Brain Aneurysm: Diagnosis

Can you spot the 2 aneurysms? The big balloon was the largest and below it was the smallest one that is still intact. This is one of the pictures from my angio showing the aneurysm before the embolization. Zoom in close for details.
This scan compares the brain pre-embolization (top half) and post-embolization (bottom half). Zoom in close for a clear view and details.

Most brain aneurysms go unnoticed until they rupture or are detected during medical imaging tests for another condition. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Cerebral-Aneurysms-Fact-Sheet#5

If you have experienced a severe headache or have any other symptoms related to a ruptured aneurysm your doctor will order tests to determine if blood has leaked into the space between the skull bone and brain. 

Several tests are available to diagnose brain aneurysms and determine the best treatment. These include: 

  • Computed tomography (CT)This fast and painless scan is often the first test a physician will order to determine if blood has leaked into the brain.  CT uses x-rays to create two-dimensional images, or “slices,” of the brain and skull.  Occasionally a contrast dye is injected into the bloodstream prior to scanning to assess the arteries, and look for a possible aneurysm.  This process, called CT angiography (CTA), produces sharper, more detailed images of blood flow in the brain arteries.  CTA can show the size, location, and shape of an unruptured or a ruptured aneurysm. 
  • Magnetic resonance imaging (MRI).   An MRI uses computer-generated radio waves and a magnetic field to create two- and three-dimensional detailed images of the brain and can determine if there has been bleeding into the brain.  Magnetic resonance angiography (MRA) produces detailed images of the brain arteries and can show the size, location, and shape of an aneurysm. 
  • Cerebral angiography.  This imaging technique can find blockages in arteries in the brain or neck.  It also can identify weak spots in an artery, like an aneurysm.  The test is used to determine the cause of the bleeding in the brain and the exact location, size, and shape of an aneurysm.  Your doctor will pass a catheter (long, flexible tube) typically from the groin arteries to inject a small amount of contrast dye into your neck and brain arteries.  The contrast dye helps the X-ray create a detailed picture of the appearance of an aneurysm and a clear picture of any blockage in the arteries. 
  • Cerebrospinal fluid (CSF) analysis.  This test measures the chemicals in the fluid that cushions and protects the brain and spinal cord (cerebrospinal fluid).  Most often a doctor will collect the CSF by performing a spinal tap (lumbar puncture), in which a thin needle is inserted into the lower back (lumbar spine) and a small amount of fluid is removed and tested.   The results will help detect any bleeding around the brain.  If bleeding is detected, additional tests would be needed to identify the exact cause of the bleeding. 

In the next segment, I will talk about treatment.

Brain Aneurysm: Symptoms

From a Distance by Bette Midler.
https://www.youtube.com/watch?v=hLHE9jrb_N4

I remember having a constant headache for 2 days or so prior to the rapture. The pain wasn’t overwhelming and I could tolerate it. I would rate it a 2 on the scale of 1-10 with 10 being the worst. New mothers, me being one of them, tend to ignore little things that their bodies are trying to communicate. We give excuses in order to make ourselves feel better. It is very true we are tired most of the time with little to no adequate rest most of the time. We prioritize the needs of our children and our loved ones. The question that still ponders my mind is – ‘was the aneurysm ruptured already prior to my hospital admission and the bleeding just got worse or did it rapture on that hectic night?’ The doctors that I have met with haven’t given me a conclusive answer yet. They tend to say…..in so many words——“we just don’t know”

So what are the actual symptoms of a brain aneurysm?

Please do not sit and start guessing what could be wrong with you or your loved one. Get emergency care if you suddenly get an intensely painful headache, lose consciousness, or have some of these other symptoms of an aneurysm that has ruptured: I cannot emphasize enough to you how critical it is to get that medical care urgently. Get help if you think something is wrong with your body. DO NOT WAIT.

