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Brain Aneurysms: What You Need to Know

Beth Greenfield

Brain Aneurysms: What You Need to Know

Martha Stewart, right, and her sister Laura Plimpton. Photo by Reuters.

The sudden death of Martha Stewart’s younger sister Laura Plimpton from a ruptured brain aneurysm this week has no doubt sent much of the general population into a panic. So Yahoo Health turned to one of the country’s biggest experts in the field, Dr. Christopher Ogilvy, director of the Beth Israel Deaconess Medical Center Brain Aneurysm Institute in Boston, for some answers — which were not, unfortunately, all that comforting.

“About 20 percent of people who have an aneurysm rupture drop dead, while another 30 percent go on to die even if they manage to get treated,” he explained. “Of the survivors, about a third do OK, about a third wind up with serious deficits, and a third are in between.” The good news, however, is that brain aneurysms are relatively rare, with about 3 to 5 percent of the population living with one that will never burst. “When I’m sitting on a bus with a hundred people, I know a couple of them have an aneurysm,” Ogilvy noted. “But not all of them will burst.”

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So what is an aneurysm, anyway? Also called a cerebral aneurysm or intracranial aneurysm (IA), it’s a weak and bulging spot on the wall of a brain artery, according to the nonprofit Brain Aneurysm Foundation, “much like a thin balloon or weak spot on an inner tube.” Over time, as it weakens more, there is a chance of leaking or bursting. The most common type, referred to as “saccular,” is a berry shaped bulge; it accounts for 80 to 90 percent of aneurysms and is most likely to burst. The other kind, called “fusiform,” is much less common, and seldom ruptures. 

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There are some risk factors for having an aneurysm, according to Ogilvy, which include smoking (about 80 percent of his patients have been smokers, he said) and having a family history of the condition. And though the presence of one can be found through an MRA scan (which differs from an MRI because it looks at blood vessels rather than organs and tissues), there is much debate over what should be done when an aneurysm is detected, Ogilvy said. Making the decision whether or not to perform risky surgeries — which may include clipping the bulge or sealing it from within (called endovascular embolization) — will depend on many factors, including the size and location of the aneurysm, as well as the age and health of the patient. But even screening for them in the first place is not as simple as it sounds.

“You can’t just go screening everyone in the U.S.,” Ogilvy said. “If we did, it would be cost-prohibitive [to the provider], and some HMOs won’t pay for it at all.” Many times, when aneurysms are found, they’re in patients undergoing screenings for other reasons, including head injuries caused in accidents. But it’s certainly worth asking about if you think you’re having symptoms, which —when they do appear (and they don’t always) — can include double vision, difficulty speaking, pain behind an eye, or what some may describe as “the worst headache of my life,” Ogilvy said. But in Plimpton’s case, he believes, “It must have burst in a way so severe, there was nothing they could do.”

So, bottom line: What can you do? Stop smoking, for starters. And if you’ve had at least two instances of aneurysms in your family’s history, consider getting screened. Beyond that, keep calm and carry on.