Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Brain aneurysms occur because of weakness in the wall of an artery in the brain that causes a small bulging or ballooning.
An aneurysm by itself does not cause symptoms and may be found in up to 10% of the population.
Symptoms occur when blood leaks from the artery into the subarachnoid space (the area that surrounds the brain and spinal cord that is filled with cerebrospinal fluid) or into adjacent brain tissue and causes inflammation or even brain tissue compression. Severe headache, stiff neck, and vomiting most commonly occur.
Usually, there is a sentinel or "warning" headache with a small leak of blood. This is a sign that one should seek help and have his or her symptoms evaluated. The second bleed tends to be more catastrophic, causing significant brain damage.
The diagnosis of brain aneurysm and subarachnoid hemorrhage includes a high index of suspicion by the physician. A CT scan of the brain is the first test and is helpful 95% of the time. A lumbar puncture may be performed to look for bleeding if the CT scan is normal and an aneurysm has not been ruled out.
Treatment for a ruptured aneurysm depends upon the patient's presentation and potential for recovery. Neurosurgery to place a clip across the aneurysm or interventional radiology to place platinum coils into the aneurysm may be appropriate options.
Worst Headache of Your LifeThe worst headache of your life may be a life-threatening emergency. Symptoms such as a headache with fever and a stiff neck, a headache that starts with a thun...learn more >>
There are some patient complaints that cause a fair amount of angst for physicians, because certain words conjure up fear of missing a potentially fatal diagnosis that might be curable if found early. It has been drilled into most medical students that a patient complaining of "the worst headache of their life" likely has a subarachnoid hemorrhage due to a leaking brain aneurysm and action needs to be taken immediately. Even with improved technology, the diagnosis of a brain aneurysm hasn't changed much in a generation. However, not all patients with headaches need a CT scan and/or a lumbar puncture. Unfortunately, the worst headache term is sometimes exaggerated by patients and the art of medicine is appreciating the severity of a patient's pain and deciding how aggressive to be in trying to make the diagnosis.
SOURCE: Tintinalli's Emergency Medicine: A Comprehensive Study Guide.