According to the Brain Aneurysm Foundation, an estimated 1 out of every 50 people in the United States are walking around with an unruptured brain aneurysm. Aneurysms are not just something that only affects our elderly population—even young and healthy people can be at risk. A ruptured brain aneurysm could have tragic consequences for everyone. So, what if there were a simple way for someone to find out if they are at risk for having an aneurysm based on their genetics?
Dr. Ricardo Hanel, a neurosurgeon and co-medical director of the Baptist Stroke & Cerebrovascular Center at Baptist Health, is leading a research study funded by The State of Florida to assess the hereditary probability of brain aneurysms in families. Today, he’s here to speak with us about aneurysm risk factors, symptoms and treatment, while highlighting the study and how it may help save lives in the future. Welcome, Dr. Hanel.
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Calm, Cool & Coiled
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Learn more about Ricardo Hanel, MD, PhD
Ricardo Hanel, MD, PhD
Ricardo Hanel, MD, PhD, is known for his skill in treating acute stroke and cerebrovascular conditions with ground-breaking endovascular therapy that can be performed from inside the blood vessel. Dr. Hanel also has a special interest in neurosurgical research.Learn more about Ricardo Hanel, MD, PhD
Transcription:
Prakash Chandran: Welcome to Baptist Health Radio. As the most preferred healthcare provider in Northeast Florida, we're here to help you stay informed with the latest news, views and resources for your health and wellbeing.
Today, we'll be discussing brain aneurysms, a condition that is often referred to as the silent killer because of the lack of warning signs. But the important thing to know is that they are treatable, and even more so when you are aware of the symptoms and risk factors. We're going to talk about it today with Dr. Ricardo Hanel, a neurosurgeon and Co-medical Director of the Baptist Stroke and Cerebrovascular Center for Baptist Health of Northeast Florida.
This is Baptist Health Radio. My name is Prakash Chandran. So Dr. Hanel, thank you so much for joining us today. I wanted to get started by asking, in simple terms, what exactly is an aneurysm? And what is the difference between a ruptured and unruptured one?
Dr Richardo Hanel: It's great to be here with you guys. So, if you think about an aneurysm, we think about a little balloon that forms on the side of a blood vessel and, in this case, the blood vessels on the brain, thus, brain aneurysm. When the balloon bursts, we call these a ruptured aneurysm. Before the balloon bursts, we call this a non-ruptured or unruptured aneurysm. They happen up to 4% of people that carries a brain aneurysm. So, it's not truly a rare problem.
Prakash Chandran: I did not realize that so many people had them. So, in the case of an unruptured aneurysm, where the balloon hasn’t popped yet, what exactly does it do? And what are some of the risk factors of living with an unruptured aneurysm and what can it cause?
Dr Richardo Hanel: So, a brain aneurysm that never bled pose a risk of a bleeding. So, it depends on the size of the aneurysm, location of the aneurysm; if the balloon is regular or irregular, if it’s a smooth surface or if it's a bumpy surface. So, a person that has a brain aneurysm and the aneurysm bleeds, it pops, that carries a chance of 40% chance of killing this person. So, it's important to find out if you have a brain aneurysm before it pops, because after it pops, it's a life-threatening condition and many of the options are not great when the damage is already established by the bleeding.
Prakash Chandran: Taking more of a step back, can you talk about some of the risk factors that actually cause aneurysms? And if we have any of them, should we talk to our doctors?
Dr Richardo Hanel: Absolutely. So, cigarettes is number one. Cigarettes create brain aneurysms. Cigarette makes you more prone for bleeding of an aneurysm. If you got treated from an aneurysm, if you smoke, it makes you more prone to have the aneurysm coming back. That's a factor that you can control. High blood pressure is another one that you can control. If you have high blood pressure, you should be treated and that prevents formation of brain aneurysms.
Some other factors you cannot control, for example, if you have a family history of brain aneurysm and that one is very important to know about. If you have a family history of brain aneurysm, you need to tell your primary care physician, "My mom died from an aneurysm. My father died from an aneurysm." Because if you have more than one family member, there's good recommendation to get the screen for brain aneurysms.
Prakash Chandran: Okay. Yeah, my sense is from what I've heard about brain aneurysms is they happen pretty quickly. So, for example, there are standards and guides around when you should get screened for lung cancer if you're a smoker, a certain amount of pack years. Do you have certain criteria for when someone should be screened for brain aneurysms?
Dr Richardo Hanel: Definitely if you have more than two family members or two or more to be more precise, you should be screened. If you have just one family member, then it's a personal decision to discuss with your primary care physician if you want to be screened or not.
Another condition that is very common in the ladies is called fibromuscular dysplasia. If you have fibromuscular dysplasia and you’re a lady, you have four times higher chance of having a brain aneurysm. So, you should be screened for a brain aneurysm.
Prakash Chandran: Now, are there any symptoms that people should be on the lookout for?
Dr Richardo Hanel: So when an aneurysm ruptures, in general, a person is going to have one of the worst headaches of their life. So if you have type of headache that you always have, that's not typical of a concern. But if you're a headache person and you have a different type of headache, or I like to tell my patients, different flavor of headache, "This is not my typical headache," that's a red flag and you should see a doctor.
Prakash Chandran: And is this something where if they have that type of symptom, they should call 911, because that kind of sounds also like a stroke, if you're having the worst headache of your life. What do you recommend someone does if they have that severe headache that comes on?
