Hi pgammo,
I have both an aneurysm and a dissection. I have saved a lot of information on these over the years, and have copied it below.
These are known as the silent killers unless they are monitored and corrective action taken. So please do not ignore, and educate yourself on this condition, and validate if you do have this condition with your doctors. Seek 2nd opinions, and ask questions.
Apoligies for the length, but there is a lot of information here.
FREQUENTLY ASKED QUESTIONS
What is an ANEURYSM?
An aneurysm is a balloon-like swelling which develops in the wall of a weakened blood vessel.
AORTIC ANEURYSMS
What is an AORTIC ANEURYSM?
The aorta is the largest artery in the body. It starts at the heart and passes through the chest to the abdomen.
Aortic aneurysms can develop anywhere along the aorta. Once an aneurysm has started to develop, it slowly grows in diameter over a period of several years.
As an aneurysm grows larger, the wall of the artery thins. When the strength of the aneurysm wall becomes too weak the wall can break, resulting in a ruptured aneurysm.
Blood loss from a ruptured aneurysm is usually large and rapid. In most cases, aortic aneurysms cause no symptoms until they rupture; at which point they cause sudden, severe abdominal and/or back pain, sometimes loss of consciousness, and shock due to severe blood loss.
Despite best efforts, most patients die soon after aneurysm rupture.
What causes AORTIC ANEURYSMS?
The exact cause of aortic aneurysms has been difficult to identify with certainty. Although it is thought that family history (Of all patients with aortic aneurysms, approximately 20% are eventually found to have a family member that was, or is, also affected.), smoking, hypertension, and high blood cholesterol are probably the most important risk factors, it is not yet clear how these factors interact to cause the development of aneurysms.
Once an aortic aneurysm is known to be present, the best guides to its risk of rupture are size, progressive growth, or any symptoms that might suggest the aneurysm is dangerously close to rupturing.
Who is most at risk?
Although aneurysms cut across race and gender, they are ranked in the top ten causes of death for white males over 55.
How are AORTIC ANEURYSMS detected?
Patients sometimes detect an aneurysm by feeling a pulsating mass in the abdomen, or it may be found by their physician during a routine physical examination. The best way to detect unsuspected aortic aneurysms is by an ultrasound or CAT scan of the abdomen. Ultrasound is quick, inexpensive, non-invasive, and accurate; if the aorta can be seen, the presence of an aneurysm can be identified or excluded. CAT scans of the abdomen remain the most accurate tests for aortic aneurysm, both for initial detection and for determining aneurysm size. They provide information equal to MRI scans.
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How are AORTIC ANEURYSMS treated?
Once an aneurysm is detected, a decision must be made as to the best treatment for each individual patient. This decision is primarily based on the size (diameter) of the aneurysm as a reflection of its risk for rupture.
On average, most aneurysms increase in size by 0.5 cm diameter each year. For patients with small aneurysms, observation and careful follow-up is recommended.
It is equally important to stop smoking and maintain good blood pressure control. For patients at risk of rupture, aortic aneurysm operations involve replacement of the aneurysmal part of the aorta with an artificial graft.
The most commonly used grafts are made of Dacron or Teflon. This operation is done under general anesthesia.
There is also a minimally invasive catheter-based procedure (stent-graft system) e.g., AneuRx® (Medtronic), ANCURE® (Guidant).
What are the results of treatment for ABDOMINAL AORTIC ANEURYSMS?
While the chances of surviving a ruptured aneurysm are poor, elective aneurysm surgery survival rates are quite good when the surgery occurs in centers where the operation is performed routinely.
If aneurysms are so deadly, why hasn't more been done on aneurysm research?
The study of aneurysms was not funded for many years because scientists thought they were just a late, degenerative stage of hardening of the arteries. That concept is changing.
Work from diligent researchers has persuaded more and more scientists that aneurysms are an inherited disorder.
Section B
BRAIN ANEURYSMS
INTRACEREBRAL ANEURYSMS
Frequently asked questions/answers prepared by: Gary L. Bernardini, M.D., Ph.D. Department of Neurology and Neuroscience
The New York Hospital/Cornell University Medical Center 1300 York Avenue NY, NY 10021
What is an intracerebral aneurysm?
An intracerebral aneurysm is a small, thin walled outpouching or dilatation of one of the large blood vessels that supply the brain.
Aneurysms pose a risk to health from the potential for rupture and subsequent bleeding into the substance of the brain and/or the fluid-filled spaces that surround the brain (the subarachnoid space).
These so-called saccular or berry aneurysms occur at the bifurcation of the large blood vessels at the base of the brain.
What causes aneurysms?
Intracerebral aneurysms can result from trauma, infection, or neoplastic disease.
Most aneurysms, however, result from a developmental abnormality of the inside lining or intima of an artery with abnormal thinning of the vessel at the site of origin.
