Michele Souto, a 47-year-old advertiser, survived the rupture of two brain aneurysms in 2009 in São Paulo after a sudden, intense headache led to a coma. Her experience, which included a vision of floating children during the coma, marked her fight for life. Aneurysms, abnormal dilations in artery walls that can rupture, are often silent until they become fatal. After a 14-hour surgery and a stroke on the operating table, Michele had to relearn how to speak and write. Today, she lives with annual medical follow-ups and minor limitations. Experts explain that the condition affects 3% to 5% of the population, with women at higher risk, and emphasize the importance of prevention and early diagnosis.
The pain that changed everything struck on a busy São Paulo avenue. Michele, then 31, was driving when she felt unbearable pressure in her head. The previous day, hospitals dismissed the severity, diagnosing sinusitis. On the roadside, she called for help. At the hospital, tests revealed two ruptured aneurysms, triggering a massive brain hemorrhage. She went into a coma, underwent high-risk surgery, and survived with sequelae that required months of rehabilitation.
- Aneurysm rupture: causes brain hemorrhage, with up to 60% lethality.
- Delayed diagnosis: many cases are asymptomatic until rupture.
- Challenging recovery: Michele lost speech and writing but regained abilities.
Michele’s story highlights the severity of a condition that can go unnoticed until it’s too late.
What aneurysms are and why they’re dangerous
Aneurysms are abnormal dilations in artery walls, which become fragile and prone to rupture. In the brain, they often occur at arterial bifurcations, forming sacs that may leak blood. When they rupture, they cause subarachnoid hemorrhages, irritating brain tissue and increasing intracranial pressure. Helder Picarelli, a neurosurgeon from USP, explains that blood outside the vessels is toxic and can lead to vasospasms, reducing oxygen flow to the brain.
These events can result in sudden death or severe sequelae. Brain aneurysms affect about 3% to 5% of the global population, but many remain asymptomatic. Women face a 60% higher risk of developing the condition and a 1.4 times greater chance of rupture, according to Feres Chaddad from Unifesp.
- Types of aneurysms: saccular (sac-shaped) are more unstable; fusiform affect the entire artery.
- Risks: hypertension, smoking, and family history increase likelihood.
- Diagnosis: imaging tests like angiotomography or MRI are essential.
Not all aneurysms require intervention. Small, stable ones can be monitored with regular imaging and blood pressure control.
Symptoms that cannot be ignored
Brain aneurysms rarely show signs before rupturing. When they do, a sudden, severe headache, described as “the worst ever,” is the main warning. Michele Souto felt this pain while driving, accompanied by confusion and desperation. Other symptoms include nausea, vomiting, neck stiffness, and loss of consciousness.
Outside the brain, aneurysms in areas like the aorta may cause abdominal, lower back, or chest pain, along with localized pulsing. Carlos Alberto Costa, a vascular surgeon at Santa Catarina Hospital, notes that many cases are found incidentally during routine exams.
- Warning signs: intense, sudden pain, mental confusion, loss of consciousness.
- Peripheral aneurysms: swelling or pulsating mass in arms or legs.
- Incidental diagnosis: common in imaging tests for other conditions.
Early detection can be lifesaving, especially for those with a family history.
Causes and risk factors
Aneurysm formation can have genetic or acquired origins. Syndromes like Marfan and Ehlers-Danlos, which affect connective tissue, increase arterial fragility. Acquired factors include hypertension, smoking, atherosclerosis, and high cholesterol. Ricardo Kazunori Katayose, a cardiac surgeon, warns that trauma or invasive medical procedures can also cause pseudoaneurysms.
Women, like Michele, are more prone due to hormonal and arterial structure factors. Those with first-degree relatives with aneurysms should undergo preventive screening, even without symptoms.
- Genetic factors: connective tissue syndromes elevate risk.
- Acquired factors: high blood pressure and smoking are common triggers.
- Prevention: blood pressure control and regular exams are crucial.
A mix of genetic predisposition and lifestyle factors determines individual risk.
Treatment and recovery
Aneurysm treatment varies by size, shape, and location. Small aneurysms may be monitored, while larger or unstable ones require intervention. Endovascular procedures, like coiling or stenting, are less invasive and often preferred in acute phases. Open surgeries, such as clipping, are used in specific cases.
Michele underwent a 14-hour surgery, interrupted by complications like a stroke. Recovery involved months of speech therapy and physiotherapy to address motor and cognitive difficulties. “It was like learning everything again,” she recalls.
- Treatment options: endovascular (less invasive) or open surgery.
- Sequelae: over half of survivors face some degree of disability.
- Rehabilitation: speech therapy and physiotherapy aid recovery.
- Follow-up: annual exams are essential to monitor the condition.
Individualized treatment is key to maximizing recovery chances.
Prevention and awareness
While not all aneurysms can be prevented, risk-reducing measures help. Controlling blood pressure, avoiding smoking, and maintaining a healthy diet are recommended steps. Regular physical activity also strengthens vascular health. Those with a family history should prioritize imaging tests like MRIs.
Michele maintains annual neurological follow-ups and urges listening to the body. “If I had pushed harder at the first visit, I might have caught it sooner,” she reflects. Experts stress that awareness of sudden symptoms can mean the difference between life and death.
- Preventive measures: blood pressure control, balanced diet, exercise.
- Regular exams: MRIs detect asymptomatic aneurysms.
- Family history: early screening is advised for close relatives.
Prevention combines medical vigilance and lifestyle changes.
