Tag Archives: Brain aneurysm

Depression following a Brain Aneurysm

Dealing with the new you….









Brain Aneurysm: Diagnosis

Can you spot the 2 aneurysms? The big balloon was the largest and below it was the smallest one that is still intact. This is one of the pictures from my angio showing the aneurysm before the embolization. Zoom in close for details.
This scan compares the brain pre-embolization (top half) and post-embolization (bottom half). Zoom in close for a clear view and details.

Most brain aneurysms go unnoticed until they rupture or are detected during medical imaging tests for another condition. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Cerebral-Aneurysms-Fact-Sheet#5

If you have experienced a severe headache or have any other symptoms related to a ruptured aneurysm your doctor will order tests to determine if blood has leaked into the space between the skull bone and brain. 

Several tests are available to diagnose brain aneurysms and determine the best treatment. These include: 

  • Computed tomography (CT)This fast and painless scan is often the first test a physician will order to determine if blood has leaked into the brain.  CT uses x-rays to create two-dimensional images, or “slices,” of the brain and skull.  Occasionally a contrast dye is injected into the bloodstream prior to scanning to assess the arteries, and look for a possible aneurysm.  This process, called CT angiography (CTA), produces sharper, more detailed images of blood flow in the brain arteries.  CTA can show the size, location, and shape of an unruptured or a ruptured aneurysm. 
  • Magnetic resonance imaging (MRI).   An MRI uses computer-generated radio waves and a magnetic field to create two- and three-dimensional detailed images of the brain and can determine if there has been bleeding into the brain.  Magnetic resonance angiography (MRA) produces detailed images of the brain arteries and can show the size, location, and shape of an aneurysm. 
  • Cerebral angiography.  This imaging technique can find blockages in arteries in the brain or neck.  It also can identify weak spots in an artery, like an aneurysm.  The test is used to determine the cause of the bleeding in the brain and the exact location, size, and shape of an aneurysm.  Your doctor will pass a catheter (long, flexible tube) typically from the groin arteries to inject a small amount of contrast dye into your neck and brain arteries.  The contrast dye helps the X-ray create a detailed picture of the appearance of an aneurysm and a clear picture of any blockage in the arteries. 
  • Cerebrospinal fluid (CSF) analysis.  This test measures the chemicals in the fluid that cushions and protects the brain and spinal cord (cerebrospinal fluid).  Most often a doctor will collect the CSF by performing a spinal tap (lumbar puncture), in which a thin needle is inserted into the lower back (lumbar spine) and a small amount of fluid is removed and tested.   The results will help detect any bleeding around the brain.  If bleeding is detected, additional tests would be needed to identify the exact cause of the bleeding. 

In the next segment, I will talk about treatment.

Brain Aneurysm: Risk Factors/causes

Brain aneurysms/cerebral aneurysms form when the walls of the arteries in the brain become thin and weaken.  Aneurysms typically form at branch points in arteries because these sections are the weakest.  Occasionally, cerebral aneurysms may be present from birth, usually resulting from an abnormality in an artery wall. Reference          

Risk factors for developing an aneurysm

Sometimes cerebral aneurysms are the result of inherited risk factors, including:

  • genetic connective tissue disorders that weaken artery walls
  • polycystic kidney disease (in which numerous cysts form in the kidneys)
  • arteriovenous malformations (snarled tangles of arteries and veins in the brain that disrupt blood flow.  Some AVMs develop sporadically, or on their own.)
  • history of aneurysm in a first-degree family member (child, sibling, or parent).

Other risk factors develop over time and include:

  • untreated high blood pressure
  • cigarette smoking
  • drug abuse, especially cocaine or amphetamines, which raise blood pressure to dangerous levels. Intravenous drug abuse is a cause of infectious mycotic aneurysms.
  • age over 40.

Less common risk factors include:

  • head trauma
  • brain tumor
  • infection in the arterial wall (mycotic aneurysm).

Additionally, high blood pressure, cigarette smoking, diabetes, and high cholesterol puts one at risk of atherosclerosis (a blood vessel disease in which fats build up on the inside of artery walls), which can increase the risk of developing a fusiform aneurysm.

Risk factors for an aneurysm to rupture

Not all aneurysms will rupture.  Aneurysm characteristics such as size, location, and growth during follow-up evaluation may affect the risk that an aneurysm will rupture. In addition, medical conditions may influence aneurysm rupture.