Although brain aneurysms usually don’t show symptoms, they can press on the brain and nerves as they get bigger. See a doctor at once if you’re having the following symptoms of an unruptured aneurysm:

  • Headache
  • Dilated pupils
  • Blurred or double vision
  • Pain above and behind an eye
  • Drooping eyelid
  • Hard time speaking
  • Weakness and numbness in one side of your face

Please remember that no matter what you are going through or how things turn out, you are not alone. God is with you and He has everything under control. He will lead you to where you need be at the right time. He will bring the right people to your case. God is watching us from a distance. You are a very special child of Him. Have faith and trust in nothing else but in Him. https://www.youtube.com/watch?v=hLHE9jrb_N4

Brain Aneurysm: Risk Factors/causes

Brain aneurysms/cerebral aneurysms form when the walls of the arteries in the brain become thin and weaken.  Aneurysms typically form at branch points in arteries because these sections are the weakest.  Occasionally, cerebral aneurysms may be present from birth, usually resulting from an abnormality in an artery wall. Reference          

Risk factors for developing an aneurysm

Sometimes cerebral aneurysms are the result of inherited risk factors, including:

  • genetic connective tissue disorders that weaken artery walls
  • polycystic kidney disease (in which numerous cysts form in the kidneys)
  • arteriovenous malformations (snarled tangles of arteries and veins in the brain that disrupt blood flow.  Some AVMs develop sporadically, or on their own.)
  • history of aneurysm in a first-degree family member (child, sibling, or parent).

Other risk factors develop over time and include:

  • untreated high blood pressure
  • cigarette smoking
  • drug abuse, especially cocaine or amphetamines, which raise blood pressure to dangerous levels. Intravenous drug abuse is a cause of infectious mycotic aneurysms.
  • age over 40.

Less common risk factors include:

  • head trauma
  • brain tumor
  • infection in the arterial wall (mycotic aneurysm).

Additionally, high blood pressure, cigarette smoking, diabetes, and high cholesterol puts one at risk of atherosclerosis (a blood vessel disease in which fats build up on the inside of artery walls), which can increase the risk of developing a fusiform aneurysm.

Risk factors for an aneurysm to rupture

Not all aneurysms will rupture.  Aneurysm characteristics such as size, location, and growth during follow-up evaluation may affect the risk that an aneurysm will rupture. In addition, medical conditions may influence aneurysm rupture.

Risk factors include:

  • Smoking.  Smoking is linked to both the development and rupture of cerebral aneurysms. Smoking may even cause multiple aneurysms to form in the brain.
  • High blood pressure.  High blood pressure damages and weakens arteries, making them more likely to form and to rupture. 
  • Size.  The largest aneurysms are the ones most likely to rupture in a person who previously did not show symptoms.
  • Location.  Aneurysms located on the posterior communicating arteries (a pair of arteries in the back part of the brain) and possibly those on the anterior communicating artery (a single artery in the front of the brain) have a higher risk of rupturing than those at other locations in the brain.
  • Growth.  Aneurysms that grow, even if they are small, are at increased risk of rupture.
  • Family history.  A family history of aneurysm rupture suggests a higher risk of rupture for aneurysms detected in family members.
  • The greatest risk occurs in individuals with multiple aneurysms who have already suffered a previous rupture or sentinel bleed.

For my case, I had been diagnosed with high blood pressure in the first trimester of my second pregnancy and the condition was being managed when I suffered the brain aneurysm. No family history of brain aneurysms that I am aware of. No smoking, no alcohol abuse, and absolutely no drug use except for the ones for BP and vitamins. My take from this is that we are all pretty much at risk. I have heard stories of completely healthy people, very athletic, and with no family history get them. The more information we know about brain aneurysms, the more lives we can help save.

Brain Aneurysm: Definition

Let’s be honest, how many people are familiar with brain aneurysm? Even with a background in healthcare, I did not know what brain aneurysms were all about except for the definition. Often, we find ourselves becoming quite familiar with a condition once we experience it either directly or indirectly.

According to WebMD, https://www.webmd.com/brain/brain-aneurysm#1 , brain aneurysm is defined as below:

Think of a weak spot in a balloon and how it feels stretched out and thin. A brain aneurysm is like that. It’s a weak spot in the wall of a blood vessel inside the brain.

That area of the blood vessel gets worn out from constant flow of blood and bulges out, almost like a bubble. It can grow to the size of a small berry.

Although brain aneurysms sound alarming, most don’t cause symptoms or health problems. You can enjoy a long life without ever realizing that you have a brain aneurysm.

