What is Cerebral Aneurysm?

Dr Cheang Chee Keong is a neurosurgeon who has special interest in treating cerebral aneurysm. Cerebral aneurysm, refers to a spot in a blood vessel in the brain which enlarges like a tiny balloon and is filled with blood. This tiny balloon can then rupture which causes blood to spill into the surrounding tissue.

Out of every 100 people you come across, one of them is bound to have an aneurysm. 40% of people whose aneurysm ruptures never make it to hospital. Those that do, describe it as a thunderclap headache, where the kind of pain they feel is like somebody hitting their head with a hammer.

Rupturing depends on the size of the aneurysm itself. If it is less than 5mm, it is less likely to rupture. However, if it is more than 7mm, it needs to be treated. An aneurysm is usually located along the main arteries in the brain.

Cerebral aneurysm is more common in females than males. People with high blood pressure, high cholesterol, smokes or drinks alcohol are increasing their risk of getting it by 3 times. On the other hand, for people with a family history of sudden death, their risk of getting it increases by 7 times.

Our brain’s blood vessels form a connection of vessels called Circle of Willis, which is a circulatory connection that supplies blood to the brain and the surroundings. Therefore, if a blood vessel is blocked, other blood vessels will take over the supply. It  is a complex connection.

When the aneurysm ruptures, the scale can range from grade 1, where the patient is still fully conscious to grade 5, where the patient falls into a coma.

The best method to diagnose cerebral aneurysm is through angiogram or computed tomography angiogram (CT angiogram). Through this, doctors can identify the aneurysm before proceeding with the surgery.

There are two kinds of treatment, mainly clipping, which involves major surgery and coiling, which involves securing the aneurysm. The difference is one involves surgery and other, radiology. Clipping is the better option for long term results while coiling has better results after one year. Giant aneurysms, however, are better off clipped instead of coiled.

Clipping is a surgery, where doctors will use a clip and clip off the aneurysm. Coiling, however, is using an X-ray to look for the aneurysm before filling the aneurysm with wire to stop the bleed. It uses a continuous X-ray and views the process on a TV monitor.

Unfortunately, there are no coiling procedures available in Ipoh. Thus, patients will either be sent to Kuala Lumpur or hospitals will get neurosurgeons / radiologist to come down to Ipoh. In good hands, both procedures can be done in two hours. Some may take up five to seven hours, depending on the condition of the patient.

To avoid this, people should start looking after their blood pressure as it is a precursor to a rupture and can occur to people of any age. The youngest patient Dr Cheang Chee Keong had was 10 years old.

Some of the symptoms of cerebral aneurysm include sudden bad headaches, stiff necks, seizure, nausea and vomiting as well as loss of consciousness. One needs to start seeing a doctor if they experience any of these, especially the headache as people tend to take headaches lightly.

For more information, call Dr Cheang Chee Keong of KPJ Ipoh Specialist Hospital at 05-240 8777 (Ext 131, 132).

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