Risk factors include:

  • Smoking.  Smoking is linked to both the development and rupture of cerebral aneurysms. Smoking may even cause multiple aneurysms to form in the brain.
  • High blood pressure.  High blood pressure damages and weakens arteries, making them more likely to form and to rupture. 
  • Size.  The largest aneurysms are the ones most likely to rupture in a person who previously did not show symptoms.
  • Location.  Aneurysms located on the posterior communicating arteries (a pair of arteries in the back part of the brain) and possibly those on the anterior communicating artery (a single artery in the front of the brain) have a higher risk of rupturing than those at other locations in the brain.
  • Growth.  Aneurysms that grow, even if they are small, are at increased risk of rupture.
  • Family history.  A family history of aneurysm rupture suggests a higher risk of rupture for aneurysms detected in family members.
  • The greatest risk occurs in individuals with multiple aneurysms who have already suffered a previous rupture or sentinel bleed.

For my case, I had been diagnosed with high blood pressure in the first trimester of my second pregnancy and the condition was being managed when I suffered the brain aneurysm. No family history of brain aneurysms that I am aware of. No smoking, no alcohol abuse, and absolutely no drug use except for the ones for BP and vitamins. My take from this is that we are all pretty much at risk. I have heard stories of completely healthy people, very athletic, and with no family history get them. The more information we know about brain aneurysms, the more lives we can help save.

Brain Aneurysm: Definition


According to WebMD, https://www.webmd.com/brain/brain-aneurysm#1 , brain aneurysm is defined as below:






Brain Aneurysm: Symptoms

From a Distance by Bette Midler.

I remember having a constant headache for 2 days or so prior to the rupture. The pain wasn’t overwhelming and I could tolerate it. I would rate it a 2 on the scale of 1-10 with 10 being the worst. New mothers, me being one of them, tend to ignore little things that their bodies are trying to communicate. We give excuses in order to make ourselves feel better. It is very true we are tired most of the time with little to no adequate rest most of the time. We prioritize the needs of our children and our loved ones. The question that still ponders my mind is – ‘was the aneurysm ruptured already prior to my hospital admission and the bleeding just got worse or did it rupture on that hectic night?’ The doctors that I have met with haven’t given me a conclusive answer yet. They tend to say…..in so many words——“we just don’t know”

So what are the actual symptoms of a brain aneurysm?

Please do not sit and start guessing what could be wrong with you or your loved one. Get emergency care if you suddenly get an intensely painful headache, lose consciousness, or have some of these other symptoms of an aneurysm that has ruptured: I cannot emphasize enough to you how critical it is to get that medical care urgently. Get help if you think something is wrong with your body. DO NOT WAIT.


  • Headache
  • Dilated pupils
  • Blurred or double vision
  • Pain above and behind an eye
  • Drooping eyelid
  • Hard time speaking
  • Weakness and numbness in one side of your face

Please remember that no matter what you are going through or how things turn out, you are not alone. God is with you and He has everything under control. He will lead you to where you need be at the right time. He will bring the right people to your case. God is watching us from a distance. You are a very special child of Him. Have faith and trust in nothing else but in Him. https://www.youtube.com/watch?v=hLHE9jrb_N4

Diminished Sense of Smell and/or Taste

During recovery, a good number of brain aneurysm survivors complain of having a diminished sense of smell or taste. This can be irritating and unfortunately, it does not help reduce the anxiety that you are already suffering from. You want to be normal, you want to be able to smell that coffee and enjoy your steak without having to load it up with salt!

We know that the brain is very complex and controls just about all the functions in the body. When a brain aneurysm ruptures, the blood starts leaking into the brain. Depending on the location, quantity and duration of the blood that is leaking, several functions that the brain controls in the body becomes affected.

Diminished sense of smell and/or taste occurs due to the leaking blood that irritates the nerves that control these senses. If the aneurysm did not rupture, smell and taste deficits can occur if the aneurysm compresses the surrounding nerves. Unfortunately, these deficits may not get better with time.

The complexity of the Brain





Procedural complication rate of coiling of ruptured aneurysms


Before we continue talking about the recovery process, which is a life-long journey, let’s talk a little bit more about complications that may arise following the treatment of a ruptured brain aneurysm. While we know that out of the 2 major treatment options available throughout the world: endovascular coiling and the clipping surgery, the coiling procedure is the least invasive and most successful. The decision on which option to take lies entirely on your team of healthcare providers. I had the coiling procedure done and so far, so good.

I found a very interesting article from the American Journal of Neuroradiology (AJNR) about a study they carried out from 1985 to 2005 studying 681 consecutive patients with ruptured intracranial aneurysms who were treated with detachable coils. Procedural complications (aneurysm rupture or thromboembolic) of coiling leading to death or neurologic disability at the time of hospital discharge were recorded. For patients with procedural complications, odds ratios with corresponding 95% confidence intervals were calculated for the following patient and aneurysm characteristics: patient age and sex, use of a supporting balloon, aneurysm location, timing of treatment, clinical condition at the time of treatment, and aneurysm size.


