The Aneurysmal Time Bomb


Feature Story

Most aneurysms, be it in the cerebral circulation, thoracic or abdominal aorta, remain symptomless; and the first signs or symptoms of a previously undetected aneurysm could be complications upon rupture

By Henrylito D. Tacio


Filipinos were shocked when Isabel Granada, who catapulted to fame as a child and teen star in the 1980s, died at Hamad General Hospital in Doha, Qatar due to a ruptured cerebral aneurysm. After all, she was only 41 years old and was physically fit.

According to some reports, Granada fell into coma after experiencing six cardiac arrests while on a business trip with her husband. She reportedly suffered from a nassive intraceberal hemorrhage due to the ruptured aneurysm.

Granada suffered from a nassive intraceberal hemorrhage due to ruptured aneurysm (Photo from www.expatmedia.net)

A day after her reported death, there was a sudden surge of people, mostly women, going to the doctor when they felt headache. One doctor posted jokingly in his social media account that they need not worry since they were not actors.

Actors with aneurysms

It may be said in a jest but there’s some truth to it. After all, the phenomenal martial artist Bruce Lee reportedly died of it, too. Hollywood actor John Ritter, known for the television sitcom, “Three’s A Company,” also died of ruptured cerebral aneurysm.

Guy Williams, an actor best known for playing Zorro on the popular Disney series in the 1950s, was in good health when he died of aneurysm in 1989. Shelby Grant, who appeared in such TV hit series, “Bonanza” and “Batman,” also succumbed to the fatal disease.

In 1974, singer Quincy Jones suffered a burst brain aneurysm and survived. Another famous singer, Neil Young had aneurysm in 2005 that was repaired, but started hemorrhaging a few days later.

If you have never heard of Sharon Stone (yes, that sensational star of “Basic Instinct”), it’s because she also suffered from ruptured cerebral aneurysm in 2001. “I bled in my brain for nine days,” she told Hollywood Reporter. “I spent two years learning to walk and talk again. I came home from that stroke stuttering, couldn’t read for two years. I was in an intensive care unit for nine days and the survival rate for what I went through is very low.”

Experts have likened aneurysms to time bombs for good reason: You can be without symptoms until the defective blood vessel bursts. “Most aneurysms do not show symptoms and are not dangerous. However, at their most severe stage, some can rupture, leading to life-threatening internal bleeding,” wrote Markus MacGill in a feature published by Medical News Today.

Types of aneurysm

Aneurysms are classified by their location in the body. The arteries of the brain and heart are the two most common sites of a serious aneurysms. Of the 30,000 brain aneurysms rupture that occur in the United States each year, an estimated 40 percent result in death within 24 hours. Over 25,000 Americans also die of aortic aneurysm each year, according to the Centers for Disease Control and Prevention (CDC).

Aneurysms are not limited to the cerebral vessels and aorta. They can also develop in the arteries at the back of the knee (popliteal arteries), the main arteries of the thighs (femoral arteries), and the arteries supplying the heart muscle (coronary arteries).

“In older people, aneurysms are most likely to occur in areas where arteries branch (for example, where the abdominal aorta branch out to the femoral arteries) or the areas of stress (for example, in the popliteal artery),” says the Merck manual.

The bulge created by aneurysms can take two main shapes: fusiform (bulge all sides of a blood vessel) or saccular (bulge only on one side). “The risk of rupture depends on the size of the bulge,” MacGill wrote.

Risk factors, causes

It is not known why aneurysms occur in some people and not in others. “People with high blood pressure, high cholesterol and smokers are the most likely to suffer,” says Dr. Alfred Cheng, head of the cardiac clinic at the Mount Elizabeth Medical Center in Singapore. “Those with close relatives who have had aneurysms and diabetics are also at risk.”

Men are eight times more likely to have an aneurysm than women. In older people, almost all aneurysms are associated with arteriosclerosis. “Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff – sometimes restricting blood flow to your organs and tissues,” says the Mayo Clinic.

Aside from arteriosclerosis, other causes of aneurysms include injuries, inflammatory diseases of aorta, hereditary connective-tissue disorders, and some infectious diseases such as syphilis.

Aside from aorta, aneurysms may also occur in other arteries: at the back of the knees (popliteal arteries), in the thighs (femoral arteries), around the heart (coronary arteries) and rarely in the neck (carotid arteries).

“Many of these aneurysms result from a weakness present at birth (congenital) or arteriosclerosis. Others results from injuries caused by stab or gunshot wounds or from bacterial or fungal infections in the wall of the artery. “Such infections usually start elsewhere in the body, typically in a heart valve,” the Merck manual points out.

