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Comment by woutr_be | Hacker News Reader

Brain aneurysm is truly something terrible, I lost a friend to it a couple of years ago. (She was 22 at the time and in good health). She just woke up one day in the middle of the night with a headache and had to vomit. On the way to the hospital she fell into a coma and never woke up. Really scary.

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My significant other (23 at the time, otherwise perfectly healthy) felt a sudden headache one evening. Since it didn't stop, she was taken to the emergency room immediately, where they've dismissed her with "menstrual problems".

A day after that the pain didn't stop, she ended up in the hospital, and had a (fortunately successful) brain operation some days later. Luckily it was in an accessible place, so she ended up with no apparent long-term damage.

Definitely a terrible situation to be in. About 4% of people have it, and a small percentage of those only find out when it bursts.

Being dismissed from the ER while having serious conditions that they overlooked is an awful experience. I wanted to let you know that my wife and I can sympathize with you and your SO.

4% seems to be a scary high number.

Glad your SO made it fine.

>Since it didn't stop, she was taken to the emergency room immediately, where they've dismissed her with "menstrual problems".

Infuriating.

It is something terrible, and really scary. My best friend at the time suffered one at 23 years old. He eventually recovered but he suffered a huge loss of concentration capabilities and had to drop from college eventually. He also fought with speech impairment for many years but with a lot of training he was able to recover 99% of it.

So what can be done preventatively against a brain aneurysm?

Seems like there is something called a Magnetic Resonance Angiography.

(I'm not really here to discuss the pros and cons, false positives and what not here as it's a complex topic, but..) I have a medical every three years that involves a full body MRI and ultrasounding which monitors for both brain and aortic aneurysms. There are people who have caught aneurysms in early stages through such monitoring, but there are enough downsides to such screening that it's not something that would usually be recommended for everyone. My next is next week and I'm going to try and tweet as much of the process as I can since enough people have asked about it in the past.

Do you have an idea of some of the downsides? (Imagining cost - but also radiation?)

As a sibling response says, false positives are a big issue. Understanding risks is another issue (consider if you're told you have an aneurysm with annual risk of spontaneous rupture at 0.1% versus an operation with 10% mortality rate.. do you choose the op?)

In some people, indulging anxieties around health can be problematic in itself or have mental health repercussions. Anxieties could also be aroused by benign findings. For example, I have a 7mm cyst on my left kidney. It is entirely benign and not growing but some people may find such a finding unduly alarming and seek treatment they don't need.

Oh man, this is me right now! I had some minor but constant back pain and got an MRI. They found a bulging disc which had shrunk (a good thing) since the last MRI 5 years ago (when I presumably injured the disc, though there's no way to even know that for sure). I CANNOT stop worrying about it. Ever since the doctor labeled it, even though she says it's not cause for concern, I cannot stop worrying about it and imagining the worst; it bursting and leaving me in agony for the rest of my life. Fun times.... The best part, bulges are not even necessarily abnormal, I know all this and yet, cannot let it go.

Yes, that's exactly the downside to screening, although it sounds like it was necessary in your case nonetheless :-) I hope it continues to get better! Maybe a third improvement will set your mind at rest.

I went through with screening because I'm pretty sure I wouldn't have similar concerns over such findings, but it's quite hard to know that for sure until something comes up, I suspect. If I had a benign, but growing, tumor somewhere in my body, it's hard to know how I'd take it, though I do tend to be pretty prosaic.

Researchers seem nervous about the contrast dye used in the process.

It would seem unwise to do a MRI with GBCA for fun or speculative purposes, on the other hand "makes 1 in a zillion people sick" is actually quite acceptable odds for something that's fatal unless treated.

It seems those dyes can cross the blood-brain barrier as very few things can, which is good during the MRI process, however the body may or may not be terribly good at cleaning them out (and the process of cleaning those dyes out of the blood once they're outta yer brain is also hard on the kidneys).

Also edited to add, we DO know everything there is to know about stupid tricks involving ferrous metal being attracted to giant MRI magnets with squishy humans in the way, and that risk of damage is probably higher than the GBCA risk.

Not the poster but I imagine false positives as one specific cost to excessive monitoring unless there’s an underlying condition or history that necessitates it. One of the reasons in the US they raised the recommended age for mammograms.

MRIs and ultrasounds don't involve any ionizing radiation. You may be thinking of CT scans or X-rays.

About 1 per 100,000 people have a ruptured brain aneurysm each year. You have to screen a whole lot of people to detect one person who will suffer from this.

Worse, you'll get a whole lot of "positives" / questionable imagery in people who would never have had a problem, and may end up giving some not insignificant number of people unnecessary brain surgery.

Looks like the shift from 3T to 7T will really open up what they can see inside the brain:

https://www.auntminnie.com/index.aspx?sec=rca&sub=ecr_2019&p...

7T scanners for structural imaging is amazing, hands down. I dream daily of being able to move on my the 3T I get to work with for brain volumetry.

Having a controlled blood pressure really helps. Other than that... good luck I guess.

I guess that would also entail, surrounding yourself with people who don't embroil your blood pressure. That's something within some level of control.

Also not being a smoker. But that's not really preventative I guess.

Absolutely, it's preventative.

Diet and exercise.

Don't know why you're being downvoted. Anecdotally, my brother-in-law had surgery to correct an aneurysm, and was told to change his diet and start running after to help his recovery.

And sleep. Since I made a real effort to re-establish regular sleeping patterns of sufficient length (sadly I need a full 8 hours) the diet and exercise thing also got a lot easier to whip into shape too.

Taking your vitamins is the first step. People seem healthy until it turns out they had chronic low levels of vitamin D and K.

Any thoughts or places to look for what impacts D & K have on the condition?

It's just, such a terrible thing to think about. Nothing you can do either.

It is, she was on life support for about a week, the doctors had said that there was no chance she would ever wake up, so her parents decided to take her off life support and donate her organs. I can't even begin to understand what they must've gone through, such a terrible thing to happen to anyone.

I went to see her the night before (as did many of her friends), it's very unsettling knowing this is the very last time you'll ever get to see that person. And especially given her age, it's very upsetting how unforgiving life can be.

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