Cerebral Aneurysm: Neurosurgeon Talks About The Causes And Treatments Of The Condition Which Can Kill If Not Detected Timely

Cerebral Aneurysm is a condition that may be not as commonly heard as heart attacks or strokes, but it definitely has severe consequences if left untreated. An aneurysm is a saccular (balloon-like) bulge in a blood vessel, with a weak and thin wall. Intracranial aneurysms can burst (rupture) and blood leaks into the brain, leading to subarachnoid hemorrhage or intracranial hemorrhage. They can also become large enough to compress the brain or develop clots that can block the blood vessels.

Cerebral aneurysms are on the rise in today's population and affect a growing number of individuals. Among the Indian population, nearly 1% of the population report aneurysms, with almost half present with ruptured aneurysms. This condition is quite common among people in the productive age group of 35 to 65 years, and when left untreated, 85% of ruptured aneurysms can result in severe neurological deficits or death. Most of these cases are of ruptured aneurysms identified in the emergency centers when patients come to the hospital with complications and complaints of symptoms.

Cause of Aneurysms:

The main causes of aneurysms can be environmental factors associated with poor lifestyle habits and metabolic diseases like High blood pressure, High Cholesterol, Cigarette smoking, binge partying and binge alcohol consumption, psychotropic drug consumption (those which raise blood pressure notably Cocaine), Oral Contraception, etc. Only a small percentage of people have genetic causes due to abnormalities in the blood vessel walls or an auto-immune (self-destructive) disease.

What Happens When an Aneurysm Ruptures (Bursts)?

A ruptured aneurysm can have devastating effects on the body and quality of life. It can cause symptoms like sudden and intense thunderclap headaches, vomiting, breathlessness, neck pain, and altered levels of consciousness, leading to unconsciousness and death. The aftermath of a ruptured aneurysm can be even more damaging, with severe neurological disabilities and even paralysis and a state called "Coma Vigil". These debilitating complications can result in complete dependence on others for daily activities and a significant shift in career and lifestyle for nearly 92% of those affected. This life-altering event is more common in men compared to women.

How Do We Detect or Screen This Condition?

The early detection and treatment of aneurysms are crucial to prevent severe complications and death. An easy way to screen for an aneurysm is a special CT scan of the brain called a CT Angiogram which takes 15 minutes to set up and 13 seconds for the study. Patients with chronic kidney disease, hypertension, sudden headaches, and diabetes are at high risk of developing an aneurysm and should undergo a CT Angiogram every 2 to 3 years for an evaluation.

How to Treat an Aneurysm?

Depending on the size and shape and location, each aneurysm is treated differently. If an aneurysm is detected, it can be treated through coiling or bypassing the aneurysm using a stent via a catheter in the groin or forearm (similar to heart stents), called coil embolization or through open surgery, called clipping or craniotomy where a small clip is placed on the aneurysm. The success rate of aneurysm treatment is around 92 to 97%.

Weeks before rupture, an aneurysm may show warning signs such as persistent headaches or neck pain. If this occurs, it is important to seek medical attention immediately. Thus, if treated right on time, 98% of patients can go back to a normal lifestyle with a few lifestyle changes such as regular exercise, controlling blood pressure, and limiting alcohol and tobacco consumption. Thus, it remains crucial to be aware of the warning signs and get evaluated regularly to prevent the serious consequences of a ruptured aneurysm.

(The article is authored by Dr. Sharad S Rajamani, Consultant – Neurosurgery, Manipal Hospital Whitefield)