BEWARE OF BRAIN ANEURYSMS
After recent reports about the president of a prominent Asian country supposedly suffering a brain aneurysm — the unexpected bulging of blood vessels to the brain —there has been a lot of curiosity about the a potentially life-threatening condition.
The incidence of brain aneurysms is relatively higher in Japan and Finland where it is around 20-25 cases per one lakh people. The exact reason for this is not known but is often attributed to the genetic make-up. Worldwide, the incidence is almost 3% in the population (3 out of 100) above the age of 50 years. The death rate among patients affected by cerebral aneurysm is around five out of 200 patients. Below the age of 50, almost equal instances of aneurysms are found in both males and females, but in the 50 plus age group, it is found more among the females, mainly due to weakened blood vessels owing to menopausal hormonal changes, say experts.
CEREBRAL ANEURYSM EXPLAINED
An aneurysm is a bulge or balloon-like outpouching from blood vessels/arteries that carry blood, and a cerebral aneurism is one occurring in a vessel from the heart to the brain. Usually, a defect develops in one of the three layers of the thick blood vessels and blood will be pushed from the point of the defect in the arterial wall, causing a pouch. Over time, this pouch will grow and someday may rupture (causing bleeding in the brain). It can even be fatal. Though aneurysms can form anywhere in the brain, usually, they are found in arteries at the base of the brain. If the rupture happens, around 30% people die immediately, 30% fall unconscious following a severe headache while another
30% suffer from a mild headache but more or less remain okay,” says Dr B J Rajesh, senior neurosurgeon from Yashoda Hospital. Repeat ruptures are common in those patients who survive and the second rupture is more likely to be fatal.
UNEXPLAINED HEADACHE - A WARNING SIGN
“Cerebral aneurysms do not have prominent symptoms but patients who have survived the rupture say that prior to the incident, they experienced sudden severe headaches. They refer to the ‘thunderclap’ headache as the worst headache ever. The severity varies according to the degree of the rupture,” says Dr Rajesh.
Risk factors
Though the specific causes of brain aneurysms are not known, it is often seen in patients with hypertension and the habit of smoking. The risk factors include uncontrolled high blood pressure, smoking and substance abuse, family history of cerebral aneurysms, genetic factors, older age, vasculitis (inflammation of the blood vessels), infections and high fat content in blood etc. Therefore, an active, healthy lifestyle, good diet and abstaining from smoking are required to cut down the risk factors.
ANEURYSM
IS A BULGE OR BAL- LOON-LIKE OUT-POUCHING FROM BLOOD VESSELS/ARTERIES THAT CARRY BLOOD, AND A CEREBRAL ANEURISM IS ONE OCCURRING IN A VESSEL FROM THE HEART TO THE BRAIN. USUALLY, A DEFECT DEVELOPS IN ONE OF THE THREE LAYERS OF THE THICK BLOOD VESSELS AND BLOOD WILL BE PUSHED FROM THE POINT OF THE DEFECT IN THE ARTERIAL WALL, CAUSING A POUCH. OVER TIME, THIS POUCH WILL GROW AND SOMEDAY MAY RUPTURE.
IT CAN BE FATAL.
DIAGNOSIS
Screening is advisable if you experience sudden unexplained headaches. Diagnosis can be done through MRI or CT scan combined with a cerebral angiogram. This will help detect the point of rupture and its shape and structure and the blood vessel from which it is arising and also help in determining the treatment.
MODE OF TREATMENT
“There are two aspects of treatment. The first is identifying the affected blood vessels and parameters of the aneurysm and provide emergency care to prevent a repeat rupture. This treatment can be either the less invasive endovascular coiling (without opening the skull) or surgical (by opening the skull) and clipping at the neck (opening) of the aneurysm to prevent any further blood flow. The disadvantage of the endovascular coiling method is that if a rupture suddenly happens during the coiling, it becomes very difficult to save the patient, whereas if rupture happens during an open skull surgery, saving the life is easier. Nowadays, with advanced technology, complications of endovascular intervention are fewer and safer and many patients prefer this,” elaborates Dr Rajesh. “The second aspect is treating the patients for the effects of rupture such as swelling in the brain, seizures, loss of consciousness, nausea, blurred vision, weakening of hand and legs, and hearing or speech problems depending on the area where the bleeding happens and the blood vessel affected” adds the neurosurgeon.