Headache Due to Aneurysm


The picture that occurs when blood leaks into the subarachnoidal space as a result of rupture of an artery or vein is called “subarachnoidal hemorrhage”. The subarachnoidal space or space is the distance between the very thin membrane called the pia mater, which surrounds the outermost part of the brain, and the arachnoidea, the membrane on this layer. Although subarachnoidal hemorrhages occur for many different reasons, the most common cause is aneurysms. Subarachnoidal hemorrhage is one of the most severe clinical conditions that can lead to sudden death among intracranial pathologies, and the incidence of subarachnoidal hemorrhage due to aneurysm rupture is highest in the 40-60 age group. About 50% of patients with aneurysms have warning signs, usually 1 to 3 weeks before bleeding. Headache is unilateral in 30% of cases, mostly on the side of the aneurysm. 30% of aneurysmal subarachnoidal hemorrhages occur during sleep. Although the reason is unknown, the spring and autumn months are the months when the frequency of bleeding is seen more.

When it comes to aneurysm, popularly known as a bubble; In general, the enlargements of the veins (arteries) carrying clean blood are understood. Aneurysms can occur in very large vessels such as the aorta, as well as in small and medium-sized vessels. The subject of this section is brain aneurysms, which sometimes give very dramatic results with sudden hemorrhages.
Aneurysms occur at the points where the vessel wall is congenitally weak, usually at the points where the vessel divides into smaller branches. Due to the intravascular pressure (blood pressure) at the point where the vessel wall is weak, the vessel wall bulges outward from the weak point in each heartbeat and bubbles form over time. As soon as the bubble wall cannot withstand the pressure, it bursts, either spontaneously or with effort. eg. actions that cause pressure increase such as coughing, straining, sexual contact…

Who has an aneurysm, what are the risk factors?
Deficiencies in the vessel wall (Congenital)
Arteriosclerotic or hypertensive changes in the vessel wall.
Traumatic (hit or accidental head injuries)
due to infection
Risk factors:
Oral Contraceptives (Birth control drugs)
Alcohol (Suspicious)
Where the aneurysm forms in the brain:

The vessels feeding the brain unite at the base of the brain and form the vascular network called Willis Polygon (See Picture). Aneurysms usually form in this willis polygon.

Most people with aneurysms have no complaints. However, sometimes there may be migraine-like or non-specific headaches. In addition, in cases where the aneurysm is large, symptoms related to the adjacent nerves in the brain may be seen due to the mass effect. Such as impaired sense of smell and paralysis of the optic nerves…

How does an aneurysm occur?
Incidentally, in general-purpose tomography or MRI examination
Giving signs of cranial nerves. For example, paralysis of the optic nerve.
Bleeding result: Bleeding can also occur in two types, in the form of leakage between the meninges (subarachnoid hemorrhage) or into the brain tissue.

The most important of the above reasons is bleeding. It may appear suddenly, with very severe headache, followed by neck stiffness, which is a sign of meningitis (usually settles within 6 – 24 hours), vomiting, impaired consciousness depending on the type and weight of the bleeding, and sometimes low back pain. Headache is the most common symptom and is present in 97% of cases. The patient often describes it as “the worst headache of my life”.

Diagnosis and Treatment

The first thing to do for diagnosis is to apply to a neurologist or neurosurgeon. In subarachnoidal hemorrhages, the first non-medicated brain tomography gives sufficient information about whether there is bleeding or not. In the second stage, MR or catheter angiography must be performed. The incidence rate of aneurysms was found to be between 6 and 10 per hundred thousand, according to the statistical data in the USA. The treatment of aneurysms is surgery. However, the important point here is to intervene in the aneurysm without bleeding, or at least to perform the surgery if the general condition of the patient is suitable after the first bleeding. The surgery is performed by applying microsurgery and endovascular interventions have been successfully applied in recent years.