But in rare cases, aneurysms can grow big, leak, or explode. Bleeding in the brain, known as hemorrhagic stroke, is very serious and requires urgent medical care.

A ruptured brain aneurysm can be life-threatening and lead to:


How did it happen? My brain aneurysm story: Overview

It’s in the raw hours of Saturday morning on July 29th, 2017, 1:00AM to be exact. Nothing much seems to be going on in this posh neighborhood of Kampala, except for the security guards struggling to stay awake.  On the street of Naguru Vale, however, in one house, something is happening that will change the lives of this young aspiring family forever. “Somebody help, help me please, call the ambulance” A male voice is heard by the security guard on duty that night. Through the confusion, the security guard doesn’t know what do but listen keenly again for the voice. Meanwhile, the situation in this house is worsening. It’s a matter of life and death and time is of essence. “Post one, post one, can you read me? My wife is unresponsive, I need somebody to help me right now” My husband managed to get hold of the walkie talkie and placed a call that he hoped would end the nightmare.

The Journey Begins: Waking up from the Nightmare.

Thanks for joining me!

Psalm 118:17 King James Version (KJV)

17: I shall not die, but live, and declare the works of the Lord.

Things are always better in the morning!

Have you ever had a really really bad nightmare only to wake up and find out that nothing really happened and it was just a very bad dream? Well, I have had those nightmares too only that one day I woke up to find out that I was living my worst nightmare!

The world around me seemed to be moving faster than I could comprehend. There were people talking, paging, mentioning the ICU room 3, elevator doors opening and closing, and the stretcher moving faster that there was no time to ask a question. Everyone around me seemed to know exactly what they were doing, everything seemed to evolve around me. Then before I could open my eyes, I froze in time.

Suddenly, the silence occupied the air and everything came to a complete stop. I found myself in a hypnopompic state listening to this song:
I’m only human, I’m just a woman.
Help me believe in what I could be
And all that I am.
Show me the stairway, I have to climb.
Lord for my sake, teach me to take
One day at a time.

One day at a time sweet Jesus
That’s all I’m asking from you.
Just give me the strength
To do everyday what I have to do.
Yesterday’s gone sweet Jesus
And tomorrow may never be mine.
Lord help me today, show me the way
One day at a time.

Do you remember, when you walked among men?
Well Jesus you know if you’re looking below
It’s worse now, than then.
Cheating and stealing, violence and crime
So for my sake, teach me to take
One day at a time.

One day at a time sweet Jesus
That’s all I’m asking from you.
Just give me the strength
To do everyday what I have to do.
Yesterday’s gone sweet Jesus
And tomorrow may never be mine.
Lord help me today, show me the way
One day at a time.

The lyrics to the song: One day at a Time  https://www.youtube.com/watch?v=JhUvFqOY00I, were sounding so clear to me being sung in a very soothing female voice. When I opened my eyes, there was a lady standing by my bedside. She asked:
Lady: ‘Mè, what kind of tea would you like to drink?
Me: What kind do you have?
Lady: Bush tea and black tea. You should drink the bush tea, it will help you heal sooner.
Me: What is Bush tea and who are you and where am I? Are you the one who has been singing to me?
Lady: (smiling) I will give you the Bush tea, the English call it Rooibos tea. We have been praying for you and waiting for you to wake up. Your husband just stepped outside but he should be back shortly. He came with the children, however, they would not let them in your room. Shame! It is okay take it easy. Here is your tea and some rusks.

She left the room without giving me another chance to ask more questions or give me time to comprehend what was going on. Furthermore, I was experiencing a really bad headache that I could barely get the strength to reach out for my special tea. Just then, the nurse came back. She asked me how I was doing and if I needed any medicine for the headache. It was as though she was quite familiar with the pain that I was having. I told her it was about a 9 out of 10 and she gave me some medicine that went under my tongue. The medicine acted instantly and I was able to drink my tea. The nurse told me she would be around if I needed anything. Apparently, she was my private nurse since I needed much attention.

