Recently, I shared with you the journey of my 3-year angiogram for my brain aneurysm, a story I’ve been intent on telling as openly and often as possible in order to bring awareness to the disease. Thanks to Dr. Aman B. Patel, I am still well and healthy. But my goal is for anyone who may be experiencing these symptoms to be able to say the same. So I arranged an interview with Dr. Patel, a surgeon and friend whom I appreciate beyond words, in order to answer some basic questions on detection and prevention. My hope is that everyone who reads this will share it with someone so we can finally bring attention to this cause. The most important thing is to listen to your body when it is trying to tell you something. It may just save your life.
Loren Ridinger Interviews Top Neurological Surgeon Dr. Aman B. Patel
As Director of Cerebrovascular and Endovascular Neurosurgery and Co-Director of the Neuroendovascular Program, Aman B. Patel, MD is a neurosurgeon at Massachusetts General Hospital specializing in the treatment of vascular disorders of the brain and spine, including cerebral aneurysms, vascular malformations and stroke. Read ahead for more information on what causes brain aneurysms and how to best treat them.
LW: What causes aneurysms? Is there any genetic predisposition?
AP: Aneurysms are caused by a weakness in the muscular layer of arteries in the brain. At the site of weakness the vessel bulges out and forms an aneurysm. Most aneurysms occur sporadically and are not hereditary – however, there is a genetic predisposition in some families.
I usually recommend screening for patients with two family members with known aneurysms. In addition, there are some genetic conditions such as polycystic kidney disease which have a higher incidence of aneurysms.
LW: What are some of the common symptoms?
AP: Most aneurysms that have not bled or leaked some blood do not have any symptoms. The absolute size of these aneurysms is actually very small so that they tend not to create pressure of headache like symptoms.
If they are larger they can cause headaches, double vision, drooping of the eyelid, facial numbness. If an aneurysm bleeds the typical symptom is the worst headache of life. This is often associated with nausea and vomiting and can be associated with neck stiff, confusion, lethargy, double vision and coma.
LW: What other ailments are aneurysms sometimes mistaken for (misdiagnosed as)?
AP: Other diseases that present with similar symptoms – such as migraines, meningitis, primary eye issues.
LW: What advice would you give to someone experiencing these symptoms?
AP: I would say that they should seek medical evaluation. New onsets of severe disabling headaches, especially ones associated with nausea and vomiting, should be worked up emergently to rule out a hemorrhage.
New onset headaches and other neurological symptoms should be worked up to rule out an aneurysm or other causes. It is important to let the health care provider know that these are not typical symptoms so that they are not mistaken for migraines or other ³routine² causes.
LW: Can you tell us more about Loren’s angiogram?
AP: Loren had a cerebral angiogram today. A cerebral angiogram is a procedure that studies the blood vessels in the brain. This procedure was done to evaluate the prior closure of an aneurysm to make sure that there was not any recurrent filling of the treated aneurysm or the development of a new aneurysm.
LW: How can having an aneurysm change a person’s life?
AP: Having an aneurysm that ruptures can dramatically change a person’s life because a hemorrhage from an aneurysm has a high chance of causing neurological changes or death. The specifics of how aneurysm rupture changes one’s life depends a lot on the initial effects of the hemorrhage and subsequent recovery. In patients with aneurysms that are treated before rupture – the aneurysm can have very little effect on subsequent quality of life.
If the aneurysm is treated before rupture the future risk of bleeding from the aneurysm can be eliminated. It should be stated, that many patients have very small aneurysms that do not require immediate treatment. Small aneurysms carry very tiny risk of rupture and these are followed intermittently with scans to make sure there is no growth. In this interval the patients can have normal life, except they should stop smoking since this is the only modifiable risk factor.
LW: What advice would you give to a patient who is recovering from an aneurysm in terms of helping them find a balance between resting and exercising?
AP: I tell them to trust their bodies. If they are tired it means they need rest. Also it is important to slowly increase activity level in the recovery period to get back to normal, rather than have a strenuous day followed by a whole day of rest. It is better to gradually increase activity level to normal.
LW: Should symptom-free individuals still get checked as a precaution if aneurysms have been present in their families?
AP: Yes, I recommend that patients with 2 family members with aneurysm definitely get screened with
a MRI or CT angiogram. If they have one family member it is worth discussing the pros and cons with their doctor. I often will screen patients with one family member, especially if that family member had a hemorrhage from the aneurysm at a younger age.
LW: Are there any precautions one can take (such as with diet and/or exercise) to help reduce the risk of developing an aneurysm?
AP: The only modifiable risk factor is cigarette smoking. But excessive alcohol intake, illicit drug use, and uncontrolled hypertension has been associated with aneurysm formation, growth and rupture.
LW: How can we help raise awareness for aneurysms?
AP: Essentially by what you are doing. I think the disease does not get that much awareness. If there are ways to get more awareness on the national level and lay media it would be important.
To watch the full video series of my journey from the beginning through the surgery and beyond to recovery, click here.
