- What is a brain aneurysm?
Let's start by explaining what a brain aneurysm is. A brain aneurysm is a disease in which a part of the inner wall of a blood vessel is defective, resulting in a partial structural abnormality, and the blood vessel wall swells to form a new intravascular space like a balloon. These brain aneurysms are surprisingly common. About 3.2% of the population, especially adults, are known to have a brain aneurysm, and some studies report as many as 5%. You can think of it as a fairly common arterial cerebrovascular disease.
2. Causes of cerebral aneurysms
It is said that cerebral aneurysms are most common in people in their 40s~50s and 60s. And unlike other vascular diseases, the incidence rate is about 1.5~2 times higher in women. In addition, women are 2~3 times more likely to have ruptured aneurysms. Factors related to female hormones are also known to be important factors in the occurrence or rupture of aneurysms.
Also, if I had to name just two main causes of aneurysms to develop, grow, and burst, I would say high blood pressure and smoking. In addition to high blood pressure, smoking, diabetes and hyperlipidemia, there are other factors that can worsen atherosclerosis. Then there are things like excessive alcohol consumption that cause aneurysms to develop and grow.
And then there's the concept of familial brain aneurysm. In fact, the link between brain aneurysms and family history is already known. There is no exact research that says which genes cause aneurysms, but there is definitely a genetic influence on the disease. If two or more family members have been diagnosed with an aneurysm, or if the aneurysm ruptured and suffered from a subarachnoid hemorrhage, it is recommended that the family members also be screened. And then there's the concept of multiple aneurysms. In general, people who have three or more aneurysms are called multiple brain aneurysms, and they are known to have a higher rupture rate than normal. It is characterized by bursting a little more easily even at a young age and popping well even at a small size.
3. Reasons and symptoms to treat a brain aneurysm
So why treat these aneurysms? The reason for this lies in the risk of aneurysms. In fact, about 30~50% of those who have an aneurysm, and about half of the patients have an aneurysm. In general, the annual rupture rate of non-ruptured cerebral aneurysms is approximately 1%. You can think of it as having a 10% chance of detonating over a period of about 10 years, and a 20% chance of detonating over a period of 20 years. So what are the risks of a ruptured brain aneurysm? A bleeding in the brain caused by a burst aneurysm is called a subarachnoid cerebral hemorrhage, and the mortality rate within a month is about 50%. It is known that about 15% of patients who rupture die before they arrive at the hospital, and even if they arrive at the hospital at the right time and receive good treatment, about 28% of them die during treatment, and about half of the patients die within a month.
And subarachnoid cerebral hemorrhage is a dangerous disease that about 20~30% of those who survive have neurological disorders and may live with sequelae for the rest of their lives. For this reason, treatment of non-ruptured cerebral aneurysms that are thought to have a high rupture rate should be considered to prevent subarachnoid hemorrhage.
An unruptured cerebral aneurysm and a ruptured cerebral aneurysm are, technically very different diseases. Most cases of unruptured brain aneurysms are asymptomatic. This case can be found by chance during a medical check-up or brain MRI scan performed because a person is concerned about brain disease due to a headache, or by chance when an elderly patient is examined because he is worried about dementia.
However, when some aneurysms compress the nerves in the cranial area, symptoms such as drooping eyelids, drooping of one eyelid and not being able to open it, double vision or strabismus in which objects are seen overlapping. You can think of this as a case where you visit an ophthalmologist and there is no ophthalmic problem, so it is discovered by chance during a cerebrovascular examination. And, as I mentioned earlier, there are also symptoms that occur when it ruptures, which are caused by a subarachnoid cerebral hemorrhage. One of the most common is severe headaches. However, there are two characteristics of these headaches. The first is that it comes out of nowhere. For example, it's not like I've been feeling a little sore lately or that my head feels a little heavy in a few days, but it's clear when the headache starts. For example, a sudden headache while having a bowel movement, or a sudden headache while washing dishes in the morning. The second is a severe headache. In textbooks, the pain is like being hit with a hammer, Or it is described as a lightning strike. In addition, nausea may be severe, such as vomiting, neck stiffness in the back of the neck, and in severe cases, loss of consciousness.
4. Aneurysm diagnosis and treatment
The method of diagnosing this aneurysm is MRA, CTA, which is called cerebrovascular CT, and then cerebroangiography in which a tube about 70~80cm is inserted through the femoral artery to the entrance of the neck and the septum is directly injected. Tests that are usually performed with contrast media cannot be performed during a medical examination. Therefore, most of the people who are found through a medical examination are diagnosed through MRA. And if you need a thorough examination or treatment after you have been diagnosed, or if you have ruptured and need immediate treatment, you can think of it as a cerebral angiography to determine the method and timing of treatment.
And there are only two treatment methods: clip ligation at the cranial head and coil embolization by approaching the inside of the blood vessel.
The first craniotomy involves opening the skull in the head and carefully dissecting between the brain folds to identify the protruding aneurysm and pinching the area where the aneurysm begins with metal forceps called a clip to cut off blood flow into the aneurysm.
The second method is called coil embolization, which has been used a lot in recent years. Coil embolization involves inserting a thin tube into a convex aneurysm into a blood vessel like cerebral angioplasty and filling it with a metallic substance thinner than a human hair, called a platinum coil, like a yellow circle (bottom right image in the photo), to match the size and shape of the aneurysm. This will lead to the formation of blood cakes within the aneurysm, which will block the flow of blood into the aneurysm.