I think I must have fallen back asleep because when I woke up, my husband was sitting next to me on a chair holding my hand with tears rolling down his eyes. I could not comprehend the world around me. Before I could gather my thoughts and ask him why he was crying, a lady came in my room. She told me that she was the physiotherapist and was going to give me a breathing treatment. She also told me that she was glad to see me awake and alert with a lot of improvement. She asked me if I was still coughing and how bad my headache was. Before I could gather my thoughts and say something, the mask was already on my face and the breathing treatment had been started.

A lot of questions were going through my mind and I wished for someone to tell me where I was, where my children were and what was going on with me. I started staring at the pictures on the wall while the breathing treatment was going on. Then, I started to realize that perhaps I was in the hospital but was not quite sure where. The words in the pictures on the wall were written in English and Afrikaans. How could this have happened so fast? The last thing I remembered was getting my kids ready for bed as usual in our residency in Uganda. It was on Friday, my husband usually came home early from work. Our house help had requested to have off on that day and was to come to work the following day, Saturday, instead. My husband went to bed early because he was feeling a bit tired. My oldest child wasn’t feeling well and he needed a lot of attention from me. He must have caught a cold or flu from his new school. My little one, who was only 5 months, was fine but needed mommy the most. That evening was a bit busy but nothing out of the ordinary that I couldn’t manage. We did our evening routing as usually and after the kids fell asleep, I went back to the family room to have a quiet moment where I could talk to God, something that I do often. After my prayer, I went to bed.

As I was still doing my flashback, the physiotherapist told me that my treatment was done and she will come back in 4hours time to give me another one. My husband was still sitting on the chair by my bed. I noticed a great sense of relief on his face. I tried to talk but I don’t think he heard me or maybe I just did not say anything out loud. He held my hand again and told me that he loved me so much and he vows to take care of me no matter what happened. He also told me that my family was praying for me and my sister was in the process of acquiring her Visa to come and see me. It appeared as though he was reading my mind and he had started answering some of the questions I had in my head.

Finally, I opened my mouth and was able to speak. The first thing I told him was to give me something for the headache. He told me he would notify the nurse immediately. While we were waiting for the nurse, I managed to ask him a question that was bothering me the most: where were the children. He told me the children were in the hotel with a nanny that the staff from the CLO office at the embassy had recommended. He said that besides the flu, they were doing well. I wanted to know what they were feeding the baby since I had never introduced her to formula and she had refused to use the bottle. He said that she was taking formula from the bottle and she was also eating baby cereal. Then I wanted to know how my son was doing. He said that he was fairing on well and was taking medication that the doctor had ordered for him from the health unit at the embassy. He said that he would not eat any food but was drinking pediasure that I had instructed him to buy the day we left Kampala for South Africa. When I heard the mention of South Africa, I asked him if that is where we were and what had happened to me exactly. So, that led him to start narrating to me what had happened exactly. Before he could start, however, the nurse interrupted when she brought me the pain medicine. At the same time, a man came in with a stethoscope around his neck and introduced himself as one of the neurosurgeons who had done my procedure. He had come to check on me and see how I was progressing. He was concerned about the severe cough I had developed following the coiling procedure but was glad to hear the positive report from the physiotherapist. He listened to my lungs and said that I was fine but will continue with the breathing treatments and he would come back the following day to check on me.

Again, I found myself very confused with all the bits and pieces of information that I was gathering from various people. I was ready for everyone to leave so I could have time with my husband to know exactly what had happened to me. Unfortunately, as soon as the doctor left the room, the nurse told my husband that he had to leave too since the visiting hours were done and he had overstayed. I begged with her to let him stay a little bit longer but she insisted he had to leave and that I needed to rest. My husband kissed me goodnight and told me that he would see me the following day. Everything was dim in my room and I had no idea what time, day, date or place I was. The nurse stayed in my room with me the entire night.

As I was laying there in my bed trying to put all the pieces together and try to understand what was going on with me, the nurse approached me with a message. She said that my brother from the US had called to check on my progress and he had extended his well wishes. She also said that he wanted to talk to me but the doctor wanted me to rest and limit a lot of brain stimulation for that day following the procedure. There was a lot of new information that I was receiving but nobody had told me even a third of the information that I needed to know. I managed to ask the nurse to give me some information on where I was exactly and why. She told me that I was at Unitus hospital in Centurion, South Africa in the ICU unit and I had suffered a brain aneurysm approximately 5 days ago while in Uganda. I wanted to know more but she advised me to get some rest and the following day my husband, the doctor, and nurses would give me full details. With a bit sense of relief, I was able to relax knowing at least some of the key details that I was dying to know.

