While you are likely to be aware of stroke — the life-threatening medical condition that effects the brain — you may not be aware of what distinguishes it from an aneurysm.
The most significant difference is that an aneurysm is an abnormality that can lead to stroke. Dr Suhail Abdulla Alrukn, Consultant Neurology, Head of Stroke Programme — Rashid Hospital, President of Emirates Neurology Society, describes aneurysm as a “structural anatomy, where there is an abnormality in the wall of the artery that will give you a bulging sack and the blood will leak outside the artery and into the brain”.
“Stroke is a syndrome where there is damage in a certain part of the brain because no blood is going to that area,” he says.
There are a several causes for an aneurysm in the brain, ranging from head trauma to lifestyle-related complications caused by factors such as a lack of exercise and high blood pressure. “Usually, between 0.1 and 0.5 per cent of the population can experience an aneurysm in the brain,” says Dr Alrukn. “There is a certain type of aneurysm that can run in the family but these are very rare and mainly affect people from African and Hispanic populations.
If a patient has had an ischemic stroke, we will prescribe a blood thinner [and] we will try to open the artery by giving a thrombolytic agent.
“High blood pressure is a major risk factor for forming an aneurysm and bleeding in the brain and 90 per cent of aneurysm cases are caused by it.”
Dr Alrukn also says that smoking is one of the major risk factors. “Smokers have also been found to be more at risk than non-smoking patients. There are certain products in cigarette smoke that can cause damage to the arteries and cause weak points where an aneurysm can form.”
In contrast, stroke is generally categorised in two ways. “There are two sub-types of stroke — an ischemic stroke and a haemorrhagic stroke. Ischemic stroke accounts for 80 per cent of all strokes and occurs as a result of a blockage of the artery in the brain,” says Dr Alrukn. “A haemorrhagic stroke is a rupture of the artery.”
According to Dr Alrukn, both stroke and aneurysm carry the same three main symptoms. “Firstly patients will report feeling acute and sudden, thunderclap headache. Secondly, patients can fall into a coma following a bleed in the brain. The third symptom is that patients will experience severe neck pain.”
If a person has an intact aneurysm, the abnormality may produce a symptoms such as pain around or above the eye, vision issues as well as headaches and difficulty with thinking.
With stroke, patients can also experience issues with their vision as well as a weakness and problems with balance. One of the other well-known symptoms of stroke is a numbness or sense of tingling on one side of the body or face.
Diagnosis and treatment
If it is suspected that a patient is exhibiting the signs and symptoms of stroke or aneurysm, they will usually be sent for an MRI or CT scan.
Aneurysms can be a life-threatening condition and there are high rates of mortality, particularly in the first few days of treatment. “We usually treat patients with surgery or vascular intervention,” says Dr Alrukn.
He describes how one treatment involves endovascular coiling with the use of a small, titanium coil. The aim of the procedure is to block blood flow to the aneurysm. This technique is minimally invasive and does not require an incision in the head.
Alternatively, a surgeon can opt to perform an operation on the patient. “During open-skull surgery, the surgeon will clip the neck of the aneurysm. With aneurysms, we don’t prescribe aspirin or blood thinners for aneurysm as the risk of a bleed is very high.
“If a patient has had an ischemic stroke, we will prescribe a blood thinner [and] we will try to open the artery by giving a thrombolytic agent, which is sometimes called a blood clot buster, which opens the artery,” he says.
In the less common cases of haemorrhagic stroke, which only accounts for around 20 per cent of stroke cases, surgery may be required to repair the blood vessel where the rupture occurred.
Dr Alrukn advocates maintaining a healthy lifestyle to reduce the risks of stroke and aneurysm and recommends people visit a specialist if they experience symptoms but he is also quick to point out that the two issues are distinct. “You can’t compare stroke to aneurysm as aneurysm bleeds and aneurysm malformations are one of the causes of stroke.”