It appears there may be a genetic predisposition to the development of intracerebral aneurysms; the existence in some families runs as high as 10%, approximately 10 times higher than that found in the general population.
There are several other causes of intracerebral aneurysms. For example, they can result from infected embolic material from a bacterial infection on one of the heart valves being deposited on one of the arteries in the brain (mycotic aneurysm).
Who is at greatest risk for aneurysmal rupture?
Aneurysmal rupture leads to subarachnoid hemorrhage (SAH) and occurs most often in patients between 40 and 60 years of age with approximately equal sex distribution.
Cigarette smoking and excess alcohol use have been shown to increase the risk of rupture.
Likewise, the existence of intracerebral aneurysms is associated with other diseases such as polycystic kidney disease, coarctation of the aorta, and fibromuscular hyperplasia.
Other factors such as high blood pressure seem to be less important since aneurysms often occur in persons with normal blood pressure.
Pregnancy has not been associated with an increased incidence of aneurysmal rupture.
What are the symptoms of intracerebral aneurysmal rupture?
Prior to rupture, saccular aneurysms are usually asymptomatic. However, an expanding aneurysm can have a "mass" effect causing problems with double vision, loss of vision, numbness in the face, an enlarged pupil size, or a drooping eyelid.
Usually patients who have an aneurysm rupture experience sudden onset of a severe headache, often described as "the worst headache of my life", frequently accompanied by transient loss of consciousness and sometimes vomiting.
A stiff neck often follows. Rupture of an aneurysm usually occurs while the person is active rather than during sleep.
Occasionally, patients experience a warning or "sentinel" headache that is attributed to a smaller leakage of blood usually preceding a major bleed by several hours to days later.
These milder headaches are often associated with nausea and vomiting and are often mistaken for migraine headaches.
What kind of tests do I need to determine if I have an aneurysm?
Carotid and vertebral angiography is the only definitive means of demonstrating an intracerebral aneurysm, while a CT scan of the head will confirm the presence of blood within the brain or subarachnoid space if an aneurysm has ruptured.
Lumbar puncture is sometimes used to evaluate for the presence of blood in the cerebrospinal fluid if the results of the CT scan are equivocal.
More recently, non-invasive studies using magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) have shown promise in detection of aneurysms.
However, the intracerebral angiogram remains the test of choice.
I have an intracerebral aneurysm. What is the risk of death from rupture?
If rupture occurs, only approximately half of the patients survive. The best predictor of risk of rupture is the size of the aneurysm.
Most aneurysms that rupture have a diameter equal to or greater than 10mm (about half an inch) but rupture also occurs with aneurysms of smaller size.
A guide to prognosis is provided by the neurologic grade (Hunt and Hess Grades I-V) of the patient determined by his/her level of consciousness and neurologic deficits when first examined upon arrival to the hospital.
In a large study of survival of patients from aneurysm rupture, a Grade of I-II (awake with slight to moderately severe headache and neck stiffness) predicted a low mortality (4%) and an independent life (up to 90%) at follow-up whereas Grades IV-V (stupor with neurological deficits to deep coma) predicted increasingly higher mortality rates (up to 46%) and decreased independent functioning (only about 30%).
What are the most serious complications associated with aneurysmal rupture?
The development of cerebral vasospasm, rebleeding from the aneurysm, swelling of the ventricles in the brain (hydrocephalus), and seizures may occur after rupture of an intracerebral aneurysm.
Cerebral vasospasm after aneurysmal subarachnoid hemorrhage usually occurs within the first 14 days of rupture and is a major cause of morbidity and mortality in survivors of the bleed.
Its incidence has varied in different studies between approximately 20 to 80% of all patients with SAH and its occurrence is related to the amount of subarachnoid blood in the brain.
Other complications including rebleeding from an aneurysm and hydrocephalus also contribute to the overall morbidity and mortality.
In addition, dangerous cardiac arrhythmias may develop in the acute period following a bleed.
What are the risks of surgical repair?
The timing of surgery is now recognized as an important factor in the prevention of complications associated with aneurysmal rupture.
Successful early surgical clipping of a ruptured aneurysm (within the first 5 days of a bleed) helps to prevent the occurrence of rebleeding, likely to be an even more catastrophic event when it occurs, and permits the safe treatment of cerebral ischemia due to vasospasm.
High morbidity and mortality may occur even in low-risk patients (leading to risk of death or disability).
Surgery is usually recommended for large accessible aneurysms; but with small ones (with a proportionally lower chance of rupture) you should discuss the ratio of risk to benefit with your physicians.
How can I get more information on this subject?
Your neurologist or neurosurgeon should be your primary resource. A FAQ like this one is very general in nature, and details about your own situation may result in the possibility that the general guidelines do no apply.
For additional reading, large bookstores carry rather comprehensive reference works (like the one from the Mayo clinic).
If you have access to MedLine, you can download abstracts from the primary medical literature
