Trillium In The News

The Mississauga News

A Killer Headache

August 15, 2003

It’s been nicknamed the worst headache of your life and it can strike without notice.

Whether you’re out walking the dog, cruising on the highway or enjoying a summer outing with the family, this headache can kill you before you make it home.

Statistically, as many as 30,000 residents in Mississauga could be prone to suffering it-and when it hits, it hits hard, causing permanent brain damage, disability or even death.

Chances are you won’t know it’s about to strike. If you’re lucky you’ll wake up in a hospital bed; if not, you might not wake up at all.

This scary condition is a brain aneurysm.

Neurological experts such as Dr. Dennis Izukawa, a neurosurgeon at Trillium Health Centre, have a simple way of describing this terrifying disease that affects up to five percent of Canadians. Sitting in second-floor office across from the hospital on Queensway West, Izukawa doesn’t mince words when talking about brain aneurysms.

“It’s like someone hitting you over the head with a baseball bat,” he said. “It’s instant and extremely painful. It will be the worst headache of your life.”

Those who have survived an aneurysm understand its impact and don’t want to feel it again. Those who have lost a loved one to a brain aneurysm recognize its ruthless consequences; many live the rest of their lives wondering what could have been done if only they had known about it, if only it could have been treated.

To know in advance is very rare, and treatment carries huge health risks, says Izukawa.

Last year in Mississauga, more than 71 brain aneurysm operations were conducted at Trillium Health Centre’s Neurosurgery unit. Only if aneurysms run in your family or you’re showing several symptoms will doctors perform an angiogram to see if they can detect it.

Aneurysms occur at weak point in the wall of a blood vessel that supplies the blood to the brain. Because of the flaw, the artery wall bulges outward and fills with blood.

It’s this bloody bulge that can rupture, spilling blood into surrounding body tissue that can cause hemorrhaging in the brain.

Izukawa says the “greatest danger” of an aneurysm comes if it ruptures. Among those who have an aneurysm, there is a one to two per cent chance it will rupture, medical studies show.

In many cases, an aneurysm remains undetected and the unexpected rupture can mean death. The larger the aneurysm, the greater the risk to the patient. “If and when it rupture, some patients don’t survive to the hospital,” says Izukawa.

According to his research and experience- 14 years in neurosurgery surgery seeing about 50 patients annually – about 33 per cent of those who suffer a ruptured aneurysm die, another third survive and do well, while the remaining third survive with neurological problems such as brain damage, mental disorders and greater susceptibility to stroke.

Other than the worst headache of your life, other symptoms that might mean you are having a rupture include nausea and vomiting, stiff neck or neck pain, blurred or double vision, pain above and behind eye, dilated pupils and sensitivity to light.

Brain aneurysms can occur in people of all ages, but are most common in people aged 35-60. They are usually diagnosed in the third or fourth decade of someone’s life, rarely in childhood and adolescence.

Women are actually more likely to suffer them than men are, by a ratio of 3:2. But studies indicate white men over the age of 55, especially smokers and those with a family history of aneurysms, are at greatest risk.

There is some confusion over what causes a brain aneurysm. What doctors know is that smoking increases your chances of having an aneurysm by four hundred percent, according to medical research. Other studies suggest some aneurysms are formed from a traumatic head injury.

While some research suggests some aneurysms have a genetic link, a pattern of inheritance has not yet been determined, according to the Genetic Health System in the United States.

Some studies seem to show that first-degree relatives of people who have suffered hemorrhaging from an aneurysm are more likely to have aneurysms themselves. These studies reported immediate family members were four times more likely to have aneurysms than the general population.

Izukawa says about five per cent of aneurysm patients have had a family history of the disease. Other factors linked to brain aneurysms include high blood pressure, use of oral contraceptives and other inherited disorders (Ehler’s Syndrome, Polycystic kidney disease, and Marfan’s Syndrome).

Preventive surgery is an option being discussed more frequently these days. Brain scans performed for other reasons are detecting more aneurysms.

While most brain aneurysms never rupture, death is likely in more than 30 per cent of cases. Some medical officials argue the chance of rupture is so small about two per cent, there is no need to expose the patient to the risks and dangers- including stroke, brain damage or death- of preventative surgery.

Therein lies the controversy, according to Dr. Dominic Rosso, a neuro-interventionist at Trillium. “You don’t like to be walking around knowing there’s a weakness in a blood vessel in your brain and it can pop out and kill you,” he said. “You want to think there’s something you can do.”

Researchers at the Mayo Clinic in Rochester, Minnesota, found that a small aneurysm- one less that three-eights of an inch wide- carries a .2 per cent chance of rupturing. In contrast, the risk of death or brain damage from surgery to repair such an aneurysm is about 10 per cent. However, if the aneurysm is larger or is a patient has already had an aneurysm that ruptured, the risk increases substantially, making surgery possibly worth the risk, the researches concluded.

“Historically, there has been little if any consensus on the issue of which aneurysms need to be treated and which could be left alone and monitored,” said Dr. David Wiebers, chair of the Division of Cerebrovascular Disease at the Mayo Clinic.

An aneurysm can be treated either by endovascular coiling or neurosurgical clipping.

Clipping requires a section of the skull cap to be removed so that the surgeon can access the aneurysm and place a tiny metal clip across the neck. This is done to stop blood flow into the aneurysm, and to prevent re-bleeding and further damage.

In contrast to surgery, coiling uses less-invasive endovascular techniques in which physicians rely on x-rays to visualize the patient’s vascular system and treat the disease from inside the blood vessel.

Endovascular treatment involves insertion of a catheter into the femoral artery in the patient’s leg and navigating through the vascular system into the head and into the aneurysm. Tiny platinum coils are threaded through the catheter and deployed into the aneurysm, obstructing blood flow.

“Coiling is safer,” says Izukawa.

A recent study by the International Subarachnoid Aneurysm Trial suggests Izukawa is right. The risk of death or significant disability after one year of endovascular treatment with coils was 22.6 percent lower than for those treated neurosurgically with clipping.

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