You think it would be obvious if a critical blood vessel in your body was in danger, but that isn’t always the case. Aneurysms, if they haven’t ruptured, are often found by accident during routine scans. The wear and tear that causes an aneurysm isn’t something you can avoid completely, but there are ways that you can lower your chances of ending up with this dangerous condition.
Joining us this week to talk about some of the often overlooked warning signs of aneurysm and the latest in treatment is Dr. Robert Singer. A neurovascular surgeon, Singer practices at Eastern Maine Medical Center where he’s also coordinator of the Neuroscience Institute.
An aneurysm occurs as a result of wear and tear that thins a blood vessel, causes degeneration of the blood vessel wall and eventually a bulge. It’s usually seen in people over 40 years of age. And while wear and tear is a normal part of aging, there are other factors and even lifestyle choices that could cause someone to develop an aneurysm:
- A genetic disposition
- Some syndromes, which usually account for aneurysms found in childhood
- High blood pressure
- Drug use -- particularly cocaine
“The big factors are the smoking history and the hypertension that can be controlled by the patient,” Singer says.
Regardless of cause, aneurysms can occur in a variety of places. Singer’s work is primarily in cerebral circulation, so he sees many aneurysms occurring in the brain, but they’re also found in the heart (the aorta) and in other large tributary arteries (like in the kidney).
Often, an unruptured aneurysm can have fairly mild, non-specific symptoms, including:
- Sinus infection
- Persistent headaches
- Dilated pupil and blurred/double vision (less common)
A ruptured aneurysm is a much different situation.
“When that happens, patients bleed and it can be very, very serious. About 40 percent of patients that have ruptured brain aneurysms die within three months of the rupture,” Singer says.
As many treatments go, physicians have to consider the variables. After determining the size and location of the aneurysm, and the age and medical history of the patient, there are a few possible courses of action.
Monitoring: Smaller aneurysms (seven millimeters or smaller) will often just be monitored to track changes.
Craniotomy: Up until 1995 or 1996, Singer explains, surgery consisted of removing a plate of bone in the skull.
“They would go to the operating room for a traditional craniotomy, which is when we make an incision on the scalp and remove a plate of bone and then get under the microscope and detect and place a clip along the base of the aneurysm,” Singer says.
They can still perform this type of surgery and do, depending on the aneurysm and patient, but there is also a less invasive option.
Endovascular approaches: Doctors are now able to enter the body through the blood vessel with a catheter-based approach to cut off or divert blood flow from the aneurysm.