THURSDAY, March 28, 2024
nationthailand

A sudden and extremely painful headache could be fatal

A sudden and extremely painful headache could be fatal

A life-threatening medical emergency with an annual incidence of one out of 10,000 people, the rupture of a cerebral or brain aneurysm requires immediate transfer to a stroke unit, a highly specialised intensive care unit combining multiple neurological e

Although simple questioning of the patient – often a middle-aged adult – or the witness should provide ample evidence to diagnose or at least suspect this acute condition, far too many people suffer the consequences of delayed recognition and treatment of this event.
As with a heart attack, knowledge and awareness of friends, family and members of the public are essential to improving the outcome of this illness. 
A brain aneurysm is an inherited (congenital) or acquired vascular malformation on a cerebral artery that looks like a bulge or localised enlargement on the vessel wall. Most aneurysms remain unchanged during life and do not lead to any symptoms. Although rarely, some may cause initial signs like a well-localised headache, some changes in vision or numbness in the face that should prompt investigations and lead to early diagnosis before rupture. 
Unfortunately, most of the time, a brain aneurysm is only recognised when the vessel suddenly bursts, the result of the excessive thinness and fragility of the vascular defect. The rupture induces immediate bleeding spreading to the surrounding cerebral tissue that corresponds to a type of haemorrhagic stroke known as subarachnoid haemorrhage. Usually the bleeding lasts a few seconds because a clot process rapidly occurs and limits the amount of blood leaking into the brain. Depending on the size, location and predisposing factors, a brain aneurysm can lead to a large variety of symptoms from moderate headache due to minor bleeding to sudden coma and death triggered by a massive haemorrhage. Nevertheless in the majority of cases, the symptoms include – always with an acute onset – a headache that gives off the worst ever pain experienced by the person, unprompted vomiting, dizziness or unstable walking and confusion. Others manifestations include disturbed vision, painful stiffness of the neck, slurred speech, convulsions or muscle weakness. A minor aneurysm may lead to a moderate headache that risks being misdiagnosed but despite the minimal warning signs, still carries the same potential gravity. In short, any episode of unusually brutal and severe headache could well be a rupture of an aneurysm and should be immediately evaluated by a doctor, preferably a neurologist. 
Most of the time the proper questioning coupled with clinical examination will indicate the occurrence of cerebral bleeding. An emergency CT scanner or CT angiography (with the injection of a dye product) will confirm the diagnosis by revealing blood leakage within the brain tissue.
When the diagnosis is confirmed, the patient should be promptly taken in hand by an experienced team comprising a neurologist, neuro-surgeon as well as an interventional neuroradiologist. The modern treatment of brain aneurysm is often initiated with an interventional neuro-radiologic procedure. Here, a specialist inserts a catheter (small hollow tube) into an artery of the groin and pushes it to the cerebral circulation. A dye is then released, which allows for visualisation of the precise shape and location of the aneurysm. Through a special catheter, the doctor then places some thin platinum wires inside the aneurysm that correct the vascular defect, a procedure named endovascular coiling. Some patients may not be candidates for this minimally invasive procedure and may require neuro-surgery (skull opening with surgical clipping of the aneurysm).
After the curative treatment of the aneurysm, the patient is transferred to a specialised stroke unit where sophisticated intensive therapy is carried out to prevent possible secondary complications. These include excessive pressure or fluid in the brain, insufficient blood supply to the brain tissue due to vessel spasm, infection and seizures. Although mortality of aneurysm remains around 40 per cent at one month after the event, early diagnosis, the interventional radiologic procedure and well-managed intensive care significantly improve the prognosis of this cerebral vascular disorder.
 
DR GERARD LALANDE is managing director of CEO-Health, |which provides medical referrals for expatriates and customised |executive medical check-ups in Thailand. He can be contacted at [email protected].
 
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