When to Refer: Identifying the Signs of a Brain Aneurysm Before It Becomes an Emergency

Brain aneurysms are often referred to as “silent threats.” Many remain undiagnosed until a rupture occurs—leading to life-altering or fatal consequences. But with advancements in minimally invasive neurosurgery and increased awareness among referring physicians, we now have an opportunity to intervene before a crisis occurs.

As a board-certified neurosurgeon specializing in cerebrovascular and endovascular care, I’ve seen firsthand how early diagnosis and treatment can change the trajectory of a patient’s life. This article is designed to help primary care physicians, neurologists, and ER providers in Central Florida recognize the signs of aneurysm and know when it’s time to refer.

Understanding Brain Aneurysms

A brain aneurysm is a weakened, bulging section of a cerebral artery that can rupture and cause a subarachnoid hemorrhage, leading to stroke, brain damage, or death. While most aneurysms are asymptomatic and discovered incidentally, roughly 30,000 Americans experience a rupture each year.

The good news: many aneurysms can be treated without open surgery, using minimally invasive techniques that reduce recovery time and risk. But timing is critical—once an aneurysm ruptures, outcomes are far more complex.

Common Signs and Symptoms

Although aneurysms may be silent, they sometimes present with symptoms—especially just before rupture. Physicians should refer immediately if a patient presents with:

• Sudden, severe headache ("worst headache of my life")

• Vision changes, including blurred or double vision

• Drooping eyelid or dilated pupil

• Neck stiffness or pain

• Pain behind the eye

• Facial numbness or weakness

• Nausea, vomiting, or seizures

• Brief loss of consciousness

• Focal neurological deficits

  
  

These can be signs of a “sentinel bleed”—a small leak that often precedes full rupture. Early referral to a brain aneurysm specialist can allow us to act before a catastrophic event.

Being told you may have a brain aneurysm is understandably overwhelming. Patients often arrive at our office filled with anxiety—worried not only about their health but also about what the path forward might look like. That’s why we prioritize clear communication, compassion, and reassurance at every step. Our team takes the time to explain the diagnosis, walk patients through their options, and develop a care plan that’s both effective and personalized. While the word “aneurysm” can feel frightening, today’s minimally invasive techniques offer real hope—and we’re here to guide each patient through it with skill and heart.

High-Risk Patient Populations

Certain patients are more likely to develop aneurysms and may warrant earlier imaging or consultation:

• Family history of brain aneurysm or subarachnoid hemorrhage

• Personal history of aneurysm

• Hypertension or smoking history

• Polycystic kidney disease

• Ehlers-Danlos or Marfan syndrome

• Prior head trauma or tumors

• Women (more common in females over 40)

For these patients, even vague neurological symptoms can justify further evaluation.

Recommended Imaging Protocols

If a brain aneurysm is suspected, the following imaging tools can aid diagnosis:

• CT scan (non-contrast): first-line for sudden severe headache

• CT angiography (CTA): excellent for initial aneurysm detection

• MR angiography (MRA): ideal for patients needing long-term monitoring

• Digital subtraction angiography (DSA): gold standard for evaluating aneurysm anatomy and treatment planning (performed by a neurointerventional specialist)

Minimally Invasive Treatment Options

At Orlando Neurosurgery, our goal is to provide the least invasive, most effective treatment for every patient. Options include:

• Endovascular coiling: using a catheter to place platinum coils inside the aneurysm to block blood flow

• Flow diversion: inserting a stent to redirect blood flow away from the aneurysm and allow healing

• Stent-assisted coiling: combining a stent and coils for wider or more complex aneurysms

These techniques are performed through a tiny incision, typically in the wrist or groin, allowing patients to avoid open craniotomy and often return home within 1–2 days.

Referral Checklist: When to Consult a Specialist

Consider a referral for brain aneurysm evaluation if your patient:

✅ Reports sudden or severe headache with or without vision changes

✅ Has focal neurological symptoms with no clear diagnosis

✅Has imaging that suggests a vascular abnormality

✅ Has a known aneurysm and presents with new or worsening symptoms

✅ Has strong family history and new-onset neurological complaints

Early referral doesn’t always lead to surgery—it leads to options.

A Team Approach to Brain Aneurysm Treatment in Central Florida

At Orlando Neurosurgery, we’ve provided advanced brain and spine care to patients across Central Florida for over two decades. Our neurosurgeons partner with top institutions, including AdventHealth Neuroscience Institute, to bring patients world-class outcomes using the latest in neurointerventional technology.

We approach every patient as if they were a member of our own family—delivering compassionate, individualized care while working closely with referring physicians to ensure seamless coordination.

If you’re a provider looking for a trusted neurointerventional specialist to support your patient’s journey, we’re here to help.

Dr. Ravi H. Gandhi

Board-Certified Neurosurgeon

Fellowship-Trained in Cerebrovascular, Endovascular, and Skull Base Neurosurgery

Orlando Neurosurgery | Serving Central Florida from 7 Locations

This article is intended for informational and educational purposes only and does not constitute medical advice or create a physician-patient relationship. Individuals experiencing symptoms or seeking diagnosis or treatment should consult their own healthcare provider.