Olfactory hallucinations induced by clip-enhanced unruptured posterior communicating artery aneurysm: A case report with literature review - Surgical Neurology International (2023)

FAQs

What does an aneurysm smell like? ›

In the present case, the patient complained of an unusual smell of something like burning rubber. However, the nature of the unusual smell perceived was completely different from the smell reported in the cases of middle cerebral artery aneurysms, such as the sweet pleasant smell of flowers, sweet fruits, or roses.

While most unruptured PCOM aneurysms are asymptomatic, when symptoms do occur, clinical manifestations typically include severe headache (HA), visual acuity loss, and cranial nerve deficit.

Posterior communicating artery aneurysms (PCAs) are the common site of aneurysms, accounting for about 45.9% of all aneurysms, and have a high rupture rate. Oculomotor nerve palsy (ONP) is a common clinical manifestation of PCAs because of the adjacent anatomical relationship.

Posterior communicating artery aneurysm, may occur at either end of the posterior communicating artery; that is at the junction with the posterior cerebral artery, or more commonly at the junction with the carotid (typically points laterally, posteriorly, and inferiorly).

Auditory hallucinations have been shown to arise from many different intra-cranial lesions, but seizures manifesting as musical hallucinations triggered by unruptured intracranial aneurysms are rare.

For middle cerebral artery aneurysms, loss of balance, insomnia, motor and sensory impairment, and visual hallucinations were common symptoms.

Posterior Cerebral Artery Strokes

PCA strokes will primarily cause a visual field loss or homonymous hemianopia to the opposite side. This large occipital or PCA stroke causes people to be “blind” on one side of the visual field. This is the most common symptom of a large occipital lesion or PCA stroke.

Treatment options of PCOM aneurysm include surgical clipping and endovascular techniques; surgical treatment is preferable in large aneurysm especially when it is causing mass effect on the oculomotor nerve, aneurysms with unfavorable fundus, and those associated with fetal PCOM artery origin [3, 4].

Rupture risk increased with aneurysm diameter, with aneurysms larger than 25 mm carrying a 6% annual risk of rupture.

Posterior Communicating Artery. Second branch of supraclinoid internal carotid. Supplies thalamus, hypothalamus, optic chiasm, and mamillary bodies.

What does it mean to clip an aneurysm? ›

Brain aneurysm clipping is a type of microsurgery in which a metal surgical clip is used to close off an aneurysm in the brain. The surgeon makes a small opening in your skull to reach your brain. They use an operating microscope and very small instruments to perform detailed surgical procedures.

For an unruptured brain aneurysm, your doctor will decide whether it's better to treat the aneurysm now or monitor you carefully (called watchful waiting). Certain aneurysms are more likely to bleed, or rupture. A rupture is a critical and potentially life-threatening situation.

Cerebral aneurysms can occur anywhere in the brain, but most form in the major arteries along the base of the skull.

This blockage keeps blood from reaching its destination in the brain, resulting in a loss of function in the affected region. Strokes can happen when a blood clot gets lodged in an artery, becomes blocked from disease, or if a blood vessel bleeds.

The most common location of an aneurysm is the aorta, which carries oxygenated blood from the heart to the body. The thoracic aorta is the short segment of the aorta in the chest cavity.

The short-term mortality rate is between 8.7% (one week after treatment, during the hospitalisation period), and 18.4% (after three months). One year after the vascular event, this figure reaches 22.9% and, five years later, 29%. Only 7% of the patients who survived after five years presented disabling sequelae.

It usually occurs as a result of damage to the frontal lobe, the temporal lobe, or the basal ganglia. Seizures can also lead to psychosis. When hallucinations are caused by psychosis, they will usually accompany other symptoms, such as: Delusions.

Survivors often report changes in their ability to taste and/or smell. If the aneurysm ruptured, smell and taste deficits can be caused by blood that irritates the nerves that control these senses.

