Dr. Vipul Gupta
Female mortality rate attributed to brain bleeding is higher than men. According to the reports of WHO 2020, approx 4.98 lakh fatalities occur each year worldwide out of which around 2 lakh are under the age of 50 years. A brain (cerebral) aneurysm is a bulging, weak area in the wall of an artery that supplies blood to the brain. In most cases, a brain aneurysm causes no symptoms and goes unnoticed. In rare cases, the brain aneurysm ruptures, releasing blood into the skull and causing a stroke. The most common location for brain aneurysms is in the network of blood vessels at the base of the brain called the circle of Willis. A recent report from the Institute of Medicine (IOM), arm of the National Academy of Sciences confirms that females are up-to two times more likely to develop cerebral aneurysms compared to males.
Why are women so vulnerable?
There has been dearth of research in the field; it is still too early to say why women are at a higher risk than men. Since pre and post menopausal women are more likely than their younger counterparts to harbor aneurysms.
Women over the age of 35 are particularly exposed to the risk. In fact, there are several instances of sex differences in the incidence and sign of cerebrovascular disease and trauma that warrant further investigation. Smoking, high blood pressure, and a family history of brain aneurysms seem to further increase a woman’s risk of developing this potentially fatal condition.
A recent data from University of Texas Southwestern Medical School in Dallas recommend early aneurysm screening for young women smokers, alcoholic at risk, that is, those who have hypertension or a family history of brain aneurysms.
Some research also suggests that level of estrogen is also responsible for the cause. However it is still too early to derive any conclusion. Only further studies examining the relationship between estrogen and aneurysms will provide a clear answer.
Many patients (up to 30%) do not survive initial bleeding. Even the patients who survive more than 50% of patients may not survive without treatment even for a month because the aneurysm bleeds again. Haemorrhage due to aneurysms is a medical emergency that is frequently misdiagnosed. The aneurysms are diagnosed by angiography and early aneurysm treatment should be performed to prevent repeat bleeding.
Most brain aneurysms causes no symptoms and may only be discovered during tests for another, usually unrelated, condition. In other cases, an unruptured aneurysm will cause problems by pressing on areas in the brain. When this happens, the person may suffer from severe headaches, blurred vision, changes in speech, and neck pain, depending on what areas of the brain are affected and how bad the aneurysm is.
What are the early signs?
Signs are persistent once the aneurysm ruptures and unluckily more than 50% of the cases are detectable only when it ruptures. A sudden, explosive headache – often described as the “worst headache of the patient’s life” – is the cardinal symptom of a burst aneurysm. But many people walk around with silent aneurysms for years.
Other symptoms of a ruptured brain aneurysm may include: Headache with nausea or vomiting, stiff neck, muscle weakness, difficulty moving any part of the body, numbness or decreased sensation in any part of the body, vision changes, eye lid drooping, lethargy, seizure, speech impairment.
A number of factors can contribute to weakness in an artery wall and increase the risk of a brain aneurysm. Brain aneurysms are more common in adults than in children and more common in women than in men. Some of these risk factors develop over time; others are present at birth.
How can it be treated?
With the recent advancements in the field of neuro intervention, minimally invasive approach has now replaced the conventional open surgeries. Surgeries that entails direct exposure of the aneurysm and occlusion by placing a metallic clip over the affected part, involves complications like invasiveness and trauma to normal brain parenchyma. The minimally invasive approach involves treatment through endovascular means wherein a micro catheter is placed into the brain through the blood vessels in the leg. With the use of specialized coils the aneurysm is occluded and hence the procedure is known as coiling. The procedure ensures 100% safety and has shown better outcomes. The outcomes are better with embolization for patients being treated for aneurysm.
(The author is Group Director and Head of Neurointervention at Paras Hospital, Gurugram)
