โรคที่สาเหตุหนึ่งของภาวะเลือดออกในสมอง คือการที่มีหลอดเลือดสมองโป่งพอง (Cerebral aneurysm) ภาวะนี้อาจไม่เป็นที่คุ้นหูมากนัก แต่ถือเป็นภาวะที่อันตราย หากเป็นแล้วไม่ได้รับการรักษาอย่างถูกต้อง อาจเกิดภาวะแทรกซ้อนคือหลอดเลือดสมองแตก มีเลือดออกในสมอง จนอาจนำไปสู่การเสียชีวิตฉับพลันหรือทุพลภาพถาวรตามมา

Cerebral Aneurysm: A Silent Threat That Can Be Life-Threatening!

One critical cause of intracranial hemorrhage is a cerebral aneurysm (brain aneurysm). While this condition may not be widely known, it poses significant health risks. If left undiagnosed and untreated, it can lead to acute rupture and subarachnoid hemorrhage, resulting in sudden death or permanent neurological disability.

What Causes a Cerebral Aneurysm?

A cerebral aneurysm occurs due to progressive weakening and structural degradation of the arterial wall in the brain, causing it to thin and bulge outward into a sac-like balloon. This weakened area is susceptible to rupture, leading to subarachnoid hemorrhage. Arterial wall degradation is predominantly driven by age-related vascular degeneration, chronic hypertension, diabetes mellitus, and prolonged tobacco smoking. Additional contributing factors include congenital structural weaknesses of the vascular wall, previous traumatic brain injury, and illicit drug abuse that accelerates neurovascular damage.

What Are the Symptoms of a Cerebral Aneurysm?

Some individuals harbor unruptured cerebral aneurysms without experiencing any symptoms; these are often discovered incidentally during brain CT scans performed for unrelated conditions. Patients in this asymptomatic group may remain completely unaware of the condition. When aneurysms become symptomatic or develop complications, common clinical manifestations include:

• Large unruptured aneurysms that mechanically compress adjacent brain tissue or cranial nerves may cause localized neurological deficits, such as ptosis (drooping eyelid), diplopia (double vision), or unilateral headaches.
• Thrombus formation within the aneurysmal sac that dislodges and occludes distal vessels can induce ischemic stroke symptoms, including limb weakness, numbness, facial drooping, and slurred speech (dysarthria).
• Aneurysmal rupture leading to subarachnoid hemorrhage causes a sudden, excruciating “thunderclap” headache—frequently localized to the occipital region and neck—accompanied by nausea, vomiting, loss of consciousness, or focal neurological deficits/paralysis caused by hematoma compression. Without emergency medical intervention, rupture carries high mortality.

How Is a Cerebral Aneurysm Diagnosed?

Diagnosis relies on specialized neuroimaging modalities, including:

• Brain Computed Tomography (CT Scan) with CT Angiography (CTA Brain)
• Brain Magnetic Resonance Imaging (MRI) with Magnetic Resonance Angiography (MRA Brain)
• Catheter-based Cerebral Angiography (Digital Subtraction Angiography / DSA)

How Is a Cerebral Aneurysm Treated?

• For unruptured aneurysms identified prior to rupture, management is determined by the size, morphology, anatomical location, clinical symptoms, and overall patient health. Interventions include endovascular coiling (deploying platinum microcoils into the aneurysm) or microsurgical clipping (applying a surgical clip across the aneurysm neck) to eliminate blood flow into the sac and prevent rupture.
• For ruptured aneurysms, emergency intervention is critical. Urgent surgical or endovascular management is required to secure the aneurysm, repair the arterial wall, and evacuate intracranial hematomas where necessary.

Prevention of Cerebral Aneurysms

• Avoid high-sodium foods and high-fat diets.
• Maintain blood pressure within optimal target ranges.
• Engage in regular physical exercise.
• Abstain from tobacco smoking and avoid illicit substance use.
• Undergo regular medical health check-ups, especially for individuals with high-risk profiles such as a family history of cerebral aneurysms or a history of significant head trauma.