Aneurysms Common, Sometimes Deadly

Brain Aneurysm Triggers Fatal Hemorrhage for Rep. Tubbs Jones, 58

From the WebMD Archives

Aug. 21, 2008 -- The type of brain aneurysm that triggered a hemorrhage and killed Rep. Stephanie Tubbs Jones (D-Ohio), 58, late Wednesday is not uncommon, says a neurology expert from Vanderbilt University.

Often, a brain aneurysm will go undetected and not cause problems, says Howard Kirshner, MD, professor and chairman of neurology at Vanderbilt University School of Medicine in Nashville. But if it ruptures, it can quickly prove fatal, Kirshner says.

Tubbs Jones died Wednesday evening after being admitted to Huron Hospital at the Cleveland Clinic late Tuesday evening, according to Kevin Ziegler, a clinic spokesman. "Throughout the course of the day and into this evening, Congresswoman Tubbs Jones' medical condition declined," according to the statement announcing her death.

Kirshner, who did not treat Tubbs Jones and is not familiar with her medical history, agreed to answer some questions about brain aneurysms for WebMD.

What is a brain aneurysm?

"An [unruptured] aneurysm looks kind of like a balloon, an out-pouching of an artery," Kirshner says. "It almost always occurs at a point where the artery branches off."

While Tubbs Jones had a cerebral, or brain aneurysm; aneurysms can also occur in the aorta (the major artery from the heart), the leg, and other areas. Aneurysms are related to weaknesses in the blood vessel wall.

How common is a brain aneurysm?

''We think that many people have them -- up to 4% have it at autopsy," Kirshner says, citing research, but many show no symptoms. According to Kirshner, about 5% of people will develop a brain aneurysm during their lifetime, but only about 10% of them will experience a rupture.

As a crude estimate, he says, perhaps 25,000 to 50,000 people a year in the U.S. have a brain hemorrhage caused by a ruptured aneurysm. Family history plays a role, experts believe. Family members of a patient with a brain aneurysm have an increased risk of having one. Yet only a small percentage of these are related to hereditary syndromes associated with aneurysms.

Women are more likely than men to have an aneurysm, and African-Americans have more risk of hemorrhage from an aneurysm than do whites.


What are the symptoms that an aneurysm has ruptured?

Aneurysms often go undetected because they can have no symptoms until they rupture and bleed. When that happens, it can cause a sudden severe headache and sometimes nothing more than that, Kirshner says. "But it is usually not like any other headache you've had. It is very sudden or severe, the worst headache of your life." Other symptoms include severe neck pain, dizziness, nausea, and sensitivity to light.

One-third to nearly half of patients have minor hemorrhages or "warning leaks" that later lead to a severe devastating brain hemorrhage days later.

Sometimes, when an aneurysm ruptures, it can go unnoticed, with the person passing off the headache. But once it ruptures, Kirshner says, it is more likely to re-bleed.

Is there a typical age bracket for aneurysms to rupture?

"They are most common in middle age -- the 40s and 50s are the peak ages," he says. But they can happen at any age. "I've seen them in teenagers. They do occasionally occur in elderly people."

What can someone do to reduce the risk of an aneurysm growing and rupturing?

"Not smoking and treating hypertension prevent aneurysms from growing and rupturing," Kirshner says.

In general, what is the outlook for someone whose brain aneurysm bursts?

The prognosis, Kirshner says, "is very uncertain." A ruptured aneurysm can cause sudden death, he says. In general, "if you are in bad shape right in the beginning, the odds of recovery are much lower." The overall death rate once the aneurysm ruptures is about 40%, he says.

What might be done when the rupture is discovered?

Getting treatment as soon as possible is critical, he says. If it's possible to do surgery, one option is to go in surgically and put a clip across the aneurysm to stop bleeding. "An even more common surgery is to go through the artery and deploy a coil [into the aneurysm, using a tiny catheter] and the coil causes the aneurysm to shut off." The coil causes a clot to form around the sac, sealing off the aneurysm defect.

WebMD Health News Reviewed by Brunilda Nazario, MD on August 21, 2008



Howard Kirshner, MD, professor and vice chairman, department of neurology, Vanderbilt University School of Medicine, Nashville.

Kevin Ziegler, spokesman, Cleveland Clinic.

Statement, Cleveland Clinic, Huron Hospital and Tubbs Jones family.

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Willinsky, R. Journal of the Canadian Medical Association, November 1999: vol 161: p 1136.

WebMD Medical Reference from Healthwise: "Brain Aneurysm: Topic Overview."

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