Ask the doctor: Is there anything like a harmless bleed in the brain?

When is a persistent headache a matter of concern that should warrant seeing a doctor?

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If it has been happening over a long time, you need to see a doctor. Other cases are if it is gradually increasing in intensity and getting worse despite taking painkillers. An example is if you find yourself 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 is 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 that is an indication of a bleed in the brain.

Some people get intense migraines. How can one differentiate between this and a life-threatening headache?

A headache from a bleed is sudden and one may actually 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 they tend to occur in the middle of the day.

I read a story of a lady who had two aneurysms in the brain and were discovered after she complained of a headache and collapsed. What are these?

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.

Is there anything like a harmless bleed in the head?

There are instances where some spontaneous bleeds do not cause any harm, the bleed resolves without damage to the brain.

Are there any warning signs of an impending rupture of a brain aneurysm?

The symptoms that one experiences will depend on the location of that aneurysm. The classic one is when it presses on the nerve that goes to the eye and makes the eyelid droop. At times one may experience dizziness or get a ‘bad’ headache that goes away. Most times there are no symptoms and we see these bleeds as an incidental finding when you do a brain scan.

How bad is a brain aneurysm?

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 also is 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.

I know of someone who feels like they have a ‘heartbeat’ in the abdomen, is it anything to worry about?

That could be an abdominal aortic aneurysm, but they will need to see a doctor, like a cardiothoracic surgeon for a proper examination to be done. It is worse than a brain aneurysm if it ruptures, as it is 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.

Are all strokes as a result of bleeding of a vessel in the brain?

No, not all strokes are as a result of bleeding, but the ones we attend to as neurosurgeons from a ruptured aneurysm will cause bleeding. During the cold season, like now, we 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.

I am a 30-year-old mother of two. My mother got a stroke last year and we were told that an artery that had ballooned burst, causing the bleeding. Can my children and I get the same thing?

Yes, you do have a risk because, though we do not know why, it has been noted that women have a higher chance of developing aneurysms than men. When it comes to such 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, like if one of your mother’s sisters has had the same. If it is only one first degree relative, the chance is five per cent.

Are there other risk factors that make one likely to develop these abnormalities?

Smoking is a big risk, as it increases the chances of a rupture. High blood pressure is, too. The high pressure on the vessels also increases the chances of one developing an aneurysm. Alcohol intake and illicit drugs like cocaine are other risk factors.

How is this sorted once one has come to hospital?

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 we call angiographic studies will show any abnormalities in the arteries.

Are there treatment alternatives that do not involve opening up the brain?

If it is ruptured, the only treatment option is surgery, as we have to access the brain and locate the bleed. In Kenya, the only option we 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. With this, the blood vessels in the brain are accessed through the groin to close the aneurysm.

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.

What are the chances of recovery from an aneurysm?

You have a 60 percent chance of recovery if you get the right help. Within the first 24 hours, we 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 per cent in the second week and 50 per cent in half a year. Unfortunately, we lose 60 percent of patients who get a re-bleed.

Are the metals you have mentioned likely to have any negative effects in the brain?

We 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.

By Dr Susan Karanja as told to Dr Mercy Korir. Dr Karanja is a neurosurgeon at KNH