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Brain Aneurysms: A Silent Killer

Sophia Cariati
Society for Women's Health Research
November 15, 2001

When a young, seemingly healthy woman dies suddenly in her sleep, many people immediately think brain aneurysm. But most don't think it could happen to them. Think again.

Women over the age of 35 are particularly vulnerable. In fact, results of numerous studies demonstrate that females are up to two times more likely to develop cerebral aneurysms compared with males. And a recent report from the Institute of Medicine (IOM) confirms that there are several instances of sex differences in the incidence and manifestation of cerebrovascular disease and trauma that warrant further investigation. Smoking, high blood pressure, and a family history of brain aneurysms seem to further increase a woman's risk of developing this potentially fatal condition.

In 1990, Thomas Kopitnik, M.D., and partner Duke Sampsom, M.D., both professors of neurosurgery at the University of Texas Southwestern Medical School in Dallas, started a database to follow patients who were surgically treated for cerebral aneurysms. A recent review of the data has prompted Dr. Kopitnik to recommend early aneurysm screening for young women smokers at risk, that is, those who have hypertension or a family history of brain aneurysms.

Over the last decade, Drs. Kopitnik and Sampsom have operated on approximately1800 people with brain aneurysms. More than seventy percent of the patients treated were women. And the majority of women with aneurysms were current or former smokers.

"Young women smokers should ask their doctors about being screened," said Dr. Kopitnik, "If they have high blood pressure or a family history, they would be advised to be screened" Brain magnetic resonance imaging (MRI) is used to detect hidden aneurysms. This noninvasive, safe technique might save lives, according to Dr. Kopitnik.

It is important to note, however, that experts disagree on the usefulness of early screening in individuals without a family history of aneurysms. Seppo Juvela, M.D., Ph.D., neurosurgeon at Helsinki University Hospital recommends only screening of family members when two or more siblings have had an aneurysm. She also advocates screening only after the age of 35 and every 10-15 years in people with a family history.

Why Are Women So Vulnerable?
Due to a dearth of research in the field, it is still too early to definitively say why women are at a higher risk than men. Since peri- and post-menopausal women are more likely than their younger counterparts to harbor aneurysms, some experts theorize that declining levels of estrogen may play a role in increasing a woman's vulnerability. Hence, some scientists believe, hormone replacement therapy may reduce this risk by "replacing" estrogen. The IOM report provides further support for this theory citing several reports that demonstrate a neuroprotective effect of estrogen and progesterone.

But Dr. Juvela emphasizes that it is still too early too tell. Only further studies examining the relationship between estrogen and aneurysms will provide a clear answer. Dr. Kopitinik agrees. "In many areas of research, women have been really underserved," said Dr. Kopitinik, "The time has come to address some of these issues for which women have been understudied."

Signs of a Silent Killer
Approximately half of all aneurysms rupture, according to Dr. Kopitinik. And often, only rupturing will provide clues of its existence. A sudden, explosive headache - often described as the "worst headache of the patient's life" - is the cardinal symptom of a burst aneurysm. But many people walk around with silent aneurysms for years.

Other symptoms of a ruptured brain aneurysm may include:

  • headaches with nausea or vomiting
  • stiff neck
  • muscle weakness, difficulty moving any part of the body
  • numbness or decreased sensation in any part of the body
  • vision changes
  • eye lid drooping
  • lethargy
  • seizures
  • speech impairment

June 2003 Society for Women's Health Research


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