We are saddened by the untimely death last week of actress Isabel Granada due to a ruptured brain aneurysm. She was just 41 years old.

Brain aneurysm, which is the bulging or ballooning of a thinned-out portion of one of the brain arteries, is really a stealthy killer. It usually has no symptoms when it’s still small (less than 1 cm). The severe headache is usually felt when it is already leaking and is about to rupture, or has actually ruptured.

When that happens, every second counts. If timely intervention to clip the aneurysm through brain surgery or coiling it through an artery is not carried out, survival is not possible.

The problem is that when it ruptures, it’s like a dam that breaks, releasing a large amount of blood into the skull, compressing the brain tissues. This may cause permanent damage on the fragile brain, such that even if the aneurysm is clipped or coiled, there’s already brain death. The prospect of the patient waking up and regaining near-normal brain function is nil.

When a brain aneurysm ruptures, the blood accumulates in the subarachnoid space of the brain. Hence, the initial diagnosis after a CT scan is subarachnoid hemorrhage. Further tests to visualize the brain arteries (CT angiogram or magnetic resonance angiogram) can reveal the ruptured aneurysm.

The network of blood vessels at the base of the brain, called the circle of Willis, is the usual site where brain aneurysms form.

There may be a familial or heredity factor which makes some individuals develop aneurysm, but uncontrolled high blood pressure, smoking, head trauma and infections have also been implicated.

Women tend to develop brain aneurysms more than men.

Compression

Bigger brain aneurysms (more than 1 cm) may already cause some symptoms even before they rupture. This is because of the compression of some nerves and brain tissues. Symptoms include headache, blurred vision, neck pain and speech changes similar to a stroke.

When the aneurysm starts to leak (imminent rupture), or has actually ruptured, the headache becomes more intense, much more severe than any headache the patient has experienced. The neck pain also intensifies, together with nausea and vomiting and sensitivity to light. The patient soon loses consciousness and may develop convulsions.

Some are fortunate to have their aneurysms diagnosed accidentally before they cause symptoms. For small aneurysms (less than 1 cm), the doctor may opt to just observe the patient, monitor him/her closely, and treat other risk factors including hypertension, diabetes, high cholesterol and smoking. But for bigger aneurysms and those with a previous history of ruptured aneurysm, surgery may be performed.

Clipping of the aneurysm may be done by actual surgery —opening up the skull and accessing the artery with the aneurysm, and clipping it at the base.

A less invasive way to treat the aneurysm without surgery is by endovascular coiling and embolization. In this procedure, a small tube is inserted into the affected artery, and once it is positioned near the aneurysm, soft metal coils are then administered through the tube into the aneurysm, filling the aneurysm. This will sort of fortify the walls of the aneurysm and make it less likely to rupture.

Some centers can also introduce a mesh in the aneurysm, which reduces the blood flow to the aneurysm, preventing its rupture.

Although less invasive than actual surgery, these procedures also entail a lot of risks, and may even aggravate the rupture of the aneurysm. In expert hands, however, the results are very good.

Some have the wrong notion that migraine headaches can lead to brain aneurysm. Although both may present with intense headache, these are two different problems.

A migraine also has a characteristic headache—pulsating or throbbing, usually one-sided, and generally preceded by a visual aura. Patients describe the aura as a spectacle of different lights, somewhat psychedelic in character.

There can be some overlap of symptoms between migraine headache and brain aneurysm. To be safe, its best to consult a physician.

It’s one headache you can’t ignore.