Procedural complication rate of coiling of ruptured aneurysms leading to disability or death was 5.9%. In the series, the use of a temporary supporting balloon in the treatment of wide-necked aneurysms was the only risk factor for the occurrence of complications.


Endovascular coiling of ruptured intracranial aneurysms has become an accepted treatment with good clinical results and adequate protection against rebleeding.

 Adverse outcome after aneurysmal subarachnoid hemorrhage may be the result of the initial impact of the hemorrhage, the occurrence of early rebleeding after treatment, and delayed events such as vasospasm and hydrocephalus.

Moreover, complications during the endovascular treatment itself can result in poor patient outcome.

Complications of endovascular coiling consist of procedural perforation by the microcatheter, microguidewire, or coil and thromboembolic complications.

Thromboembolic complications may be caused by clotting inside the guiding catheter, clot formation on the coil mesh, or clotting in parent vessels caused by induced vasospasm or malpositioned coils.

In the study, they reported the incidence of procedural complications of coiling of ruptured intracranial aneurysms leading to permanent disability or death in a consecutive series of 681 patients.


Procedural complications occurred in 40 of 681 patients, leading to death in 18 and to disability in 22 patients. There were 8 procedural ruptures and 32 thromboembolic complications. Five of 8 procedural ruptures and 13 of 32 thromboembolic complications led to mortality. Of 22 patients with procedural morbidity, 10 had a nondisabling neurologic deficit and were independent and 12 were dependent at 6 weeks after coiling. There were no patients in vegetative state. Overall procedural complications leading to death or dependency were 30 of 681.

Reference: http://www.ajnr.org/content/ajnr/27/7/1498.full.pdf

Brain Aneurysm: Treatment

Hope is what makes us believe in the promise of tomorrow


There are two common treatment options for a ruptured brain aneurysm.

  • Endovascular coiling is a less invasive procedure than surgical clipping. The surgeon inserts a hollow plastic tube (catheter) into an artery, usually in your groin, and threads it through your body to the aneurysm. He or she then uses a guide wire to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and essentially seals off the aneurysm from the artery. This is what I had done.


Flow diverters



Other treatments (ruptured aneurysms)



Treating unruptured brain aneurysms

  • Aneurysm clip
  • Endovascular coiling



Factors to consider in making treatment recommendations include:

  • The size, location and overall appearance of the aneurysm
  • Your age and general health
  • Family history of ruptured aneurysm
  • Congenital conditions that increase the risk of a ruptured aneurysm



Mayo Clinic neurosurgeons are experts in each of these procedures and have pioneered many new techniques. They also regularly use advanced technology, such as 3D-printed models and computer simulations, to better understand the structure of the blood vessels and to plan surgery.

Mayo Clinic surgeons are trained in open vascular and endovascular neurosurgery, including minimally invasive techniques, such as the modified eyebrow incision, endoscopic skull base surgery and transnasal endoscopy. They are also experts in using computer-assisted technologies to navigate the brain during surgery and microvascular surgery.

Lifestyle changes to lower your risk


Aneurysm clip
Endovascular coiling

How did it happen? My brain aneurysm story: details unfolded Part II-Treatment

His story continues…

They decided to airlift you to Pretoria, South Africa, close enough to the medevac center for US Diplomats in the region. We all agreed that despite the risks involved with flying, it was the only best option to help save your life. AMREF air ambulance from Nairobi, Kenya, was organized and by 4pm on Saturday, about 15hours from when the aneurysm happened, you were on the tarmac in Entebbe airport ready to depart for South Africa.

The kids and I flew separate on a commercial airline after the plan to go with you in the air ambulance failed. We arrived in early Sunday morning and I had a lot of help from the Embassy. They helped organize for nannies, transportation, accommodation, and treatment for the kids.

You were send straight to Kloff Hospital where the neurosurgeons immediately started working on your case. Surgery was scheduled for Monday, August 1st. At that time, it was all up to God to guide everything. Almost all of the family members, friends, and relatives who were aware of your condition, were praying. Everything was being done by the hospital staff to keep you stable until the bleeding was stopped. I was anxious but hopeful.

