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Deadly Headaches (I)

Three real-life cases that recently occurred, where the patients all shared a common symptom: "headache."

Brain Illustration

Case (1)

Ruptured Cerebral Arteriovenous Malformation (AVM) Aneurysm

In early September, Ms. Chan, a woman in her 40s, experienced a sudden severe headache while driving with her family in Hunan. She immediately returned to Hong Kong by high-speed train to seek medical attention. Upon arrival, an MRI revealed a cerebral arteriovenous malformation (AVM) in her brain, which had ruptured and was bleeding, necessitating immediate craniotomy. During the surgery, Ms. Chan lost 6 liters of blood, and her blood pressure dropped to barely detectable levels. After an 8-hour emergency operation, the neurovascular surgeon completely removed the aneurysm and hematoma. She spent some time recovering in the hospital before being discharged.

Cerebral arteriovenous malformation (AVM) is a congenital disease with unknown causes and no genetic basis. It forms during fetal brain development in the womb. AVMs are more common in females and can occur at any age, from 4-year-olds to octogenarians. Although the annual risk of AVM rupture is less than 1%, it is one of the primary causes of hemorrhagic stroke in children, young people, pregnant women, and healthy individuals. Most patients show no symptoms until the AVM ruptures, leading to severe headache, dizziness, nausea, vomiting, neurological dysfunction, confusion, seizures, and even coma.

Cases (2) and (3)

Sudden Rupture of Cerebral Aneurysms

In mid-September, Mr. Lin, 30s, and Ms. Cheng, 50s, weren't so lucky. Both led healthy lifestyles with regular exercise and had no prior symptoms, so neither had undergone any brain examinations. Their aneurysms ruptured suddenly, causing severe headaches and dizziness, followed by rapid unconsciousness and shock. CT scans showed signs of severe hemorrhagic stroke in both patients. Neurosurgeons discovered that both had suffered from ruptured cerebral aneurysms, with Mr. Lin's aneurysm being close to the brainstem, exhibiting dilated pupils upon hospital admission. Unfortunately, both patients passed away within 1-2 days.

Cerebral aneurysms are vascular conditions where weakened vessel walls, combined with blood flow pressure, cause the walls to bulge outward, forming sac-like or spindle-shaped aneurysms. Most cerebral aneurysms have no obvious symptoms, making them difficult to detect. An increasing number of people are being diagnosed during health check-ups. Some aneurysms are discovered only after rupturing and causing severe headaches or unconsciousness, while others are found when the growing aneurysm presses on nerves, leading to symptoms like double vision or eyelid drooping. Once a cerebral aneurysm ruptures, it can instantly be fatal. About 30% of patients die before reaching the hospital, and another 30% may suffer from neurological damage. Studies have found that out of 25 aneurysms, one is likely to rupture within a year, roughly a 4% chance.

Given the difficulty in detecting this condition, early prevention and timely diagnosis and treatment are crucial. Early detection and appropriate monitoring and treatment of cerebral aneurysms can prevent the life-threatening risks associated with sudden rupture.

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