Golden time is meaningless once it explodes… ‘Cerebral aneurysm’

From the death of a famous actress to the death of a nurse at a university hospital, there were two reports of deaths from a ruptured brain aneurysm this year alone. It would not be common for deaths from the same disease to be reported consecutively every three months.

The key to treating all urgent diseases is the ‘golden time shooter’. However, once it has ruptured, even this ‘golden time’ becomes meaningless, a disease that is a brain aneurysm. A brain aneurysm rupture can be adequately prevented with early diagnosis and appropriate treatment. How to deal with it wisely?

The cerebral arteries play an important role in supplying blood to the brain. It is a blood vessel that receives a lot of hemodynamic stress because it increases and decreases repeatedly according to changes in blood pressure. When oxidative stress increases due to the accumulation of such hemodynamic stress or a sudden increase in free radicals in the body, a certain part of the cerebral artery swells like a ‘balloon’ or ‘balloon’. This is called a ‘brain aneurysm’, and if the aneurysm ruptures if left unattended, it leads to a subarachnoid haemorrhage (cerebral haemorrhage).

A brain aneurysm is difficult to detect because there are no symptoms until it ruptures. However, in rare cases, symptoms such as strabismus, double vision, and ptosis (dropping eyelids) as a result of cranial nerve compression may appear. When a brain aneurysm ruptures, blood flows into the subarachnoid space of the brain, and symptoms such as severe headache and vomiting appear as ‘like being hit in the head with a sledgehammer’ or ‘like being struck by lightning in per head’. Depending on the bleeding pattern, paralysis or speech impairment can occur, and in severe cases, death can occur.

Seo Dae-cheol, head of the clinical department of neuro-interventional medicine at Gangnam Peter Hospital, advised, “If you experience wrinkled eyelids along with a headache, this is a precursor to a ruptured brain aneurysm, so you should see a specialist for treatment on once.”

The cause of a brain aneurysm has not yet been clearly explained. However, the most representative risk factors include high blood pressure, arteriosclerosis, diabetes, and smoking. Women are 1.6 times more likely to develop a brain aneurysm than men, 1.5 times more likely to develop high blood pressure, 2 times more likely to develop heart disease, and 1.8 times more likely to develop a brain aneurysm in patients with a history family history of stroke. In terms of age, it starts in the 30s and is most likely to develop in the 40s and 60s.

To determine whether a brain aneurysm has occurred, first, an angiography computed tomography (CT) is performed for a basic examination. At this stage, if suspicious findings are found, magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA) is also performed to confirm the exact location, shape and size of the aneurysm.

Currently, there are no drugs that can treat brain aneurysms. Instead, there are two treatments, ‘clip ligation’ and ’embolization coil’. Clip ligation is an operation that requires opening the head, and coil embolization is a procedure where a coil is inserted through the femoral artery in the groin.

Clip tying involves opening the skull and using a special clip to tie the neck of the aneurysm to block blood flow to the brain aneurysm and prevent the aneurysm from bursting. It is a useful method of treating large or wide neck aneurysms. However, due to the nature of craniotomy which directly opens the skull, brain tissue or blood vessels can be damaged, so careful technique is required.

Coil embolization accesses the cerebral artery by inserting a small metal tube through the femoral artery in the groin without opening the skull. A platinum thread called a ‘coil’ is then inserted into the brain aneurysm. The coil blocks blood flow to the aneurysm and prevents the aneurysm from swelling and bursting.

Seo Dae-cheol, head of the clinical department of neuro-interventional medicine at Gangnam Peter Hospital, said, “Brain aneurysms before rupture show almost no symptoms. The best treatment is to regularly check the health of the brain through health checks, etc. to detect a rupture in advance.”

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