Hidden inside the brains of about 1.5% to 5% of people in the US there is or someday will be a potentially deadly "bomb" that could blow at any moment. I’m talking about a cerebral aneurysm, a weak area in an artery in the brain that causes a balloonlike bulge in the blood vessel wall. Though many aneurysms remain small and never cause problems, some grow and leak blood into the brain or rupture without warning, often causing stroke or death.
When detected before rupturing, cerebral aneurysms can be surgically repaired in many cases, I heard from Wouter I. Schievink, MD, director of microvascular neurosurgery at Cedars-Sinai Medical Center in Los Angeles. So a vital self-defense strategy is to find out whether you have an elevated risk for aneurysm... and if so, to ask your doctor about getting screened with an MRI or CT scan. Aneurysm risk factors include...
Advancing age. Risk increases with age because blood vessels get thinner and degenerate.
Gender. Until menopause, women have a slightly lower aneurysm risk than men, perhaps because estrogen promotes blood vessel health... but after menopause, women are at higher risk than men. News: A recent study in the Journal of NeuroInterventional Surgery suggested that women who had used birth control pills or hormone therapy (HT) were at decreased risk for aneurysm. This finding is not a reason to start taking the Pill or HT, but it does provides reassurance that women who use such a medication need not discontinue it if they have or are at risk for an aneurysm, Dr. Schievink noted.
Hypertension. This is a major culprit because high blood pressure damages blood vessel walls. Best: Keep blood pressure under control with a healthy diet, exercise, stress reduction and/or medication if necessary.
Smoking. Smokers have greatly increased odds of developing aneurysms because chemicals in tobacco damage the structure and function of blood vessels and increase blood pressure. So if you smoke, here’s yet one more reason to quit.
Family history. About 20% of people diagnosed with aneurysms also have a close family member with the condition, Dr. Schievink said—and although part of that connection is due to smoking (since if parents smoke, their offspring are more likely to smoke), clearly there is a genetic component to brain aneurysms, too. Self-defense: If you have two first-degree relatives (parent, sibling, child) with a history of aneurysm, definitely get the screening test... if just one family member has had an aneurysm, your doctor can weigh this along with any additional risk factors you may have in determining whether screening is appropriate.
Bicuspid aortic valve (BAV). About 1% to 2% of people are born with this heart defect, in which the aortic valve has only two flaps rather than three regulating blood flow from the heart. Some people with BAV have no problems—but many develop narrowing or leakage of the aortic valve as adults, which may be detected when their doctor hears a heart murmur. New finding: Dr. Schievink led a study that showed a tenfold increase in aneurysms among people with BAV, suggesting that both diseases may be caused by an underlying weakness in the arteries. If you or a close relative has BAV, aneurysm screening is warranted.
Connective tissue disorders. Genetic conditions that affect the connective tissues, including polycystic kidney disease (in which numerous cysts grow in the kidneys) and Ehlers-Danlos syndrome (marked by loose joints, elastic skin and easy bruising), also can affect the health of blood vessel walls. Patients with such disorders need to be screened for brain aneurysms.
Substance abuse. A history of binge drinking or drug abuse (especially cocaine) can negatively affect the structure of blood vessels. If you ever had a problem with alcohol or drugs, be open about this with your doctor when discussing aneurysm screening.
Warning Signs and Treatments
An aneurysm that ruptures can cause a sudden and extremely severe headache, pain behind the eyes and/or loss of vision or double vision. If you experience any such symptoms, call 911!
Unruptured brain aneurysms usually do not cause symptoms, so most are detected through screening or by chance when a brain scan is done for some unrelated reason. But in some cases, particularly if the unruptured aneurysm presses on nerves, patients may experience loss of balance, speech problems, changes in vision and/or facial numbness or weakness.
Depending on an unruptured aneurysm’s size and whether it appears to be growing, a neurologist may advise simply observing it closely. In other cases, prompt surgery is recommended to halt the flow of blood into the ballooning portion of the artery (for instance, by filling it with a filler material or placing a clip across its "neck"), thus preventing rupture. Blood flow continues through the healthy portion of the artery, Dr. Schievink said.
As with any surgical procedure, aneurysm surgery does carry risks. But given the extreme danger associated with an aneurysm at risk for rupturing, the potential hazards of surgery are far outweighed by the benefits.
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