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Acute illnesses that cause death or disability not only result in enormous income loss but also become a burden requiring care from others. Sometimes, people we know suddenly lose consciousness and pass away unexpectedly, even though they were healthy, young, athletes, regularly exercised, ate healthily, slept on time, and did not use addictive substances. What about us? Do we have a chance of experiencing the same?
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Ruptured cerebral aneurysm is a disease or condition that causes sudden death and is also one of the cerebrovascular diseases found to be the leading cause of death among the Thai population, surpassing cancer and cardiovascular disease. Cerebral aneurysms usually have no symptoms if they do not rupture. On the contrary, if symptoms appear, the prognosis and treatment outcomes are often poor, making it a terrifying silent threat. Will we accept waiting for symptoms before seeking treatment? Therefore, preventing this silent threat is the key to overcoming this disease.
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<h2>Meaning of Cerebral Aneurysm</h2>
Cerebral aneurysm is a condition where a blood vessel in the brain bulges, usually due to weakness in the vessel wall, causing the vessel to resemble a balloon and posing a risk of rupture. If the aneurysm ruptures, it may cause bleeding in the subarachnoid space, a life-threatening condition.
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<h2>Causes and Risk Factors</h2>
There are many factors that cause deterioration of cerebral blood vessels, weakening the vessel walls and making them unable to withstand the pressure of blood flow, leading to aneurysm formation. The main causes can be classified into preventable and non-preventable factors as follows:
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<h2>Preventable Causes</h2>
<ol>
<li aria-level="1">Hypertension is the most common cause because most patients are unaware they have high blood pressure, as they have never measured it or believe they have no symptoms, are healthy, or are young. 
However, remember that this disease hides silently and can cause cerebral vessel rupture immediately without warning signs.</li>
<li aria-level="1">Diabetes mellitus causes hardening of cerebral vessels, leading to loss of elasticity and erosion from heart contractions, resulting in aneurysm formation.</li>
<li aria-level="1">Hyperlipidemia is the accumulation of fat on vessel walls, forming plaques or fatty deposits, causing continuous inflammation of the vessel walls and enzymatic degradation by white blood cells, leading to aneurysm formation.</li>
<li aria-level="1">Smoking, including e-cigarettes, exposes the body to many toxins, especially nicotine and tar, which damage and weaken vessel walls and stimulate inflammation, destroying endothelial cells.</li>
<li aria-level="1">Lack of exercise causes loss of vessel elasticity, increasing the risk of atherosclerosis. It also leads to weight gain and increases the risk of obesity, which raises blood pressure and the risk of cerebrovascular disease.</li>
<li aria-level="1">Obstructive sleep apnea caused by snoring reduces blood oxygen levels and stimulates the sympathetic nervous system, raising blood pressure and affecting cerebral vessels. It also causes continuous inflammation, damaging vessels and increasing the risk of cerebral aneurysm.</li>
<li aria-level="1">Substance abuse Certain drugs like cocaine and amphetamines cause vessel inflammation and weakening, sudden high blood pressure, increased vessel pressure, vasoconstriction, reduced vessel elasticity, and increased risk of aneurysm and rupture.</li>
<li aria-level="1">Low-quality food can be divided into two main types: current diet and easily available supplements. Packaged instant foods often contain high sodium to preserve freshness, raising blood pressure. Saturated fats in fast food increase blood cholesterol, causing vessel hardening. High-sugar drinks or foods increase weight and blood sugar, major risk factors for diabetes and obesity, both affecting vessel health and increasing aneurysm risk. Supplements containing</li>
</ol>
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steroids or stimulants like ephedrine, some supplements containing hormones such as growth hormone, can raise blood pressure and risk of cerebral aneurysm. Supplements with excessive antioxidants, although beneficial, may disrupt the balance of vessel cell protection and harm vessel health when consumed in excess.
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<h2>Non-preventable Factors</h2>
<ol>
<li>Age The risk of cerebrovascular disease increases with age, especially after 55 years.</li>
<li>Family history If family members have had cerebral aneurysms, the risk increases. Family history is a significant risk factor.</li>
<li>Gene mutations Certain gene mutations increase the risk of cerebral aneurysm, such as those related to vessel wall formation or blood pressure regulation.</li>
<li>Genetic diseases Rare genetic diseases like Polycystic Kidney Disease (PKD) and Ehlers-Danlos Syndrome (EDS) increase aneurysm risk due to their effects on vessel strength and elasticity. Diseases with abnormal protein accumulation in vessels, such as CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy), weaken vessels and increase aneurysm risk.</li>
<li>Gender Males have a higher risk of cerebrovascular disease in middle age. However, after menopause, females&#8217; risk increases to nearly equal that of males.</li>
<li>Race Some races, such as Asians or Africans, have a higher risk of cerebrovascular disease than others.</li>
<li>Congenital conditions Some individuals have cerebral vessel abnormalities from birth, increasing aneurysm risk.</li>
</ol>
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<h2>Symptoms of Ruptured Cerebral Aneurysm</h2>
Ruptured cerebral aneurysm is an emergency condition requiring urgent treatment because it causes subarachnoid hemorrhage and can be life-threatening. Symptoms of a ruptured cerebral aneurysm include:
<ol>
<li aria-level="1">Severe headache immediately, described as &#8220;the worst headache of life,&#8221; never experienced before.</li>
<li aria-level="1">Nausea and vomiting occur along with headache, sometimes with projectile vomiting.</li>
<li aria-level="1">Stiff neck pain in the back of the head or neck due to irritation from blood contacting the meninges in the neck area.</li>
<li aria-level="1">Visual changes blurred vision, double vision, partial vision loss, light sensitivity, eye pain, or photophobia.</li>
<li aria-level="1">Confusion and loss of consciousness confusion, disorientation, or loss of consciousness.</li>
<li aria-level="1">Neurological abnormalities such as numbness, weakness, or paralysis on one side of the face, arm, or leg, or drooping eyelid.</li>
<li aria-level="1">Seizures seizures may occur in some cases due to blood irritating and disrupting nerve conduction in the cerebral cortex.</li>
</ol>
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Assoc. Prof. Dr. Itthichai Sak Arunchai
Neurosurgeon and Interventional Neuroradiologist, Phyathai 2 Hospital

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Brain Aneurysm: A Hidden Time Bomb "Know It Early, Survive It Early"

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