This archive report was first published on 13 July 2020.
Headaches can be a normal part of life, but when they persist or worsen, it's essential to seek medical attention. Dr. Mercy Korir, a neurosurgeon, explains that a persistent headache can be a sign of a serious underlying condition, such as a brain aneurysm.
According to Dr. Korir, if a headache has been happening over a long time, it's crucial to see a doctor. Other cases that warrant concern include headaches that are gradually increasing in intensity and getting worse despite taking painkillers. An example is moving from a mild painkiller like paracetamol to stronger ones that have codeine, an opioid.
Additional symptoms like blurring of vision, dizziness, and weakness on one side of the body should also be of concern. If it's an early morning headache that gets better during the day, or one that worsens with straining like when you cough, bend, or go to the loo, see a doctor immediately.
There is a severe sudden onset headache that many people describe as the worst headache in their lives, which is an indication of a bleed in the brain. Dr. Korir explains that a headache from a bleed is sudden and may cause one to collapse or have a change of speech, experience confusion, or a specific body weakness. This headache gets progressively worse.
A migraine headache, on the other hand, is often triggered by something and tends to occur in the middle of the day. Dr. Korir notes that aneurysms occur when there is a weakness in the elastic layer of the wall of an artery, especially where two arteries meet. The artery 'balloons' out, and this is what is an aneurysm. A small trigger, like a cough or an increase in blood pressure, may rupture it, causing bleeding in the brain; a stroke.
Dr. Korir emphasizes that there are instances where some spontaneous bleeds do not cause any harm, and the bleed resolves without damage to the brain. However, there are warning signs of an impending rupture of a brain aneurysm, which include symptoms that depend on the location of the aneurysm. The classic one is when it presses on the nerve that goes to the eye and makes the eyelid droop.
Dr. Korir notes that though rare, brain aneurysms are commonly known because they are dramatic, and the effects of a rupture and bleed on the brain can be tragic. Survival is also a long and winding journey that is expensive. The commonly affected blood vessels in the brain are the ones that supply the frontal lobe, from the carotid artery system.
Dr. Korir explains that an abdominal aortic aneurysm is a different condition, but it's worse than a brain aneurysm if it ruptures, as it's usually a matter of life and death. Once it ruptures, chances of survival are low, unless one gets to a hospital with expertise very fast.
Not all strokes are as a result of bleeding, but the ones Dr. Korir attends to as a neurosurgeon from a ruptured aneurysm will cause bleeding. During the cold season, like now, they tend to see an increase in the number of people who get these kinds of strokes. A study done in South Africa showed that in winter, due to a decrease in atmospheric pressure, they tend to rupture.
Dr. Korir notes that women have a higher chance of developing aneurysms than men, and when it comes to a family history, you have a 10 percent chance of developing this if there are more than two first-degree relatives who have had it. If it's only one first-degree relative, the chance is five percent.
Smoking is a big risk, as it increases the chances of a rupture. High blood pressure is also a risk, as it increases the chances of one developing an aneurysm. Alcohol intake and illicit drugs like cocaine are other risk factors.
After getting a detailed history of the situation and the risk factors, certain scans, either CT or MRI, will be important to show how the blood is flowing around the brain. The ones they call angiographic studies will show any abnormalities in the arteries.
Dr. Korir notes that if it's ruptured, the only treatment option is surgery, as they have to access the brain and locate the bleed. In Kenya, the only option they have and use is a titanium clip at the base of the aneurysm. The other option is called endovascular coiling that uses a platinum wire.
For unruptured aneurysms, some may leave them if they are small, but aneurysms are like ticking time bombs, if they rupture and one is not in a proper centre that can attend to them, they can be fatal.
Dr. Korir notes that you have a 60 percent chance of recovery if you get the right help. Within the first 24 hours, they lose about 30 percent of the patients. Those who survive without any surgery have a higher chance of re-bleeding happening, and this increases to 60 percent in the second week and 50 percent in half a year. Unfortunately, they lose 60 percent of patients who get a re-bleed.
Dr. Korir notes that they use these metals because the brain does not react to them. The risks are mainly due to the surgical process because it involves opening up the head and one is at risk of seizures. With the platinum wire, if one has a fatty deposit in the arteries, it may dislodge causing other strokes or a heart attack.
The metals will be metallic artifacts seen on future brain scans that one does.
