The worst headache of my life.

• Sudden, explosive headache reaching maximum intensity within seconds — the hallmark of rupture
• Neck stiffness and intolerance of light
• Vomiting with the headache
• Brief loss of consciousness or collapse
• Double vision or a drooping eyelid, from pressure on the nerve to the eye
• A dilated pupil on one side
• Seizure
• Most unruptured aneurysms cause no symptoms at all and are found incidentally

• Weakness in the arterial wall at branch points, where flow stress is highest
• Long-standing high blood pressure
• Smoking, which both weakens the wall and increases rupture risk
• Inherited connective tissue disorders such as Ehlers-Danlos or Marfan syndrome
• Autosomal dominant polycystic kidney disease
• Arterial dissection or trauma
• Infection of the vessel wall, producing a mycotic aneurysm

• Smoking
• High blood pressure
• Family history of aneurysm or subarachnoid haemorrhage
• Polycystic kidney disease
• Female sex, particularly after menopause
• Age above 40
• Heavy alcohol use
• Cocaine or stimulant use

• A sudden severe headache unlike any previous headache — call emergency services immediately
• Headache with neck stiffness, vomiting or light intolerance
• A new drooping eyelid or double vision, which can precede rupture
• A brief severe headache days earlier — a sentinel bleed that must not be dismissed
• Any collapse or seizure with headache

1. 01

   History

   The speed of headache onset is the critical detail. Thunderclap onset means subarachnoid haemorrhage until proven otherwise.

2. 02

   Clinical examination

   Conscious level, pupil size and reaction, eye movements, neck stiffness and focal neurological deficit are documented and graded.

3. 03

   Blood tests

   Full blood count, clotting, electrolytes and kidney function, both for baseline and to prepare for contrast and intervention.

4. 04

   Imaging

   Urgent CT of the head, then CT angiography. Lumbar puncture if CT is negative but suspicion remains, and catheter angiography for definitive anatomy.

• Endovascular coiling

  Endovascular

  Fine platinum coils are packed into the aneurysm sac through a microcatheter until blood no longer enters it and the sac clots off.

• Balloon or stent-assisted coiling

  Endovascular

  Used for wide-necked aneurysms, where a balloon or stent holds the coils inside the sac and protects the parent artery.

• Flow diversion

  Endovascular

  A dense mesh stent placed across the neck redirects flow past the aneurysm, which thromboses and shrinks over months. Used for large or complex aneurysms.

• Surgical clipping

  Surgery

  A titanium clip placed across the neck through a craniotomy. Preferred for some anatomy, particularly wide-necked middle cerebral aneurysms.

• Blood pressure control

  Medication

  Fundamental both to prevent rupture and to manage the acute phase after a bleed.

• Nimodipine

  Medication

  Given after subarachnoid haemorrhage to reduce the risk of delayed ischemic injury from vasospasm.

• Surveillance

  Observation

  Small, low-risk unruptured aneurysms may be monitored with interval imaging rather than treated.

Imaging figures for this condition are being prepared. Case imaging is published only once it is anonymised and verified.

1. 01

   A ruptured aneurysm is secured as early as possible — the highest risk of a second bleed is within the first days.

2. 02

   Anatomy decides technique. Neck width, dome-to-neck ratio, branch involvement and vessel tortuosity are assessed on 3D angiography before a device is chosen.

3. 03

   Access is through the wrist or groin. The skull is not opened, and there is no brain retraction.

4. 04

   Wide-necked and complex aneurysms are treated with balloon assistance, stent assistance or flow diversion rather than forced into simple coiling.

5. 05

   Unruptured aneurysms are discussed honestly: size, location, growth and patient age are weighed against the risk of treatment, and observation is a legitimate outcome of that discussion.

6. 06

   Follow-up imaging is scheduled from the outset, because coil compaction and recurrence must be detected early.

• Cerebral aneurysm coiling

  Packing an aneurysm until blood no longer enters it.

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• Embolization

  Performed through a small puncture under image guidance — discussed in detail at consultation.

1. Day 0

   After coiling, care continues in intensive care for ruptured cases, with blood pressure control and monitoring of conscious level.

2. Days 1 to 3

   Unruptured patients are usually discharged within a day or two. Ruptured patients remain monitored for vasospasm.

3. Days 4 to 14

   The vasospasm window after a bleed, monitored with Doppler and treated promptly if it develops.

4. Weeks 2 to 6

   Gradual return to activity for unruptured cases. After a bleed, fatigue and headache commonly persist for weeks.

5. Month 3 to 6

   First follow-up angiography or MR angiography to confirm the aneurysm remains occluded.

6. Year 1 and beyond

   Ongoing surveillance imaging at intervals, with lifelong blood pressure control and no smoking.

This timeline is educational, not a personal recovery promise. Timing varies with the procedure, condition, other illnesses, and complications. Follow your treating team's discharge instructions.

• Stop smoking completely — the single strongest modifiable factor
• Keep blood pressure consistently controlled
• Avoid stimulant drugs
• Limit alcohol
• Consider screening if two or more first-degree relatives have had an aneurysm
• Screening is advised in polycystic kidney disease
• Attend scheduled surveillance scans for known untreated aneurysms

No testimonials are published here yet. Patient accounts will appear only once they are consented and verified — nothing on this page is written on a patient's behalf.

• Cerebral aneurysm

  A weak point on a brain artery slowly fills under pressure. Coils placed from inside the vessel pack the sac until blood no longer enters it — the skull is never opened.

• Brain AVM & AVF

  A tangle of vessels where arteries and veins meet directly (AVM) or an abnormal connection (AVF). Targeted embolization closes the abnormal connection from within, often before any incision is considered.

• Dural arteriovenous fistula (AVF)

  An abnormal shortcut between an artery and a vein in the covering of the brain. Pressure builds where it was never meant to. Embolic material delivered through a microcatheter seals the shunt.

• Acute ischemic stroke

  A blood clot has stopped blood flow inside a brain blood vessel. Downstream, brain tissue is on a clock. In selected patients, mechanical thrombectomy can be used to remove the clot through a small access point and restore blood flow.