ANEURISMA CEREBRAL: os sinais da dor de cabeça que preocupam!

Michele Souto, an advertising professional, is currently engaged in raising awareness about the prevention of strokes and aneurysms. Dr. Helder Picarelli, neurosurgeon at HCFMUSP and ICESP Professor Dr. Edson Bor-Seng-Shu, neurosurgeon, associate professor at HCFMUSP Dr. Marcelo de Lima Oliveira, neurosurgeon, PhD, HCFMUSP A cerebral aneurysm arises from the weakening of the walls of cerebral arteries, where a "bladder" forms, progressively reducing the thickness of this wall until rupture and consequent intracranial bleeding. It is possible to live with aneurysms without symptoms: 0.5 to 3% of the world's population has a cerebral aneurysm and doesn't know it. There are risk factors that increase the possibility of aneurysms, such as smoking and heredity. Smoking also increases the possibility of bleeding from aneurysms. Michele felt a sudden headache when she bit into a sandwich, completely different from the headaches she had always experienced. It was the worst pain of her life. It happened during intercourse that night, where the pain significantly worsened during exertion. She also felt dizzy and nauseous. She immediately went to the emergency room. Unfortunately, during the initial consultation, the doctor did not investigate the suspected aneurysm despite the change in the pain pattern, and therefore, Michele went home without further investigation. After 24 hours, the pain worsened while she was driving: she pulled over and went home. When she went to take a shower, her neck seized up with increased pain intensity, and she sought treatment at a larger hospital. A change in the pattern of pain with strong intensity leads the patient to seek medical attention for investigation. In the investigation, a cranial CT scan is mandatory when the pain changes pattern, when it is refractory to treatments, when the patient has very intense pain with exertion, in immunocompromised patients, and in patients taking anticoagulants. Other suspicious signs include: elevated systemic arterial pressure, neck stiffness, smoking, family history of aneurysms, history of aneurysms in other parts of the body, collagen disease, etc. Unfortunately, half of the people who experience a ruptured aneurysm die before receiving medical attention, and most aneurysms cause symptoms when they rupture; of the patients who survive, 50% will have permanent sequelae. Preventing rebleeding of the aneurysm is fundamental to avoiding additional deaths. Therefore, early treatment of the aneurysm is imperative. However, it is possible to diagnose aneurysms before bleeding and plan treatment before hemorrhage. In the past, aneurysms were operated on only 15 days after rupture to reduce brain inflammation. Currently, surgeries are performed early to prevent rebleeding; aneurysms can also be embolized and occluded with coils or stents without the need for surgery. Once treated, further bleeding is prevented; however, in cases of ruptured aneurysms, post-subarachnoid hemorrhage brain inflammation can cause brain swelling, vasospasm, and hydrocephalus. On the second day of her hospitalization, Michele learned she had a cerebral aneurysm and would undergo surgery. After the aneurysm was surgically removed, she had difficulty speaking; that is, she understood everything but couldn't express herself. Michele was very frightened in the ICU because, in addition to realizing her condition was serious, she saw people dying around her, and there was constant light and noise. Today, ICUs tend to have private spaces to avoid these disturbances. When she went to her room and started walking, she began to realize she could recover from that serious condition, but she had to undergo a second surgery to remove the other aneurysm, as she had mirror aneurysms. After a hemorrhage, the patient must remain in the ICU for a while because of the life-threatening complications of brain inflammation. Treating the complications of the hemorrhage is treating the "second illness." ICU monitoring is crucial. When discovered before bleeding, some aneurysms need treatment and others do not: small aneurysms should be monitored. If aneurysms begin to show irregularities and grow, then they need to be treated. Smokers and patients with collagenoses deserve special attention. Currently, there are modern tests that can study the vessel walls, showing the probability of bleeding from these aneurysms. #aneurysm #podcast #stroke