The table above compares these two treatment options. The pros and cons of each are clear. Craniotomy has the advantage of opening the head and directly checking and manipulating the aneurysm, so it is possible to manipulate the small arteries in the vicinity, and it is possible to respond quickly when a weak part bursts during surgery, and above all, it has the advantage of a low recurrence rate in the long term. But the downside is that you might have a surgical wound on your head, and then you're afraid of craniotomy. The downside is that there is a possibility of damage to the surrounding brain tissue and blood vessels before encountering an aneurysm.
On the other hand, coil embolization has the advantage that it can reach blood vessels that are too deep to reach during surgery, so it is possible to perform aneurysms in deep locations that are difficult to access. And, of course, since there is no wound to the head, there is no need for a recovery period from the surgical wound, so the procedure takes a faster time and the hospitalization and recovery period are much faster. However, it has a slightly higher recurrence rate compared to craniotomy, and in order to reach the blood vessels in the head, it has to go from the groin through the aorta that passes by the heart and up through the blood vessels in the neck. If the blood vessels in the middle are severely arteriosclerosis and tortuous, the disadvantage is that blood clots or emboles may form while inserting a catheter, which can cause cerebral infarction.
5. Is an MRI scan enough to diagnose a brain aneurysm?
No. It's often thought that MRI is the best brain scan. In fact, MRI is one of the best tests, but MRI, CT, etc., each has its own advantages.
For example, if you don't have an MRA and only have an MRI, you can't actually screen for an aneurysm in advance. MRI is a test that shows the soft tissue, but soft tissue such as the brain cannot be accurately identified as the aneurysm, which is actually in the blood vessels that are about 2 mm, 3 mm, or 4 mm in the body. Therefore, in order to screen for aneurysms, MRA scans should be performed, not MRI scans. So, if you are at high risk for cerebrovascular disease or want to do a screening test for cerebrovascular disease, you should know that you need to do an MRA test.
6. What is the biggest cause of brain aneurysm?
I tell you that this is not the case. They say stress is the root of all ills. So I'd be lying if I said that stress doesn't contribute to brain aneurysms, but there are actually factors that have been identified in large studies as risk factors for brain aneurysms to develop and burst, such as high blood pressure and smoking. High blood pressure, smoking, and other factors such as diabetes, hyperlipidemia, and excessive alcohol consumption are very important to control.
7. Should I take nutritional supplements or supplements to treat and prevent brain aneurysms?
I can confidently say no to this question. It's the same for people who are discharged from the hospital after their aneurysms are treated, and they ask me if there's anything I should eat or avoid in the future, but I don't really have that. The same goes for nutritional supplements, and the same goes for aphrodisiacs. Technically, it doesn't matter if you eat it or not. Because these things are not the direct causes.
So, rather than being related to eating habits, it is more likely to cause high blood pressure, hyperlipidemia, and hyperlipidemia. It is important to control chronic diseases such as diabetes, which are known to be factors that contribute to the development and rupture of aneurysms, and the diet associated with them. In other words, people with high blood pressure should control their high blood pressure through a low-salt diet, and those with diabetes or hyperlipidemia should reduce their intake of animal fats and carbohydrates. You can take your daily multivitamins, vitamin C, and so on. To sum it up, you don't need any nutritional supplements or supplements that you have to take, just eat a lot of delicious food evenly.
8. If the size of the brain aneurysm is large, it should be treated, and if it is small, it should not be treated?
The answer is yes, maybe not. It goes without saying, but it's obvious that the bigger the aneurysm, the more likely it is to burst. And it goes without saying that the smaller it is, the lower the rupture rate. But there's a reason why you can't say that if the aneurysm is big, you can treat it, and if it's small, you can't treat it. That's because there are many things to consider when treating an aneurysm, and the size of the aneurysm isn't the only thing that needs to be considered. Once you take a picture and the size comes out, it's divided into treatment or follow-up observation, which means it's not that simple. On the other hand, even if the size is quite large, there are quite a few cases where it does not burst for a long time and stays the same.
Then, even if they are very young and relatively small, about 2 or 3 mm in size, it is not uncommon to see them burst. That being said, the size of an aneurysm is one of the important factors, but it's not the whole story.
So, what are the factors that contribute to a ruptured aneurysm? The location and shape of the blood vessel where the aneurysm is located are also important. For example, if the one-year rupture rate of a 7 mm internal carotid artery is about 1.2%, the annual rupture rate of a 7 mm aneurysm in the posterior transit artery is about 3.2%. So size isn't everything.
Then there's the shape. It's usually called a cystic aneurysm. It is known that the rupture rate is much higher if there is a small snowman-shaped sac on top of such an aneurysm, and then if it has a bulging irregular shape like a heart, even if it is the same size, than if it is a round, regular aneurysm. So, if the aneurysm is large, it will be treated, and if it is small, it will be fine, of course, but I tell you that size is not everything. The location and shape of the aneurysm are also factors that can cause rupture, so it is important to consult a cerebrovascular neurosurgeon about the risk of rupture.
9. Can I rest assured that a non-ruptured cerebral aneurysm will be cured if treated?
This is also X. This is because a non-ruptured cerebral aneurysm is not a disease that is diagnosed and life-threatening if not treated immediately, like cancer, for example. Some non-ruptured brain aneurysms are likely to burst for the rest of their lives and go unscathed, so they don't need to be treated in a hurry. If the risk is so high that it must be treated, it should be treated, but the concept of a lifelong cure for a non-ruptured cerebral aneurysm is not easily discussed.
If treated, there is almost no chance of a treated aneurysm bursting unless it recurs. However, in very rare cases, aneurysms can recur in the area where they were treated after 10 or 20 years, or they can also occur in other areas that were completely unexpected. Therefore, even if the treatment is successful, it is necessary to follow up regularly to check whether there is a recurrence or an aneurysm in a third location
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