What’s a posterior communicating aneurysm?

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A posterior communicating aneurysm, also known as a posterior communicating artery aneurysm, is a leak in the wall of the posterior communicating artery, a blood vessel located in the brain. While why some people develop these blood vessel abnormalities isn’t fully understood, risk factors may include smoking, high blood pressure, or certain hereditary conditions. Symptoms of the condition may include problems with eye movements or headaches. Surgical treatment is recommended in some people in hopes of preventing complications such as aneurysm rupture.

Often why a posterior communicating aneurysm develops is poorly understood. Certain genetic disorders can predispose people to developing this condition, including Ehlers-Danlos syndrome, autosomal dominant polycystic kidney disease, and familial aldosteronism type I. Other risk factors might include smoking, high blood pressure, and low estrogen levels in the blood.

Some of the most recognizable symptoms of a posterior communicating aneurysm are problems with vision. The aneurysm compresses the oculomotor nerve, also known as cranial nerve III, which carries signals from the brain to the eye. This compression can cause problems with eye movement, causing the eye to remain in a fixed position looking down and away from the body. Some patients also have dilation of the affected eye due to compression of the oculomotor nerve. Because patients typically would only have a posterior communicating aneurysm, usually these symptoms would only be present in one eye.

The most feared consequence of a posterior communicating artery aneurysm is rupture. When this occurs, the blood vessel ruptures, pouring blood into the brain. Having blood in this region of the brain is called a subarachnoid hemorrhage and if enough blood accumulates this can be life threatening because it can displace the brain out of the skull, compressing the brainstem region that is responsible for critical bodily functions such as breathing. A subarachnoid hemorrhage could also cause neurological deficits, such as weakness in half of the body, because the blood interferes with normal brain function.

Treating an unruptured posterior communicating aneurysm can be difficult. Typically, doctors recommend that patients with aneurysms larger than 0.4 inch (1 centimeter) in diameter have them surgically repaired. A patient with a smaller aneurysm might be monitored with regular imaging studies to look for an increase in the diameter of the aneurysm. If a patient has aneurysm-related symptoms, however, surgery is typically recommended regardless of size.

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