February 15, 2019 by John Fernandez and Tanya Racoobian
Stroke vs. Aneurysm: Different Symptoms, Treatments (Video)
A stroke is a life-threatening medical emergency that can be triggered by two different events: ischemia, referring to an ischemic stroke which happens when a blood vessel in the brain gets blocked, or bleeding (hemorrhagic stroke), which occurs when a blood vessel in the brain bursts.
An aneurysm that ruptures can cause an hemorrhagic stroke, releasing blood into the spaces around the brain. It can be fatal if not treated immediately.
Both conditions, ischemia and hemorrhagic stroke, can be the result of diseased blood vessel walls. Some risk factors and symptoms are shared, but there are important differences.
The more widely known ischemic stroke symptoms include one side of the face drooping; slurred speech; an inability to lift an arm; and weakness or numbness in one side of the body. However, a severe headache of abrupt onset, sometimes described as a “thunderclap headache,” may be a sign of hemorrhagic stroke. All of these are major red flags that necessitate a call to 911.
When it comes to aneurysms, there is good news: ruptured aneurysms are uncommon, affecting about 30,000 people in the U.S. annually. They account for 3 to 5 percent of all new strokes. In comparison, an estimated 6 million people in the United States have an unruptured brain aneurysm, or 1 in 50 people.
The most important symptom related to a ruptured aneurysm to remember: A sudden and severe headache, the worst headache of your life, says Guilherme Dabus, M.D., (pictured above) director of the Interventional Neuroradiology Fellowship Program at Baptist Health Neuroscience Center and Miami Cardiac & Vascular Institute. A ruptured aneurysm can also produce symptoms such as nausea and vomiting, sudden blurred or double vision or trouble walking.
(Watch now. The Baptist Health News Team hears from Guilherme Dabus, M.D., interventional neuroradiologist at Baptist Health Neuroscience Center and Miami Cardiac & Vascular Institute, about the different treatments for strokes and aneurysms. Video by Steve Pipho.)
Ischemic Strokes are More Common
Ischemic strokes, which are much more common than ruptured aneurysms, are the fifth-leading cause of death in the United States and a leading cause of adult disability. Ischemic strokes, by far the most common, occur as a result of an obstruction within a blood vessel supplying blood to the brain. A new stroke-response protocol has expanded the pool of candidates that can have a procedure called a “mechanical thrombectomy,” in which doctors remove blood clots using a device threaded through a blood vessel.
“When the patient comes with ischemic stroke and there can be a large clot that blocks a very important vessel in the brain,” says Dr. Dabus. “We now have procedures where we can go there very quickly through the groin, very similar to what a cardiologist does to the heart. But instead of dropping stents there (as with a heart procedure) what we do is remove the clot and we unblock the vessel, giving the brain the ability to go back to its normal function and giving the patient a good chance for recovery.”
Treating Unruptured Aneurysms
When a patient is diagnosed with an aneurysm, it can either be ruptured, when they’ve already bled, or unruptured, which is when they haven’t bled but there’s a risk of bleeding, says Dr. Dabus. “So that’s when we treat them — either before they rupture, or when they become an emergency after they rupture,” he adds.
If an aneurysm is detected, but has not ruptured, there are more options: either treatment or observation. Treatment often means a minimally invasive procedure with a very high success rate of more than 90 percent. Most aneurysms develop after the age of 40, but are most prevalent in people ages 35 to 60. Most patients are lucky to have the aneurysms incidentally found through a CT scan or MRI after complaining of other possible symptoms, primarily bad headaches.
“So basically a patient’ is having a workup done for headaches, migraines and sometimes sinus problems or memory issues, and in those tests, such as CT scans or MRIs, sometimes you’re able to identify those aneurysms and those cases are referred to us,” explains Dr. Dabus. “Not all unruptured aneurysms will need to be treated. But usually there’s a combination of risk factors that are taken into consideration, including patient’s age and family medical history of aneurysms. “
The non-treatment option is following up with the patient to make sure the aneurysm is not growing.
There have been significant advances in endovascular techniques for treating non-bleeding aneurysms over the last few years and the field continues to evolve. Most notable is the use of new “flow diverting” embolization devices.
These devices are similar to a stent in that they are placed into the main vessel adjacent to an aneurysm. The devices divert flow away from the aneurysm and provide a “scaffolding” for healing of the vessel wall over time. A microcatheter can be navigated past the aneurysm without having to enter the aneurysm itself.
“Even if there is not a very high risk in the short-term, this risk accumulates with time,” says Dr. Dabus. “So if you have a patient who is young, like in their 40s or 50s or 60s, they still may have many years ahead of them. So depending on the size or location of the aneurysm, it makes sense to treat those aneurysms instead of just following up.”
Baptist Hospital & Baptist Health Neuroscience Center win Highest Stroke Award for the Second Year in a Row
For the second consecutive year, Baptist Hospital, in partnership with Baptist Health Neuroscience Center, has received the American Heart Association/American Stroke Association’s “Get With The Guidelines®-Stroke Gold Plus Achievement Award with Target: StrokeSM Honor Roll Elite Plus.” The award recognizes the hospital’s commitment to providing the most appropriate stroke treatment, according to nationally recognized, research-based guidelines based on the latest scientific evidence.