A brain aneurysm is a condition in which a cerebral blood vessel expands and balloons out. If an aneurysm suddenly ruptures, it can cause immediate death. Approximately 20% of patients die before reaching the hospital, which is why it is called a "time bomb in the head." Because brain aneurysms usually show no signs before rupture, early detection is difficult, and once it bursts, the consequences can be fatal — making careful attention essential.
On Seoul Economic Daily TV's "Myeongui Now" (Top Doctors Now), airing Tuesday at 9 p.m., Professor Shin Hee-sup of the Department of Neurosurgery at Kyung Hee University Hospital at Gangdong, a leading expert on brain aneurysms, will discuss the causes, latest treatments and prevention of the condition.
◇ 'Brain Aneurysm' — Vessel Wall Weakens and Swells
A brain aneurysm is a condition in which the wall of a blood vessel weakens, swells and then ruptures, causing a subarachnoid hemorrhage. Subarachnoid hemorrhage is known to have a worse prognosis than ordinary cerebral hemorrhage. According to research, about 20% of patients die before reaching the hospital, and another 20% die during the treatment process, bringing the overall fatality rate to as high as 40%. Even among survivors, more than one-third may suffer severe disabilities that make daily life difficult, making it a condition that goes beyond a simple emergency to one that greatly affects quality of life.
A brain aneurysm begins with a structural change in which part of a vessel wall weakens and, unable to withstand blood pressure, balloons out. "It tends to develop at points where blood pressure changes and turbulence occur, such as where vessels branch or merge," Professor Shin said. "The representative risk factors are hypertension and smoking." Persistently high blood pressure increases strain on vessel walls, while smoking causes chronic inflammation inside vessels, weakening them. Family history and genetic factors also play a role; when two or more immediate family members have had brain aneurysms, the individual's own risk of developing one reportedly rises to 10–15%.
The age of onset is concentrated mainly between 40 and 60, with most cases detected between ages 50 and 55. "About 70% of all patients are diagnosed at age 50 or older, but recently, with the expansion of health checkups and increased imaging tests, more cases are being found in younger people," Professor Shin said. "It is a disease that even younger age groups cannot take lightly."
◇ No Clear Symptoms Until Rupture
The biggest problem with brain aneurysms is that there are few clear symptoms until rupture. In some patients, a "warning headache" may appear days or weeks before rupture, but such symptoms are reported in only about 10% of cases. If the aneurysm grows larger, it may press on surrounding nerves, causing neurological symptoms such as double vision, visual field abnormalities, or drooping eyelids. "It is actually fortunate when symptoms appear and the condition is recognized before rupture," Professor Shin said. "Most patients go without any symptoms and then suddenly experience a rupture."
When a brain aneurysm ruptures, the situation rapidly deteriorates. Patients commonly complain of "a pain like being struck hard on the head with a hammer," accompanied by extreme headache, vomiting and reduced consciousness. Some immediately lose consciousness or are found in cardiac arrest. Because brain damage progresses rapidly from the moment of rupture, fast transport to a hospital is considered the most important factor determining survival and prognosis.
◇ Coil Embolization, an Endovascular Treatment, on the Rise
Treatment of brain aneurysms is largely divided into coil embolization and clip ligation, both of which aim to block blood flow into the aneurysm. Coil embolization involves inserting a catheter through a blood vessel in the groin or wrist and filling the inside of the aneurysm with coils to seal it. Because it does not require opening the skull, recovery is faster and the burden is lower, but there is a possibility of recurrence over time. Clip ligation, on the other hand, is a surgery in which the skull is opened and the entrance of the aneurysm is clamped shut with a metal clip, completely blocking it. Although recovery takes longer, the recurrence rate is low and long-term stability is high. "Rather than concluding that one treatment is better than the other, customized treatment that comprehensively considers the aneurysm's size, location, shape and the patient's age and condition is important," Professor Shin said. "However, thanks to advances in techniques and surgical instruments, endovascular treatment without craniotomy has become more common than in the past."
Unlike a cerebral infarction, a brain aneurysm does not have a clearly defined "golden hour," but treatment should be provided "as quickly as possible." In particular, when sudden and severe headache, vomiting or reduced consciousness appear, it is most important to call 119 without delay and be transported to a hospital.
Meanwhile, brain aneurysms are increasingly being discovered incidentally during health checkups through MRI or MRA. However, not all detected aneurysms require surgery. "When the aneurysm's size, location, shape and growth rate are comprehensively evaluated and the risk of rupture is judged to be low, it is common to monitor the progress with regular imaging tests," Professor Shin said. "In the early stages, we conduct tests at intervals of six months to one year, and if there are no changes, we gradually extend the testing intervals."
◇ Everyone Over 40 Should Get a Brain Vessel Screening
The key to preventing brain aneurysms ultimately lies in managing lifestyle habits. Quitting smoking is considered the most important preventive measure, and thoroughly managing chronic diseases such as hypertension, diabetes and hyperlipidemia is essential. Maintaining moderate-intensity exercise for at least 40 minutes, three or more times a week, is also recommended. "I recommend that everyone get a brain vessel screening at least once after age 40, and then adjust the testing cycle according to their individual risk level," Professor Shin said.
"Just because a brain aneurysm has been found does not necessarily mean it requires treatment, and not all patients show the same course," Professor Shin emphasized. "Rather than worrying alone, it is important to consult with a specialist to accurately assess your risk and receive appropriate treatment or management."
How to Recognize Brain Aneurysms, the Main Culprit of Cerebral Hemorrhage, Before They Burst [Shin Hee-sup, Professor of Neurosurgery, Kyung Hee University Hospital at Gangdong]
