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Cerebral Aneurysms: A Ticking Time Bomb
A cerebral aneurysm, often termed a silent killer, quietly lurks deep within the cranial vessels, showing no overt symptoms yet capable of fatal outcomes. Many patients only discover they have this condition after an aneurysm ruptures, causing acute stroke or severe headaches.
Rupture of an aneurysm: 20 to 30 percent die before reaching the hospital
Aneurysms can occur in any arterial site, but they are most commonly found in cerebral arteries and the aorta. The usual sites for cerebral aneurysms include the anterior cerebral artery (30-35%), the internal carotid and posterior cerebral arteries (30-35%), and the middle cerebral artery (20%), with others found in the basilar and posterior circulating arteries (5%).
Cerebral aneurysms are vascular conditions where blood pressure causes a reduction in the elastic layer of the vessel wall, leading to a weakened, outward bulging that may form an aneurysm. These are typically more prone to forming at the bifurcation points of vessels, which are naturally weaker, making these expanded vessel walls susceptible to rupture, potentially leading to hemorrhagic stroke—a deadly type of stroke with a mortality rate as high as 36%.
Once a cerebral aneurysm ruptures, 20 to 30 percent of patients die before they can be transported to the hospital. If an aneurysm that has previously ruptured is not treated timely, there is a 40% chance it will burst again within six months, with a mortality rate of up to 70%. In Hong Kong, about five per 100,000 people are diagnosed annually, primarily affecting middle-aged individuals, with a female to male ratio of 2:1. Risk factors include smoking, high blood pressure, and vascular injury. The rupture of an aneurysm can instantly be lethal, and often the condition goes unnoticed until it causes a life-threatening brain hemorrhage.
Cerebral blood vessel aneurysm on magnetic resonance imaging (MRI).
Aneurysm Clipping.
Surgical intervention is akin to defusing a bomb
In recent years, medical techniques similar to transvascular neurointervention have been employed. This procedure involves navigating a fine catheter stent (Pipeline Stent) from the femoral artery in the thigh to the primary artery in the brain, blocking blood flow into the aneurysm. The aneurysm typically resolves within six months, after which anticoagulant medication is administered temporarily to prevent thrombosis.
Conversely, in cases of acute hemorrhage due to a cerebral aneurysm, patients may require urgent surgical intervention to clip the aneurysm (Aneurysm Clipping) using a titanium clip to seal off the ruptured aneurysm. This procedure is dramatically life-saving, reducing the risk of death by 60% and severe permanent disability by 90%.
Most cerebral aneurysms exhibit few, if any, noticeable symptoms, and increasingly, individuals are diagnosed through MRI or CT scans.
Maintaining vascular health is paramount
Given the insidious nature of this condition, proactive prevention and timely diagnosis and treatment are crucial. Healthy lifestyle choices that maintain vascular health, such as a low-fat diet and regular exercise, can reduce cholesterol levels and decrease the risk of arteriosclerosis. Early detection and appropriate monitoring and treatment of cerebral aneurysms can prevent sudden, fatal ruptures, significantly mitigating the risk to life.
Pipeline Stent.