Posttraumatic delirium

The typical symptoms shown are restlessness, confusion, disorientation, hallucinations, agitation, and delusions. Delirium occurs by the effect of injury on brain tissue chemicals. However, there are other mechanisms that can cause posttraumatic delirium in TBI patients.

Depression and anxiety are very common among survivors, whether you suffered a ruptured aneurysm or were treated for an unruptured aneurysm. These may be caused by the aneurysm itself and also by the many life changes that may occur as a result of the aneurysm.

Can an aneurysm cause psychosis? ›

Patients with brain lesions offer the unique opportunity to investigate mechanisms of psychosis. To our knowledge, this is the first reported case of pericallosal cerebral artery aneurysm associated with acute-onset psychosis with symptoms characteristic of schizophrenia.

Patients with a PCA stroke may present with only a headache and mild visual changes such as vision loss, diplopia, inability to see half of the view, or difficulty reading perceiving colors, or recognizing familiar faces. Mild symptoms in the setting of a PCA stroke may delay a patient from getting medical treatment.

The Posterior Cerebral Artery (PCA) supplies the occipital lobe, the inferior part of the temporal lobe, and various deep structures including the thalamus and the posterior limb of the internal capsule. Primary and secondary visual areas. Functions in the sensation and interpretation of visual input.

Oculomotor nerve palsy (ONP) is a rare neurological deficit associated with numerous underlying pathologies. Of these, aneurysm of the posterior communicating artery (PCOM) has been described due to the intimate association with the third cranial nerve in the basal cistern.

PAA's are usually treated once they are larger than 2cm in diameter, but are sometimes treated when they are smaller than this. Treatment is required earlier for a PAA than an AAA or TAA, because all arteries are smaller than the aorta.

Nonetheless, 85% of patients with ruptured AAA (rAAA) die and 66% of these deaths occur before reaching the hospital or without undergoing an operation [1]. The mortality rate of the patients who undergo repair procedures is still 37%–74% [2].

An unruptured brain aneurysm may cause zero symptoms. People can live with them for years before detection.

Without the pulsating blood flow, the aneurysm will eventually clot off and shrink. Recovery time typically is two to four days.

Does everyone have a left posterior communicating artery? ›

About 20% of adults retain PCA origin from the posterior communicating artery, and in turn, the internal carotid arteries.

The posterior communicating artery connects the internal carotid with the posterior cerebral arteries, thus connecting the anterior and posterior cerebral circulations.

Clipping surgery is a highly successful and safe treatment for brain aneurysms. Though everyone's situation is unique, clipping surgery can make it possible to return to normal life, with the aneurysm resolved.

Surgical clipping, the better-studied of the interventions for aneurysms, has been demonstrated to completely obliterate the aneurysm in >90% of patients,^12,13 but its impact on long-term survival in patients with rupture has not been well addressed.

The neurosurgeon places a titanium clip across the neck of the aneurysm. What it does: The clip preserves normal blood vessels and stops any more blood from getting into the aneurysm. It also stops the risk of a brain bleed.

Although responsible for only 3%-5% of all cerebrovascular aneurysms, basilar artery aneurysms (BAAs) are among the most difficult to treat.

Brain aneurysms are common. But most brain aneurysms aren't serious, especially if they're small. Most brain aneurysms don't rupture. They usually don't cause symptoms or cause health problems.

If you are suffering from the effects of a brain aneurysm you may qualify for disability benefits. The Social Security Administration recognizes brain aneurysms as an impairment in their Blue Book and you may qualify for disability benefits if certain conditions are met.

Digital substraction angiography (DSA) remains the gold standard imaging test to evaluate cerebral artery aneurysms.

Posterior communicating artery aneurysms (PCAs) are the common site of aneurysms, accounting for about 45.9% of all aneurysms, and have a high rupture rate. Oculomotor nerve palsy (ONP) is a common clinical manifestation of PCAs because of the adjacent anatomical relationship.

What makes a brain aneurysm worse? ›

*Blood thinners (such as warfarin), some medications and prescription drugs (including diet pills that act as stimulants such as ephedrine and amphetamines), and harmful drugs like cocaine can cause aneurysms to rupture and bleed.

