Q: Some members of my family have had brain aneurysms. Is it
ever advisable to be screened for them? If found, how are they
treated?
A: Advances in imaging technology mean brain aneurysms are
easier than ever to detect. The hard part is deciding when to look
for a brain aneurysm
– and when and how to treat it.
Q: Some members of my family have had brain aneurysms. Is it ever advisable to be screened for them? If found, how are they treated?
A: Advances in imaging technology mean brain aneurysms are easier than ever to detect. The hard part is deciding when to look for a brain aneurysm – and when and how to treat it.
At the base of your brain, below where all the real thinking occurs, is a busy hub of arteries. The blood vessels in this area keep the brain fed with oxygen-rich blood. Sometimes a weak spot balloons out under pressure from the blood coursing inside: this is called an aneurysm.
If one of these aneurysms breaks open, blood floods into the narrow area between the surface of the brain and the skull, creating a hemorrhagic (or bleeding) stroke. Such a stroke can be devastating. Almost half of those who have one die, and a third of the survivors have a major neurological problem.
Another type of bleeding stroke affects smaller blood vessels deeper inside the brain and others occur in the parts of the brain that control speech and vision.
Many unruptured aneurysms are found when brain scans are ordered for other reasons. Both CT scans and MRIs can detect aneurysms.
Most experts, however, think that routine screening of the general population for brain aneurysms would be hugely wasteful and counterproductive.
From autopsies and other studies, experts estimate that 10 to 15 million Americans (about 5 percent of the population) are walking around with aneurysms that are producing no symptoms.
Each year, about 27,000 of those aneurysms rupture and cause bleeding between the brain and the skull. So a screening program in the general population might detect one or two aneurysms before they have a chance to rupture for every 500 or so that aren’t causing a problem and probably never will.
There’s also the danger of the treatment to consider, and whether it might outweigh that of leaving the unruptured aneurysm. Some studies show that aneurysm treatment is fatal in 2 to 4 percent of cases. Even in successful cases, the recovery often takes months and may involve headaches, depression and memory loss.
Some hemorrhages run in families, so right now, family history is the best guide. If any of your parents, siblings’or children has had bleeding from an aneurysm, you should talk to a doctor about the pros and cons of getting a brain scan.
Some studies argue for scanning those with at least two affected relatives, but others have found the benefit to be questionable even in that group.
Once a brain aneurysm is found, doctors and patients must answer two major questions. Should it be treated? And if so, how? Both questions defy easy answers.
Whether treatment is a good idea depends on the person’s age, overall health, and whether the aneurysm is causing problems.
Naturally, one of the prime considerations is the chance that the aneurysm will rupture.
As might be expected, most studies show that the smaller the aneurysm, the lower the risk. The location must also be factored in. As a rule, aneurysms affecting the arteries that supply the back part of the brain are more likely to burst and therefore are better candidates for intervention.
Fortunately, though, about 90 percent of aneurysms are in the front and are far less likely to rupture.
Doctors treat brain aneurysms in two basic ways. The traditional approach requires brain surgery to put a clip around the “neck” of the aneurysm, where it bulges off from the artery
The other treatment involves coiling a thin strand of wire inside the aneurysm. Blood clots in and around the coil instead of pushing on the weak walls of the aneurysm. This treatment does not require brain surgery, and is therefore less risky.
So which is better, clipping or coiling? Only you and your doctor can make that decision.
– By The Faculty of Harvard Medical School
You can submit questions to the Harvard Medical School Adviser at www.health.
harvard.edu/adviser.
