Have you heard of Circle of Willis?
Our brain has a larger brain in the front and a smaller but critical brain at the back; hence 2 arteries supply blood to the brain in the front and then 2 at the back each on the left and right side respectively. The 4 arteries are connected to each other through communicating arteries and hence form a circle within the brain called “Circle of Willis”.
As the arteries course through the brain, it tends to divide to supply different regions of the brain. All the potential areas of division and communication of the arteries behave as potential weak areas. These lead to a formation of a bulge in the wall that slowly takes the shape of a balloon. These balloons are potential sites for the leaking of blood running within the arteries.
Who are at a risk of Brain Haemorrhage?
People who are at the risk of brain haemorrhage are primarily due to their:
- Genetic Predisposition
- Family History
- Male Gender
- Alcohol Consumption
- Drug Abuse
The most common age is above 50 years, however, it is seen across all age groups even young adults.
When does it call for an Emergency?
Once the blood leaks within the arteries, it feels like acid is thrown on the surface. It causes a sudden intense pain, which most people call as “Thunder Clap” Headache. You can feel:
- Loss of consciousness
The presentation of the person to an emergency department is because of a persistent headache which is life disabling. Depending on the nature and location of underlying leakage of blood, the patient is examined thoroughly and a clinical score is used to predict the outcome. After the clinical score, a CT scan of the brain is done to know the extent and location of haemorrhage. The gold standard investigation to know the extent of haemorrhage under the brain coverings is Angiography of brain vessels. It will help the surgeon to know the exact cause of haemorrhage, the location of the balloon in the wall of an artery- called as Aneurysm, the relationship of an aneurysm to parent artery, its shape, and measurement at head, body and neck. Based on this the treatment will be decided.
The treatment is then decided on securing the leak of an aneurysm by occluding it. This is performed using 2 surgeries:
Clipping is where a metallic clip is applied to the neck of an aneurysm so that an aneurysm is excluded from normal circulation and the risk of aneurysm re-rupture is reduced. This requires the skull bone over the brain to be opened and the brain covering to be deflected and then isolate the neck of an aneurysm from the surrounding parent artery and apply the metallic clip on the neck itself.
Coiling is a procedure where an aneurysm is accessed through the inside of blood vessel without opening the skull bone or covering of the brain. A very small tube is used to access an aneurysm and is placed on the neck after which multiple spring-like coils made up of platinum are used to close an aneurysm from circulation.
Are there any risks involved with the two surgeries?
Dr. Amit A Khan, Senior Consultant, Interventional Neuroradiology says, both clipping and coiling are done using general anaesthesia and both of them have risks involved. An aneurysm can re-rupture in both the types of surgeries. A second rupture may prove detrimental to the survival of the patient. The blood leaked below the brain coverings can lead to narrowing of the arteries of the brain thereby leading to stroke due to a decrease in blood supply to the brain. This is common in the young and within the first 2 weeks of haemorrhage. The water sac within the brain can also become larger - needing a tube to be put within so that it can stop putting pressure on the brain from inside.
The patient is kept in the ICU till he is seen to recover the above and is ready to be ambulant. This may take several days and weeks depending on the patient and his present clinical condition. Hence it is imperative that factors like blood pressure, smoking, alcohol need to be controlled.
Get yourself screened if you are above 40 years of age and have a history of a cerebral aneurysm, and uncontrolled hypertension.