Written and developed in partnership with Dr. Ravi Gandhi, MD.
On April 20, 2018, Danny Farquhar — a 31-year-old relief pitcher for the Chicago White Sox — vomited and then lost consciousness after pitching an inning. When he arrived at the hospital, he was found to have a subarachnoid hemorrhage (SAH) secondary to a ruptured intracranial aneurysm.
What is a SAH and what is the cause?
A subarachnoid hemorrhage is a type of bleed into the fluid spaces around the brain where the blood vessels reside. When a SAH happens spontaneously, it’s most commonly caused by a ruptured aneurysm.
An aneurysm is an outpouching of a blood vessel caused by a weakness in the internal muscular layer of the vessel. The aneurysm expands like a balloon and the wall becomes weaker as it grows, subsequently rupturing.
Unfortunately, most brain aneurysms go undetected until they rupture. A large aneurysm can cause double or blurry vision, headaches, dizziness, or other neurologic symptoms by pressing on brain tissue or cranial nerves. If you experience these types of symptoms you should seek medical assistance. As in Danny Farquhar’s case, some sufferers may experience nausea, vomiting, and then go into a coma. For others, they may simply have the worst headache of their lives. It’s important to be taken to a comprehensive stroke center with experience and experts trained to care for this type of hemorrhage.
Approximately, 3–5 million people in the United States have aneurysms but most do not know and are not having any symptoms. Around one percent of those aneurysms will go on to rupture.
What causes an aneurysm?
Aneurysms usually form in adults, and after the age of 40. Although there are some families that have histories of them, aneurysms are predominantly spontaneous. Known risk factors for rupture of cerebral aneurysms include smoking and high blood pressure. Aneurysms can sometimes be associated with other conditions such as fibromuscular dysplasia, polycystic kidney disease, or infections.
If an aneurysm is identified after a rupture or SAH, the risk of re-rupture is very high and immediate treatment is usually recommended. If an aneurysm is identified incidentally or during the investigation of other unrelated symptoms, multiple factors go into the decision about how to manage it. The most important considerations include patient age, as well as size, shape, and location of the aneurysm. Size and shape are the most important factors in predicting the risk of rupture. Unfortunately, there are no medications to prevent an aneurysm from rupturing.
If an aneurysm is small or deemed to have a very low risk of rupturing a patient may be observed with diagnostic angiography, CTA, or MRA. The diagnostic angiography is an invasive diagnostic procedure but gives the most detail regarding the specific anatomy of the aneurysm and allows the specialist to make the most informed decision.
Once a decision is made to proceed with treatment, there are two options. One option is open surgical clipping. In this surgery, the aneurysm is exposed, and a titanium clip is placed across the neck of the aneurysm. The second option is endovascular, or from inside the blood vessel. Endovascular procedures entail treatment through the artery in the groin and involve occluding the aneurysm from inside the blood vessel. This procedure is most commonly done using small metal balls called coils that fill the aneurysm, so blood cannot enter it. The decision about which method should be used to treat an aneurysm is determined by highly specialized practitioners such as vascular neurosurgeons and interventional neuro specialists. And there are some surgeons, such as myself, who are trained in both methods.
Although treating aneurysms comes with risk, the potential of long-term disability after a rupture makes prophylactic treatment beneficial when deemed necessary by a specialist. For more information visit our website.