UC HEALTH LINE: Brain Aneurysm Can Masquerade as Flu

The warning signs of a deadly brain aneurysm that is about to burst are often overlooked or misdiagnosed as the flu, according to Mario Zuccarello, MD, professor of neurosurgery at the UC College of Medicine.

Every year, says Dr. Zuccarello, a neurosurgeon with the Mayfield Clinic and a member the Neuroscience Institute in Cincinnati, about 30,000 Americans experience a ruptured brain aneurysm, a dangerous condition in which a balloon-like bulge in a cerebral blood vessel suddenly bursts. Ruptured brain aneurysms, which usually result in a bleeding stroke, kill 40 percent of the victims within a month and leave many more disabled.

“About 30 percent of patients who suffer a ruptured brain aneurysm have had some history of headaches or a headache that’s not the usual headache,” says Dr. Zuccarello. “We call these warning headaches, or sentinel headaches. But people often don’t pay attention because they don’t think the headache is particularly alarming.

“If a patient has had a history of migraines,” says Dr. Zuccarello, “he will say that this headache was different. It was more intense, or it was in a different location.”

Primary-care and emergency department physicians are not always aware that brain aneurysms have warning signs, Dr. Zuccarello adds. The most common misdiagnosis of sentinel headaches is the flu, migraine or gastritis.

“Any person who has an unusual headache should seek medical attention,” Dr. Zuccarello says. “A CT scan probably should be done to rule out the presence of any small bleeds in the brain.”

In cases where the scan does not show a hemorrhage, a spinal tap is recommended. The spinal tap has shortcomings, however, because physicians cannot positively determine whether blood in the spinal fluid has originated from a brain hemorrhage or from the trauma of the spinal tap itself. Dr. Zuccarello and Chad Morgan, MD, a neurosurgical fellow at UC and the Mayfield Clinic, are addressing this problem and have developed prototype technology to differentiate a traumatic spinal tap from a true brain hemorrhage.

Detecting an aneurysm before it ruptures is the best solution, however, because the aneurysm frequently can be neutralized (clipped or coiled) by a neurosurgeon.

The American Stroke Association reports that an estimated 1.5 to 5 percent of the general population has or will develop a cerebral aneurysm. The American Stroke Association also estimates that 3 to 5 million Americans currently have cerebral aneurysms, most of which show no symptoms.

Who is at risk for developing aneurysms?

• People who have two first-degree family members who have suffered a ruptured brain aneurysm are more likely to develop or harbor a brain aneurysm than the general population.
• People who smoke, drink excessively, or suffer from hypertension are at greater risk. A smoker is 4.5 times more likely to suffer a bleeding stroke than a nonsmoker.
• People who suffer a ruptured aneurysm typically are between 50 and 60 years of age.

Dr. Zuccarello urges patients who have family members with aneurysms, or who have small aneurysms themselves, to stop smoking to prevent the development or enlargement of the aneurysm.

Ideally, patients at high risk should undergo MRI or CT angiography screening, Dr. Zuccarello says, even though insurance companies typically will not cover it.

Dr. Zuccarello, a member of the Greater Cincinnati/Northern Kentucky Stroke Team, is a participating researcher in the ongoing Familial Intracranial Aneurysm (FIA) study. Researchers hope the study will help them identify genetic markers that determine who is at high or low risk of developing aneurysms. For more information about the FIA study, including enrollment guidelines, go to

http://www.med.uc.edu/neurology/fia/

or contact Laura Sauerbeck, at (513) 558-1742, or (800) 503-3427.

The Neuroscience Institute is a collaborative effort of nine academic departments at the UC College of Medicine, University Hospital and independent physician practice groups. The institute is dedicated to patient care, research, education and the development of new medical technologies.

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