Doctors did not identify brain aneurysms until they started regularly performing post-mortem examinations of the brain. Until the late 1800s, diagnosis of brain aneurysms only took place after death. During the 20th century, clinical criteria, such as headaches, and technologies like angiography permitted diagnosis in time for surgical intervention. Surgical techniques to treat both ruptured and unruptured brain aneurysms became more sophisticated in the second half of the 20th century.
Definition of Brain Aneurysm
A brain aneurysm occurs when a blood vessel in the brain swells. The swollen blood vessel can burst, causing blood to leak into the brain. When a ruptured blood vessel causes bleeding, the condition is known as hemorrhagic syndrome. Most often brain aneurysms appear in the subarachnoid space (the area between the brain and the fine tissue covering the brain). When a brain aneurysm erupts, the consequences can be fatal.
Identification of Brain Aneurysms
The first doctors to identify brain aneurysms did so in the course of performing autopsies on patients. In the late 18th century, English physician Gilbert Blane described a cerebral aneurysm as causing the death of a patient. The patient's history included five years of headaches and vision problems and an onset of dementia before death. Throughout the 1800s, doctors generally only made a diagnosis of a brain aneurysm during an autopsy.
Diagnostic Methods
In 1859, William Withey Gull, an English doctor, proposed that a severe, precipitous headache could indicate a ruptured brain aneurysm. The development of the lumbar puncture by Heinrich Quincke in 1891 gave doctors another tool to detect ruptured brain aneurysms; if blood appeared in the spinal fluid, a ruptured brain aneurysm was likely. In 1933, an Italian doctor showed that an angiogram (an x-ray of an artery that has had dye injected into it) could reveal a brain aneurysm. Additional diagnostic methods developed during the 20th century include magnetic resonance imaging (MRI) and computerized tomography (CT).
Treatment
Treatment of either a ruptured or unruptured brain aneurysm was not possible until the field of surgery developed in the late 19th century. The first successful treatment of a brain aneurysm occurred in 1931 when Norman Dott, an Edinburgh surgeon, performed a carotid ligation, which involves tying off the affected artery. J. Lawrence Pool refined the procedure by incorporating an operating microscope in 1966 and using a clip to prevent blood from reaching the aneurysm. Today, a less invasive treatment, known as endovascular coiling, is also available. During endovascular treatment, a surgeon uses a catheter to thread a wire coil into the aneurysm. When the wire coils, it prevents any more blood from flowing into the aneurysm, in effect, making it clot.
Significance
A person with a brain aneurysm may show no symptoms unless it grows large enough to press on the brain or it ruptures. When it ruptures, a patient requires emergency treatment to prevent death. Some famous figures have suffered from brain aneurysms; for instance, Vice President Joe Biden has had two brain aneurysms, which were discovered and treated surgically before they ruptured. According to Julie Bain, 25,000 Americans suffer from ruptured aneurysms annually; about half of that number die almost immediately.
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