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Brain Aneurysm

It is a frightening scenario.  A silent bleb on a blood vessel next to your brain abruptly ruptures, causing what is often described as "the worst headache of your life."  Arterial blood is pumped into the cerebral spinal fluid that normally bathes your brain -- an event that will prove fatal for almost 50% of victims.  For those that survive, there is the terrifying prospect of a re-bleed.  Emergency surgery is almost always useless.

Don't expect the diagnosis to be easy.  Small bleeds often don't show up on C-T or MRI scans.  A lumbar puncture may be the only way to detect the bloody spinal fluid that signals the diagnosis -- and a "bloody tap" may inadvertently show a false-positive result, forcing you to undergo a cerebral arteriogram.  Many aneurysms are so small they don't appear even on arteriograms, creating diagnostic uncertainty that can cast a shadow over your entire life. And since aneurysms can run in families, the terror extends to immediate relatives who have never even had symptoms.

Brain aneurysms are also very difficult to treat.  In some cases aneurysms can be "clipped" surgically, or disrupted by coils inserted through blood vessels, but the procedures can only be performed at special institutions and are fraught with danger.

However, you may find it reassuring to hear that brain aneurysms are an uncommon cause of death overall.  Rapid advances in imaging and treatment are making your chances better every year, and you can improve the odds by a factor of ten simply by taking blood pressure medicine.  And if think you are worried about aneurysms, consider the plight of emergency physicians who must rely on gut instinct to screen thousands of identical headache patients, when a single error in diagnosis could prove fatal -- one reason why they are always so grumpy about giving migraine sufferers a pain shot.

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