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Ask the Doctor: Chris Baker, M.D.

Q. What is a brain aneurysm and what are the treatment options?

A. A brain aneurysm is a weakness in the wall of an artery supplying the brain which causes a thin bubble-like pouch to form. If an aneurysm ruptures, sudden leakage or bleeding results, and is a life-threatening condition if not treated in time. It occasionally occurs from injury or infection and can be an inherited tendency, but most often it is a random occurrence. Everyone is at risk for a brain aneurysm, but the incidence increases steadily for individuals age 25 and older, and people ages 50 to 60 are at higher risk. Women are affected three times more than men. Approximately one of a hundred individuals have a brain aneurysm.

The symptoms of a ruptured aneurysm include a sudden and very severe headache, stiff neck, light sensitivity, nausea, vomiting or altered consciousness. Some patients describe it as the worst headache of their life. One of three people who rupture an aneurysm will die suddenly and another third will die or become severely disabled over the next six months. Discovering and treating aneurysms before they bleed is desirable. Unruptured aneurysms usually do not cause any symptoms but if they do, they can cause pain behind the eye, changes in vision and seizures. Diagnostic tests include Computerized Tomography (CT scan), Computed Tomographic Angiography (CTA) and Magnetic Resonance Angiography (MRA).

There are two common treatment options for aneurysms, surgical repair known as aneurysm clipping and endovascular repair known as aneurysm embolization. Surgical clipping involves opening a hole in the skull and applying a small, silver device, like a miniature clothesline clip, to the neck (the base of the bubble) of an aneurysm. This isolates the aneurysm from the bloodstream. Endovascular repair is a minimally invasive technique which uses live x-ray to visualize microcatheters and guidewires as they are navigated inside the arteries leading to the brain. This enables placement of extremely thin embolization coils into the aneurysm or the use of other devices to eliminate the flow of blood into the aneurysm.

Time is of the essence in the treatment of aneurysms but unfortunately, COVID-19 has made some patients fearful of going to the hospital when they need to the most. Hoag is committed to patient safety, and I urge all patients to seek medical care right away. The risk of death or severe neurologic injury from a leaking aneurysm is exponentially higher the longer you wait to seek care.

Christopher Baker, M.D., specializes in interventional and diagnostic radiology.