By Janet M. McHenry DNP, FNP-BC, CCRN, CNRN
Doctor of Nursing Practice
Family Nurse Practitioner, Department of Neurosurgery
HEALTH– The journey begins: “I looked up from my desk and I felt like a bomb went off in my head. It was the worst headache of my life, it just exploded.”
“I wasn’t feeling well for about two weeks before this happened. The last thing I remember, I went into the grocery store and I woke up three weeks later in the rehabilitation hospital.”
“I was attending a family party and thought I had food poisoning. I felt like something popped behind my right eye and there was flashing in my eye like a light bulb went off, then I vomited.”
“My sister came home from work and said she had a bad day and a headache. She went upstairs to lie down before dinner. That was the last time we spoke, she died the next day.”
These stories are typical of survivors and their loved ones who have experienced a ruptured brain aneurysm resulting in a subarachnoid hemorrhage a type of hemorrhagic stroke.
Fortunately, aneurysmal subarachnoid hemorrhages account for only about 3% of all strokes. However, it is important for everyone to know the symptoms and risks, particularly in our community. First and foremost if you or a loved one get the “WORST HEADACHE OF YOUR LIFE,” please seek immediate and emergent medical attention.
The sudden onset of the worst headache of your life is a “red flag” and may be a sign of a ruptured brain aneurysm. Other symptoms of brain aneurysm which may accompany the headache include: stiff neck, sharp pain behind or in the eye, blurry vision, light sensitivity, drooping eyelid, nausea & vomiting weakness of the arms or legs numbness and tingling of one side of the face or body, dizziness, confusion & seizures and/or loss of consciousness. There is normally a sudden onset of symptoms as described in the stories. There are a small percentage of brain aneurysms that leak a week or two before the rupture. People report that they have headaches and generally feel lousy, similar to the flu symptoms. When a brain aneurysm ruptures causing a subarachnoid hemorrhage it can cause brain damage, coma and even death.
What is a brain aneurysm?
A brain aneurysm is a balloon that arises from a cerebral artery. A brain aneurysm results from a weakness in the wall of the artery that supplies blood to the brain. Because blood continues to flow and finds the path of least resistance the vessel balloons out.
Blood fills that sac and as pressure rises, that balloon can rupture and pours blood into the brain.
A Brain aneurysm ruptures in this country every 18 minutes impacting approximately 30,000 people a year. Women are affected more than men approximately 3:2 ratio, generally between 40 and 60 years of age. In contrast, approximately 6 million people in the US have unruptured brain aneurysms or 1 in 50. Cerebral aneurysms are twice as likely to rupture in African Americans and 1.6% times more likely to rupture in Latinas and Latinos. Of those who develop a subarachnoid hemorrhage resulting from a ruptured brain aneurysm 25% will die within 24 hours many more than 50% will have permanent neurologic deficits; approximately 50% will be unable to return to work and others will recover fully.
Certain genetic diseases carry higher risk for the development of brain aneurysm such as polycystic kidney disease, genetic connective tissue disorders that weaken blood vessel walls, history of rupture in a first degree relative: parent, child or siblings. Those with sickle cell disease and Arteriovenous malformations carry a higher risk for development of brain aneurysms. Other associated risk factors include: smoking, drug use particularly cocaine and amphetamines and uncontrolled hypertension. Patients who have a known brain aneurysm are 20% likely to have a second brain aneurysm, usually on the other side.
Since there are rarely signs of unruptured aneurysms they are often discovered “incidentally”. Patients may complain of headaches or dizziness and they are seen on magnetic imaging. We strongly recommend that anyone who has an incidental finding of a brain aneurysm be seen by an aneurysm specialist such as a neurosurgeon or neuroradiologist. They can offer treatment if it is required, further imaging to better characterize the aneurysm or to follow you on a regular basis. In particular, it is very important for family members of first degree relatives who have ruptured to be screened with an MRI and MRA or CTA if over age 21. We know about the connection to ruptured brain aneurysms it’s always better to find it before the rupture occurs and treat it then.
Brain Aneurysm Treatment
The only treatment for brain aneurysms in the past was open brain surgery. The aneurysm was located and a clip or clips were placed to secure the neck and stop blood from flowing into the sac. While this surgery is performed least often but is sometimes required due to the location or configuration of the aneurysm. Endovascular treatment has developed over the past 25 years and is utilized more commonly to treat aneurysm. The patient is taken to interventional suite and a cerebral angiogram is performed similar to a cardiac catheterization.
The angiogram or catheterization of the brain is performed. The aneurysm can be treated through a microcatheter by inserting platinum coils to fill the aneurysm. In addition a stent device re-directs blood flow away from the aneurysm may also be used so the aneurysm will shrink.
Message to the Community
There are disparities in health care in this country based upon race and economic status. I know from my own experience speaking to patients that this often prevents community members from seeking the help that they need.
Please don’t ignore the symptoms if they occur, Montefiore is here to help. We are not interested in your insurance or immigration status. We are a nationally designated comprehensive stroke center. We are in the forefront of aneurysm treatment and research. At Montefiore we have a multidisciplinary team that collaborates for the patients highest quality and most efficient care. In order to attain Joint Commission of Hospital Accreditation national designation as a Comprehensive Stroke Center there must be a high number of aneurysms treated and both operative and endovascular treatment must be offered. The entire staff including MDs, nurses and all health care workers who touch the patient must be educated. We must continuously maintain excellent standards of care that are benchmarked against the national standards. The standards are high, but so are the stakes for our community members who deserve only world class healthcare.