That was probably one of the longest nights I can remember. I was resting but not sleeping. My mind was wandering all over the place with so many questions to ask but no one to talk to at the time. I wished and hoped for that moment to be a nightmare and I will wake up the following day to my normal life. I truly missed my kids and I just wanted to hug them and spend time with them, I wanted to cook for them, I wanted to play with them. Even though I had a lot to be worried about, I knew that I had something great to be thankful for. That was the gift of life.

On the next segment which I will post next week, you will find out exactly how the aneurysm happened. Here are some statistics and facts of brain aneurysm according to the brain aneurysm foundation https://www.bafound.org/about-brain-aneurysms/brain-aneurysm-basics/brain-aneurysm-statistics-and-facts/

Brain Aneurysm Statistics and Facts
• An estimated 6 million people in the United States have an unruptured brain aneurysm, or 1 in 50 people.
• The annual rate of rupture is approximately 8 – 10 per 100,000 people or about 30,000 people in the United States suffer a brain aneurysm rupture. There is a brain aneurysm rupturing every 18 minutes. Ruptured brain aneurysms are fatal in about 40% of cases. Of those who survive, about 66% suffer some permanent neurological deficit.
• Approximately 15% of patients with aneurysmal subarachnoid hemorrhage (SAH) die before reaching the hospital. Most of the deaths from subarachnoid hemorrhage are due to rapid and massive brain injury from the initial bleeding which is not correctable by medical and surgical interventions.
• 4 out of 7 people who recover from a ruptured brain aneurysm will have disabilities.
• Brain aneurysms are most prevalent in people ages 35 – 60, but can occur in children as well. The median age when aneurysmal hemorrhagic stroke occurs is 50 years old and there are typically no warning signs. Most aneurysms develop after the age of 40.
• Most aneurysms are small, about 1/8 inch to nearly one inch, and an estimated 50 to 80 percent of all aneurysms do not rupture during the course of a person’s lifetime. Aneurysms larger than one inch are referred to as “giant” aneurysms and can pose a particularly high risk and can be difficult to treat.
• Women, more than men, suffer from brain aneurysms at a ratio of 3:2.
• African-Americans at twice the rate of rupture of whites (a 2.1:1 ratio)
• Hispanics at nearly twice the rate of rupture of whites (a 1.67:1 ratio)
• Ruptured brain aneurysms account for 3 – 5% of all new strokes.
• Subarachnoid hemorrhage (SAH) is one of the most feared causes of acute headache upon presentation to the emergency department. Headache accounts for 1 – 2% of the emergency room visits and up to 4% of visits to the primary care offices. Among all the patients who present to the emergency room with headaches, approximately 1% has subarachnoid hemorrhage. One study put the figure at 4%.
• Accurate early diagnosis is critical, as the initial hemorrhage may be fatal, may result in devastating neurologic outcomes, or may produce minor symptoms. Despite widespread neuroimaging availability, misdiagnosis or delays in diagnosis occurs in up to 25% of patients with subarachnoid hemorrhage (SAH) when initially presenting for medical treatment. Failure to do a scan results in 73% of these misdiagnoses. This makes SAH a low-frequency, high-risk disease.
• There are almost 500,000 deaths worldwide each year caused by brain aneurysms and half the victims are younger than 50.
• Based on a 2004 study, the combined lost wages of survivors of brain aneurysm rupture and their caretaker for a year were $138,000,000
• The cost of a brain aneurysm treated by clipping via open brain surgery more than doubles in cost after the aneurysm has ruptured. The cost of a brain aneurysm treated by coiling, which is less invasive and is done through a catheter, increases by about 70% after the aneurysm has ruptured.
• 10 – 15% of patients diagnosed with a brain aneurysm will harbor more than one aneurysm.
• The federal government only spends approximately $0.83 per year on brain aneurysm research for each person afflicted.