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Medical Edge Newspaper Column from Mayo Clinic
WHAT WE KNOW AND DON’T KNOW ABOUT ANEURYSMS
DEAR MAYO CLINIC: I am 34 years old and have endured two brain aneurysms
bursting within the last two years. I want to find out why this is happening
and what can be done. What can you tell me?
ANSWER: An aneurysm is a thinning of blood-vessel walls that produces
a sac-shaped bulge vulnerable to rupture. As you have already experienced,
a ruptured brain aneurysm is a medical emergency; unless treated swiftly,
its bleeding can cause brain damage and death.
Millions of people have brain aneurysms — some 10 to 15 million in the
United States, as suggested by autopsies — yet physicians have long been
puzzled by the fact that aneurysms rupture only in a relatively small
fraction of those people (about 30,000 per year). Clearly, some aneurysms
are more prone to rupture than others. While we do not know why, and we
also are unable to predict rupture, we are conducting studies to help
answer these questions.
Approximately 10 percent of patients have a family history of aneurysms;
these cases are known as “familial.” The remaining 90 percent fall into
the category of “sporadic” — they appear to be randomly distributed in
the population, except that aneurysms are slightly more frequent in women
and smokers. When an aneurysm ruptures, half of the patients die within
the first month. Among the survivors, half are disabled. The fact that
you have survived two ruptured brain aneurysms in two years is a testament
to good fortune and to the quality of care you have received. But this
history suggests that you are at risk to form new aneurysms.
As best we can tell from natural-history studies, many aneurysms either
stabilize or rupture soon after forming, prompting some physicians to
argue against surveillance imaging of the brain. However, given your degree
of risk, I recommend that you adopt the following practices: 1) Have lifelong
follow-up with a good cerebrovascular neurologist; 2) undergo periodic
surveillance imaging of your brain; 3) never smoke; 4) and discuss any
new problems that arise with your neurologist.
— John Atkinson, M.D., Neurosurgery, Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment of
Aneurysms
Appointment
Information
More Information
on Aneurysms
READERS: Vitamins are taking on a new role in health care —
to help manage or treat disease.
You may only think of your over-the-counter multivitamin as backup for
not getting enough vitamins in your diet. But researchers are finding
ways for vitamins to do more:
— B vitamins to manage cardiovascular health. When your body breaks down
protein, a byproduct is homocysteine (ho-mo-SIS-teen). High homocysteine
in the blood is linked to heart disease and stroke. A number of factors
are thought to influence increased homocysteine, including a lack of certain
B vitamins, especially folic acid, vitamin B9.
— Niacin (vitamin B-3) to improve “good” cholesterol. Taken in large doses,
niacin can potentially boost high-density lipoprotein (HDL), the “good”
cholesterol by 15 percent to 30 percent — or occasionally up to 50 percent.
— Riboflavin (vitamin B-2) to help prevent migraine headaches. Very preliminary
evidence has found that high doses of riboflavin might help prevent migraine
headaches for some people.
Taking vitamins as medicine should be done under a doctor’s supervision.
The recommended doses can be significantly higher than those in a multivitamin
and may cause side effects.
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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