Terre Moshe was aware that heart disease and breast cancer frequently "ran in families," but she had no idea that brain aneurysms can also have a genetic link. After she and her father experienced aneurysms seven years apart, she urged her other blood relatives to be screened. The results were shocking - four members of her immediate family, spanning three generations, have been diagnosed with aneurysms.
The good news is that this knowledge may just save their lives, because like heart disease and cancer, the earlier an aneurysm is detected, the more treatable it is.
A former forensic scientist and a mother of three, Moshe was 52 when she began experiencing earaches that soon became excruciating. An MRI revealed a 12-millimeter aneurysm (about the size of an M & M candy).
"I thought, oh my God, I have this too," remembers Moshe, whose father had experienced a brain bleed seven years earlier. "I was so scared. I told myself, 'I can't die...I have to get through this.'"
She jumped on the Internet to find a medical facility equipped to repair the abnormal carotid artery, situated by the optic nerve behind her left eye.
"I found Cedars-Sinai Medical Center online and read all the wonderful things about the hospital. I made an appointment and, when I got there, I said, 'I'm not going to leave until you fix this!'
According to Michael J. Alexander, M.D., Director of the Neurovascular Center and Vice Chairman of the Department of Neurosurgery at Cedars-Sinai in Los Angeles, approximately one in 50 people will have a brain aneurysm in their lifetime. An aneurysm is a weak, bulging or "ballooning" spot on a brain artery wall. Some are tiny and not ruptured, and may not require treatment, while others may be life-threatening.
"For those with a family history of aneurysm, the risk may be about 10 times higher than that of the general population," he says.
In June 2007, Moshe had endovascular coils and an aneurysm stent placed in the affected artery - a delicate and technically sophisticated procedure performed only at specialized medical centers. Coiling is an effective alternative to open brain surgery, and has been shown, in a large medical study of over 2000 patients, to be safer. Using a catheter threaded through the artery in the groin to the brain, the neurosurgeon places tiny platinum coils in the aneurysm, to pack it and seal off the weak part of the artery from inside the artery.
"We've followed up with Terre for a couple years because when arteries are weakened, there can be regrowth of the aneurysm," explains Alexander, who added that Moshe will have annual MRAs, or MRIs of the arteries for a few years. "Everything has looked terrific, with no evidence of any remaining aneurysm, and she recovered very quickly."
Though most aneurysms are spontaneous, Alexander recommends that people like Moshe with a family history of aneurysm should be screened. Identifying and treating an aneurysm before it ruptures can make the difference between life and death. A ruptured aneurysm is fatal in approximately 40 percent of cases.
Given her father's brain bleed and a subsequent stroke, Moshe was motivated to have her own children screened for aneurysm. She also urged her siblings to get checked. What they found was eye opening, to say the least.
"My sister went to Dr. Alexander to be screened and learned she had a 5 to 6-millimeter aneurysm in almost the same place as mine," Moshe says.
Equally startling, Moshe learned that her oldest daughter, Rachel, 23, was also affected. Though the aneurysm is small - just a few millimeters - she will need to be screened every year to monitor its growth. MRI and MRA tests indicated Moshe's other two children - Jessica, 21, and Josh, 17 - are clear. Some family members have been reluctant to get tested, she acknowledges, perhaps fearing the results.
Though Moshe's recent experience with her aneurysm has been full of anxiety and uncertainty, she's thankful for the outcome...and the lessons she learned along the way.
"The most important thing to me was realizing the family aspect of this disease," she states. "I recommend screening to anyone at potential risk. It's always better to treat an aneurysm sooner than later - before it ruptures."
About Brain Aneurisms
Though aneurysms can occur at any age, they are most prevalent in adults ages 35 to 60 and more common in women than in men. Risk factors include high blood pressure, smoking, illegal drug use, head injury, tumors, infections and congenital defects as well as family history.
According to the National Institutes of Health, people with a small, unruptured aneurysm may have few if any symptoms, while a growing aneurysm may result in localized headaches, eye pain, vision problems or loss of feeling in the face. In the event of a rupture, symptoms are sudden and severe, among them: headache; nausea; stiff neck; visual disturbance; sensitivity to light; and unconsciousness.
Once diagnosed with an unruptured aneurysm, it's critical to get to a major medical center with the clinical expertise and specialized equipment necessary to successfully treat the condition, stresses Dr. Alexander.
About Endovascular Coiling
Endovascular coiling is one of the most advanced minimally invasive approaches and doesn't require the patient's skull to be opened, as in traditional aneurysm surgery. "The endovascular technologies to treat brain aneurysms improves every year", says Dr. Alexander. "Every year we see improvements in aneurysm coils, stents, liquid polymers, and other technologies that make things safer for the patient, and easier for the neurosurgeon. The key for the patient is to find a physician with the appropriate experience and skill level to ensure a good outcome".