All aneurysms that have ruptured need to be treated as the probability of bleeding is high (2% per day for the first month – even higher in the first few days).
Aneurysms that have no history of previous bleeding with no symptoms should be assessed and the smaller aneurysms don’t need treatment as the risk of rupture may be insignificant (close to 0%). We can assess the risk based on statistics from research and follow up studies (Phases scoring system).
If the risk of the treatment procedure is greater than the rupture risk we do not treat.
It is easy to do a non invasive CT or MR angiogram to look for aneurysms, but it is not recommended to do routine screening unless you have two close family members with aneurysms as the yield is very low.
Aneurysms that have not ruptured are not an emergency and can be assessed at a convenient time.
A ruptured aneurysm is an emergency and requires hospitalisation. Treatment should be done as soon as this can be done safely. Endovascular treatment can be done at any time. Surgical clipping can be done early or late but is usually not done between 2 and 10 days post rupture due to high risk of complications.
It is safe to fly before or after aneurysm treatment.
All coils, stents and surgical clips that have been used in the last 20 years are safe for MRI. If you are unsure ask the doctor that treated you.
Patients typically have a sudden severe headache (described as a thunderclap headache) with neck stiffness. Depending on the severity, the patients condition ranges from fully conscious to completely comatose. The patient that presents with more severe neurological deficits or a coma has a worse prognosis, with significant mortality and higher risk of permanent neurological deficit.
Even after treatment of the aneurysm, patients remain symptomatic for weeks and typically get worse in the first few days before they improve. Complications of the haemorrhage such as hydrocephalus, arterial spasm and stroke can occur. Infections and electrolyte disturbances can occur and therefore patients require ICU care.
We service the Gauteng and surrounding region and regularly treat international patients from multiple African states.
There are other centres in South Africa that offer the treatments. These can be found on the website of the South African Neuro Intervention Society (SANIS).
We don’t know for sure why people get brain aneurysms, but there is a congenital or hereditary factor that is probably related to abnormal healing of arteries relating to flow/shear stress especially at artery bifurcations.
Underlying conditions such as Ehlers-Danlos syndrome, autosomal dominant polycystic kidney disease, Marfan syndrome, and fibromuscular dysplasia are associated with increased incidence of aneurysms.
A strong family history, certain nationalities (Finnish and Japanese) and hypertension are factors associated with higher incidence of aneurysms and higher rupture rates.
After stenting a blood clot a thrombus may form on the surface of the stent and this may cause stroke. The medication inhibits the platelets and therefore prevents the initiation of clotting on the stent.
Dual antiplatelet treatment (asprin and clopidogrel) is used for 6 weeks to 3 months, whereafter the clopidogrel is stopped and low dose asprin is used for 12 months or indefinitely. A layer of endothelial cells does form over the stent and therefore the risk of stroke is insignificant after 6 weeks.
CT angiography and MR angiography are noninvasive methods radiologists use to diagnose aneurysms. CT angiography does involve the intravenous administration of an iodine based contrast medium and requires radiation while MR angiography can be performed with no contrast medium and there is no radiation involved.
Catheter angiography (DSA) is a minimally invasive diagnostic procedure for diagnosing and assessing aneurysms This has the highest resolution and is often required to determine the optimal treatment strategy. This does involve arterial catheter access, administration of contrast and use of radiation.
All these investigation are performed at our facility.