03 Apr 2021
Cerebral aneurysm is a localised dilated vessel wall, forming a pouch or rhomboid. Under the pressure on the vessel wall, the aneurysm may increase in size over time, squeezing the vital organs around the aneurysm. The most dangerous complication of cerebral aneurysm is that the aneurysm can rupture and cause subarachnoid hemorrhage, with a high mortality rate if not detected early and treated promptly. The mortality rate can be up to 80% if the aneurysm ruptures a second time.
Cerebral aneurysm can proceed silently with no or vague symptoms. Sometimes it causes only a headache, so the patient tends to ignore it. For example, a patient named N.T.P, 42 years old, living in Binh Thanh district and hospitalised as an emergency at Hoan My Saigon Hospital stated that “I had a severe headache while taking a shower in the afternoon. The pain gradually increased with a numb ache in the nape of my neck, dizziness, cold sweating and vomiting. So far, I have been a very healthy person, playing sports, and take regular exercise”.
With the patient’s clinical symptoms of a sudden, intense headache, doctors in Hoan My Saigon conducted a specialist consultation, and CT scan results showed that the patient had a subarachnoid hemorrhage. Subsequent CTA (Computed Tomography Angiography) results showed that the patient had a ruptured anterior artery aneurysm, about 3 mm in size, which caused the subarachnoid hemorrhage.
To eliminate the aneurysm and prevent the risk of rupture, doctors used intravascular interventions to embolise the aneurysm with coils via the state-of-the-art digital subtraction angiography system. Pham Dinh Chuong, M.D., MSc, of the Stroke Unit, the doctor treating Mr. P. said, “These coils will embolise the aneurysm and prevent blood from flowing into the aneurysm, thereby completely eliminating the aneurysm and preventing the risk of repeated rupture. This is a minimally invasive procedure that helps embolise the aneurysm. Immediately after the intervention, the patient can recover and be discharged from the hospital within just 2-3 days of a successful intervention”.
Dr. Chuong also said the aneurysm in this patient may have been caused by long-term smoking, with a history of nearly 30 years of smoking, since there were no other risk factors in this patient such as hypertension, diabetes, dyslipidemia, nor any family history of cerebral aneurysm. When the aneurysm rupture causes a subarachnoid hemorrhage, the patient has a sudden severe headache, vomiting, hemiplegia, or worse: loss of consciousness, coma and death.
The rate of stroke has recently increased among younger people, cerebral hemorrhage can occur even in healthy young people with few or no risk factors. Dr. Chuong emphasises that the importance of symptoms such as sudden headache or vomiting cannot be understated, and immediate hospitalisation should be sought for active treatment. In addition, we should also have medical check-ups for early screening of cerebral aneurysms, cerebrovascular malformations, and cerebral stenosis, especially in the presence of diseases considered to be risk factors for developing an aneurysm such as hypertension, diabetes, obesity, dyslipidemia, a history of headache, family history of stroke, long-term smoking, etc.
Currently, there are two major treatment methods for cerebral aneurysm, namely:
Intravascular intervention: This is a minimally invasive procedure; the patient can recover and be discharged from the hospital as soon as possible. These intervention techniques include coil embolisation, balloon and coil combination or stent and coil combination, flow modification stents, etc.
Surgical procedure: The doctors anesthetize the patient, open the skull and expose the aneurysm, which is then removed with clips. This procedure is applied with superficial, easy-to-reach aneurysms and wide cervical aneurysms which are too difficult for intravascular intervention.