saccular aneurysms, or berry aneurysms, are the most common type, appearing as a rounded, blood-filled sac protruding from one side of an artery. Fusiform aneurysms involve bulging on all sides of the vessel, creating a spindle-like shape. These variations influence blood flow and treatment.
Recognizing the Signs
Many neck aneurysms are asymptomatic until they grow large or rupture. An unruptured aneurysm pressing on surrounding structures may manifest as a throbbing lump or pulsatile mass. Other indications include neck pain, hoarseness, or difficulty swallowing. Nerve compression can also lead to neurological symptoms like facial weakness or numbness.
A ruptured neck aneurysm presents with sudden, severe symptoms requiring immediate medical attention. Individuals often describe an excruciating headache, frequently called the “worst headache of life.” This pain can be accompanied by a stiff neck, nausea, and vomiting. Other signs include blurred vision, sensitivity to light, or loss of consciousness.
Identifying Risk Factors
Several factors increase the likelihood of developing a neck aneurysm, some modifiable through lifestyle changes. High blood pressure (hypertension) is a significant contributor, weakening artery walls over time. Atherosclerosis, the buildup of fatty plaques, also weakens vessel walls and links to aneurysm formation. High cholesterol and smoking are additional modifiable risk factors contributing to arterial damage.
Non-modifiable factors also play a role. A family history of aneurysms significantly increases risk. Certain genetic disorders (e.g., Ehlers-Danlos syndrome, Marfan syndrome, polycystic kidney disease) cause inherent weaknesses in blood vessel walls, increasing susceptibility. The risk also generally increases with age, as constant blood flow pressure weakens vessel walls.
Diagnosis and Treatment Approaches
Detecting neck aneurysms typically involves specialized imaging techniques. Computed tomography angiography (CTA) uses X-rays and a contrast dye for detailed vessel images. Magnetic resonance angiography (MRA) employs magnetic fields and radio waves for similar mapping. Conventional angiography (DSA) provides highly detailed images by injecting a contrast dye directly into the artery with real-time X-rays. These methods determine the aneurysm’s size, shape, and exact location.
Treatment for a neck aneurysm varies based on its size, location, symptoms, and patient health. For small, asymptomatic aneurysms, watchful waiting with regular monitoring may be recommended. If intervention is necessary, two primary approaches are used. Endovascular coiling is a minimally invasive procedure where a catheter guides tiny platinum coils into the aneurysm to block blood flow. Surgical clipping, an open procedure, involves placing a small metal clip across the aneurysm’s neck to seal it permanently.