The long awaited day came for the procedure to be done, I signed the papers and off they took you. I waited anxiously in the waiting room for the doctor to come out with good news. The procedure was to take 3-4hours. As I was gazing at the postings on the wall related to all types of aneurysms, the door opened and it was your neurosurgeon. It had only been 30minutes since they took you in. What could he be doing here right now? I asked myself as I starred at the disappointment look on his face. “Mr. Field, I am sorry to disappoint you, I know how anxious you are but things didn’t turn out the way we had planned. There has been a change of plan.” I don’t recall if I said anything to him or heard the rest of what he had to say. All I remember is feeling like somebody had just punched me right in the chest and removed my heart. I felt like I had stopped breathing. My whole body was shaking, my vision was blurry and my mind was blank all to the thought of having lost you. I must have fallen back or perhaps fainted but I recall the doctor calling a nurse to bring me some water and a cold wash cloth. After a few minutes, he explained to me that they had not lost me but rather cancelled the procedure after it was deemed to be more risky than previously assumed. He then added that he was going to consult with other neurosurgeons and the Embassy Doctor in order to come up with the safest yet most effective plan.

They brought you out of the surgery room looking a little bit drowsy from the anesthesia but still had your beautiful smile. I was so happy to see you even though I was dying inside from the anxiety. Your memory was still bad and you asked the same repetitive questions but every time I looked into your eyes, I saw hope, I saw life, I saw outstanding strength. One side of me was telling me that I shouldn’t sign the papers to give them authority to perform the procedure and accept all the complications, including death, which might occur. It was better to have you alive at that moment, bedridden, and confused than not to have you at all. I wished badly to freeze that moment in time because that was all I was sure of. The kids and I would wanted to see you and have your presence in our lives despite the disorientation. The thought of losing you especially after the procedure was stopped that day was impossible for me to accept and carry on with life. The other side of me was telling me to take the risk and have them do the procedure. Despite all the risks involved, somehow, I knew you were going to be fine. My heart was content with that decision. I tried to ask you what you wanted me to do but you were not able to answer. You did not respond to any questions that I asked other than the programed ones.

Later that day, the neurosurgeon came in and told me that they were going to transfer you to Netcare Unitas Hospital in Centurion where the other neurosurgeon would take lead on carrying out the procedure the following day. At this point, time was critical, every second was counting. The ambulance was organized and you were transferred to the ICU unit in Unitas Hospital. I went back to the hotel to organize for early checkout to another hotel that would be closer to Unitas Hospital and relieve the nanny from her job. At this point, all the kids were sick, the oldest one had refused to eat food insisting that he only wanted mama to feed him. Luckily, there was one nanny who agreed to stay for almost a week until your sister arrived. This nanny was so kind to the kids and was able to gain trust from our son, who later agreed to take food from her. This allowed me time to focus on you, the children’s medical needs, and my job.

The following day, I headed to the Hospital where you had been transferred to prepare for your procedure. I signed the documents as required and the two neurosurgeons together with the medical doctor informed me that after a careful review of the procedure, they decided to go ahead and do it using a different but safer approach. Both neurosurgeons were going to perform the coiling procedure. Well, that was enough to reassure me that God was in control and no matter what the outcome would be, the best available approach was being used. So, off you went. I kissed you softly and told you that I would see you shortly. You smiled back and that is all I needed.

Approximately three and half hours later, the lead neurosurgeon came to me in the waiting area. He seemed relaxed and content. Without wasting time, he told me “Mr. Field, your wife should be out shortly, the procedure went very well and she is expected to make full recovery in 2-8weeks but the memory should start improving as soon as the anesthesia wears off.” Tears of joy were dripping down my cheeks as I reached out to him and extended my gratitude. I was overjoyed, I wanted everyone to know that you were okay, I could not stopping smiling and thanking God. I did not mind waiting for an extra 30minutes while you were still in recovery room because I knew you were alright.

It was not too long before they brought you out on the stretcher and we started making our way to your room. As soon as we entered the elevator, however, you started coughing uncontrollably that the nurse started paging for help. She rushed you into your room where we found a team of care providers waiting. The physiotherapy took the lead to stabilize you. Fortunately, she was able to stabile you within 30minutes. I think she gave you a breathing treatment and bumped up your oxygen supply. After that, you started to verbalize more but you still complained of a severe headache. The nurse requested that I leave so she could give you some pain medicine and allow you time to rest. So, I left with a heart filled with joy ready to go and deliver the good news to the kids and our loved ones who had all been praying tirelessly and waiting anxiously to hear about the outcome of the procedure.

When I returned in the evening, you could talk to me, ask me different questions about the kids and what had happened to you and how we ended up in South Africa. You were able to follow a conversation although your memory, short term memory in particular, was not as sharp as it used to be.  When I came back the following morning, however, you had improved a lot. The focus was now on your recovery.

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