Objective: Although posterior communicating artery (PCoA) is a smaller branch of the internal carotid artery, it gives the main contribution in the formation of circle of Willis (CW) by communicating with the internal carotid arterial system and the vertebro-basilar arterial system.

Posterior communicating artery aneurysm, may occur at either end of the posterior communicating artery; that is at the junction with the posterior cerebral artery, or more commonly at the junction with the carotid (typically points laterally, posteriorly, and inferiorly).

One of the most obvious signs of a ruptured aneurysm is intense head pain, typically described as the worst headache of your life. Additional symptoms of a ruptured aneurysm include: Nausea and vomiting. Double or blurred vision.

Symptoms of an unruptured brain aneurysm can include: visual disturbances, such as loss of vision or double vision. pain above or around your eye. numbness or weakness on 1 side of your face.

Signs of a Leaking Aneurysm

Some cerebral aneurysms may start to leak before they rupture, causing a sudden severe headache. This symptom, also called a sentinel headache, is a warning sign of a major rupture. Many patients report a sentinel headache six to 20 days before a rupture.

Symptoms of a ruptured brain aneurysm usually begin with a sudden agonising headache. It's been likened to being hit on the head, resulting in a blinding pain unlike anything experienced before. Other symptoms of a ruptured brain aneurysm also tend to come on suddenly and may include: feeling or being sick.

Survivors often report changes in their ability to taste and/or smell. If the aneurysm ruptured, smell and taste deficits can be caused by blood that irritates the nerves that control these senses. If the aneurysm did not rupture, smell and taste deficits can occur if the aneurysm compresses the surrounding nerves.

What are the side effects of aneurysm clipping? ›

Risks of aneurysm clipping include bleeding, infection, and stroke-like symptoms. There is no easy formula that can allow physicians and their patients to reach a decision on the best course of therapy—all therapeutic decisions must be made on a case-by-case basis.

About 25% of people who experience a brain aneurysm rupture die within 24 hours. Around 50% of people die within three months of the rupture due to complications. Of those who survive, about 66% experience permanent brain damage. Some people recover with little or no disability.

Most survivors experience temporary loss of control over emotions. This can manifest itself in anger, frustration, and lashing out at yourself and others. You may find that you get tearful for no reason at all. Confusion about what is happening to you is also common, so do not be reluctant to talk about it.

An unruptured brain aneurysm may not have any symptoms, especially if it's small. However, a larger unruptured aneurysm may press on brain tissues and nerves. Symptoms of an unruptured brain aneurysm may include: Pain above and behind one eye.

Causes of aneurysms

high blood pressure (hypertension) over many years resulting in damage and weakening of blood vessels. fatty plaques (atherosclerosis) resulting in a weakness of the blood vessel wall. inherited diseases that may result in weaker than normal blood vessel walls.

Can people live a long time with a brain aneurysm? Absolutely. Many aneurysms cause no symptoms at all.

As far as we are aware, most patients with genetically-triggered aortic disease, thoracic aortic aneurysm or dissection, or other arterial aneurysms or dissections, are not at higher risk for developing severe COVID-19 complications, unless they fall into one or more of the high risk categories below.

Focus on olfactory hallucinations

If an abnormal smell occurs for less than a few minutes, it is usually from the uncus, in the temporal lobe of the brain. Olfactory hallucinations lasting longer than a few minutes, up to several hours, are usually because of disturbances of the olfactory organ, nerves, or bulb.

Olfactory neuroblastoma, or esthesioneuroblastoma, is a tumor that grows in the nasal cavity. The nasal cavity has nerves and other tissue that are responsible for the sense of smell. This kind of tumor begins in the nasal cavity and can grow into the nearby eyes and brain.

How long do olfactory hallucinations last? ›

Phantosmia is usually temporary and should go away in a few weeks. But your symptoms may linger if a neurological issue is the cause. You should see a healthcare provider if phantom smells last for more than a few weeks.