It’s been said that kids aren’t simply small adults — an adage that also rings true when it comes to cerebral aneurysms. These bulges in the blood vessels of the brain are relatively rare: About 3 percent of the world’s population has an un-ruptured, asymptomatic brain aneurysm. Of those people, just 0.5 percent to 4.6 percent are children.
While uncommon, cerebral aneurysms can and do occur in the pediatric population, says Edward Smith, MD, co-director of the Cerebrovascular Surgery and Interventions Center at Boston Children’s Hospital. Once they have ruptured, they can be life threatening. For this reason, it’s important to recognize the signs of a cerebral aneurysm and know when to refer to a specialist for treatment. The good news: Following successful treatment, an estimated 90 percent of children go on to enjoy full and active lives. Here, Smith answers some frequently asked questions about brain aneurysms.
How are cerebral aneurysms different in children?
Overall, cerebral aneurysms are far more rare in children than in adults. However, when they are found, children appear more likely than adults to harbor aneurysms in the posterior circulation (the blood supply to the back to the brain), and more likely to have giant aneurysms (greater than 2.5 cm in size). Unlike adult aneurysms, which tend to occur more often in women, boys are more apt than girls to have cerebral aneurysms before puberty.
What causes cerebral aneurysms in children?
Up to 40 percent of pediatric aneurysms result from trauma to the brain, either following an injury or after a surgical procedure. Infection with bacteria such as Staphylococcus and Streptococcus can also cause aneurysms in children, as can Marfan syndrome, Ehler-Danlos syndrome, moyamoya disease and other disorders.
What are the symptoms of a cerebral aneurysm?
As with adults, most aneurysms in children are asymptomatic and never detected unless they rupture. In fact, unruptured aneurysms don’t typically cause symptoms unless they are very large and put pressure on the brain or related nerves. In these cases, children may exhibit neurological warning signs such as headaches, dilated pupils, blurred or double vision, weakness and numbness, and difficulty speaking. If patients present with such symptoms, they should be referred for imaging tests and a meeting with a specialist.
A ruptured aneurysm is a medical emergency. Clinicians should instruct parents to recognize symptoms including an unusually severe headache, vision changes, focal deficits and seizures and to seek immediate medical attention.
Should pediatric aneurysms be treated?
It can be difficult to know when or if to treat a child with an asymptomatic cerebral aneurysm. In some cases, watchful waiting may be the best approach. In general, aneurysms that have ruptured, enlarge over time or are symptomatic should be considered for treatment, either with clipping or coiling techniques. The decision to treat or not should be made by a multidisciplinary team that includes neurosurgeons, endovascular specialists and neurologists.
Should children be screened for aneurysms?
“Many patients ask me if cerebral aneurysms are hereditary — should their child be screened if a parent, grandparent or other relative has had an aneurysm,” says Smith. There are no formal screening guidelines. However, most kids don’t need to be screened for cerebral aneurysms unless they have a sibling who has had one, or if they have three first-degree relatives who have had one — with particular attention to relatives who have had aneurysms as children themselves or as young adults (under age 35).
Learn about the Cerebrovascular Surgery and Interventions Center.
About our expert: Edward R. Smith, MD, is a pediatric neurosurgeon at Boston Children’s Hospital, director of Pediatric Cerebrovascular Neurosurgery and co-director of the Cerebrovascular Surgery and Interventions Center.