Signs and symptoms

As stated earlier, most people with aneurysm don’t know they have it. Symptoms do not usually occur unless an aneurysm ruptures. “However, an unruptured aneurysm may still obstruct circulation to other tissues,” MacGill wrote. “They can also form blood clots that may go on to obstruct smaller blood vessels. This condition can lead to ischemic stroke or other serious complications.”

Although generally symptomless, their complications can cause severe pain, depending on where the aneurysm is located. MacGill wrote: “Rapidly growing abdominal aneurysms are sometimes associated with symptoms. Some people with abdominal aneurysms report abdominal pain, lower back pain, or a pulsating sensation in the abdomen.”

In similar manner, thoracic aneurysms can affect nearby nerves and other blood vessels, potentially causing swallowing and breathing difficulties, and pain in the jaw, chest, and upper back.

Health experts also said that symptoms can also relate to the cause of an aneurysm rather than the aneurysm itself. For example, in the case of an aneurysm caused by vasculitis, or blood vessel inflammation, a person may experience fever, malaise, or weight loss.

“The first signs of a previously undetected aneurysm could be complications upon rupture,” MacGill noted. “Symptoms tend to result from a rupture rather than the aneurysm alone.”

Triggers for rupture

In an article posted in the website of ABC News, Courtney Hutchison reported eight everyday ways that could trigger the aneurysm to explode. Dr. Khaled Aziz, director of the Center for Complex Intracranial Surgery at Allegheny General Hospital in Pennsylvania, was quoted as saying that “a sudden increase in blood pressure puts strain on the wall of an aneurysm, increasing the chances that it will break.”

Among those that may cause the bulge to erupt are as follows: drinking coffee, vigorous exercise, drinking soft drinks, sex and masturbation, a shock or startle, getting worked up, blowing one’s nose, and straining on the toilet.

On sexual activity as a triggering factor for rupture of an aneurysm, Hutchinson wrote: “Doctors treating aneurysms note that patients often report a splitting headache – the most common sign of a rupture – right after sex or while straining to make a bowel movement.” He qioted Dr. Claran Powers, assistant professor of medicine at Ohio State University.”

Some studies have found that “sexual intercourse increased risk of rupture by 11.2 times, while masturbation increased it by 5.9 times.” Hutchinson, quoting Dr. Aziz, wrote a disclaimer: “This doesn’t mean that those with aneurysms should declare celibacy. It might be better to manage high blood pressure in other ways.”

A sudden, severe headache is the key symptom of a ruptured aneurysm, according to the Mayo Clinic. This headache is often described as the “worst headache” ever experienced.

The Mayo Clinic says the common signs and symptoms of a ruptured aneurysm include: sudden, extremely severe headache; nausea and vomiting; stiff neck; blurred or double vision; sensitivity to light; seizure; a drooping eyelid; loss of consciousness; and confusion.

Diagnosis

The Pacific Vascular Research Foundation says aortic aneurysms can be diagnosed prior to rupture. Regular physical examinations can be helpful. One reason a doctor examines a patient’s abdomen during a routine exam is to feel for an abnormally pulsating aorta in the mid-abdominal region.

Other tests include ultrasound examination and various radiological imaging studies including computerized tomography (CT), magnetic resonance imaging (MRI), and aortography (an x-ray procedure performer after injection of a dye that outlines theaneurysm).

Doctors may diagnose a thoracic aortic aneurysms based on symptoms, or they may discover the aneurysm by chance during a routine physical examination. Cerebral aneurysms can be detected by imaging tests such as MRI, CT scans, and angiograms (X-rays are used to produce pictures of the inside of blood vessels).

Aneurysms that are less than two inches in width rarely rupture. In the case of abdominal aortic aneurysm, “the only treatment required may be antihypertensive drugs to lower blood pressure,” the Merck manual states. “Aneurysms that are wider rupture fairly common, so doctors usually recommend surgery, unless surgery is too risky for a particular patient.” The risk of death during an operation for a ruptured aneurysm is about 50 percent.

Because cerebral aneurysms are near the brain and are usually small, their diagnosis and treatment differ from those of other aneurysms. “Once detected, most brain aneurysms can be repaired with microsurgery,” says the Boston-based Brain Aneurysm Foundation, Inc. in the United States. “This type of surgery is performed with the aid of an operating microscope and tiny instruments. During surgery, the aneurysm is identified and removed. After the aneurysm is removed, the wound is closed.”

“A sudden, severe headache is the key symptom of a ruptured (cerebral) aneurysm, and the headache is often described as the ‘worst headache’ one ever experienced”

Nov 2018 Health and Lifestyle

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