Dr Richardo Hanel: If it's a severe headache they never had before, you should see a doctor immediately, because sometimes we have what we call sentinel bleed, a small little bleed that comes before a big one. So, if you find the aneurysm before you have a big burst, that can be a lifesaver. And a bleeding is a type of stroke that one can prevent.
Prakash Chandran: Okay, understood. I want to talk a little bit about treatment. Is there a treatment for an aneurysm? And if so, what does it look like?
If an aneurysm ruptures, it is a medical emergency. This person needs to be treated as soon as possible to prevent a second possible devastating type of bleeding. So ruptured aneurysm equals medical emergency, got to be treated right away.
For an aneurysm that never ruptured, then you have many options you can discuss with your doctor.. Traditionally, opening up the skull or clamping up the aneurysm that we call clip, that applies for both ruptured and unruptured. We can go through the groin or through the wrist of the patient all the way to the inside of the aneurysm and stop this aneurysm with little platinum wires that we call coils. We can put a little mesh on the inside of the aneurysm that are called the Web device. We can put a little mesh on the inside of the vessel, the mother vessel where the aneurysm is coming from, that we call flow diverter to change the flow on that. So all these options are available and patients do better when they go to places that have all these tools available.
Prakash Chandran: When they are treated in this way that feels minimally invasive, I imagine that the recovery time isn't that long. Is that correct?
Dr Richardo Hanel: Yeah. So if you're dealing with that aneurysm that never ruptured on an elective way with a minimal invasive treatment like coiling or the Web device or flow diverter, those in general is an overnight stay.
If the procedure requires a craniotomy for clipping, then we're talking about two, three days in hospital for an aneurysm that never bled. If the aneurysm bled, then it's a totally different ballgame. Because an aneurysm that bled, you have the aftermath of the bleeding that can give you short-term memory problem, trouble with concentration, chronic headache, all kinds of different problems if the bleeding occurs.
Prakash Chandran: So one of the things that I've heard about is a Familial Brain Aneurysm Study. Can you tell us what this is and what you hope to find with a study like this?
Dr Richardo Hanel: When you go to your primary care physician, there's a list of questions that you're going to answer. If you look at your primary care physician list, there's no such a thing as do you have a history of family with a brain aneurysm? Do you have anybody in your family, mom or dad's side with a brain aneurysm? And we know this happens and we know this exists, but there is a tremendous need to educate the population, including the physicians about the fact that aneurysms are preventable and aneurysms are screenable. You can find this before they rupture.
So, the Florida Familial Aneurysm Study, with the help of the Trinity Hoblit Foundation and Senator Aaron Bean, we are able to submit this to Governor DeSantis and we got funded last year and got funded again this year to offer to our patient's families. So, anybody that has a brain aneurysm and has a family member that wants to be screened, it has to be a first-degree relative. So, if your mom had an aneurysm, as a daughter or a sibling of that person that had an aneurysm, you're eligible to come and get a screen. We're collecting blood samples from both the patient and the family members looking for genetic markers in the future for brain aneurysm, and all these people are getting an MR angiogram. So we're hoping that in the near future, we have good information about the prevalence in our region for a person that has a family history of a brain aneurysm.
Prakash Chandran: And as a result of what you find, might it change the way you treat the aneurysms themselves?
Dr Richardo Hanel: I wouldn't say we're going to change the way we treat the aneurysm, but we screen now over 200 people and we found already many aneurysms. So, it gives the opportunity of that family member to have a discussion with his doctor or her doctor about, "Look, my mom had an aneurysm. Now I have an aneurysm. What should we do about that?" So, we're giving these people an opportunity to do a preventive measure because, again, some of these aneurysms will be small in safe locations that don't require treatment, but some of the aneurysms would require treatment and will prevent a catastrophic brain hemorrhage that could happen in the future.
Ideally, we would love to come up with a screening test that doesn't require an MRI. The dream is in the future to find a blood test that we can run in a family or in any given individual that wants to know, "Do I have a risk of a brain aneurysm?" And you run a genetic test and potentially you define if you're higher risk or lower risk for that. We're not there yet, but that's the dream.
Prakash Chandran: And it seems like broadly the initial goal is to really have that family history of aneurysms be just part of a general questionnaire in medical exams, just like heart and cancer history. Is that correct?
Dr Richardo Hanel: Absolutely. We are working very heavily on that in many fronts. We're hoping when we have this publication, we can work with American Heart Association and others to put this on the screening list for all primary care physicians in the country.
Prakash Chandran: And, you know, just in terms of the audience that's listening, can you share with us some of the challenges that you're facing to make this common practice? Is there anything we can do to help make this a reality?
Dr Richardo Hanel: I think the major issue was the problem of complication of the treatment of a brain aneurysm. If you think about just 10 - 15 years ago, an aneurysm would carry a risk of a 10 - 15% risk of complication for the person undergoing treatment. So maybe back then, it did not make sense to screen an aneurysm and find an aneurysm in a person that has no symptoms and expose this person to the risk of treatment. In 2022, this is not the reality anymore. We have multiple options of treatment with a risk profile under 2 to 5%. That makes sense on the right person to treat an aneurysm to prevent a bleeding. So screening makes more sense today than it did 10 years ago.
Prakash Chandran: Well, thank you, Dr. Hanel, for the work that you do, your research that you and your team are doing, and thank you for joining us today.
Dr Richardo Hanel: I was glad to be here. Thank you.
Prakash Chandran: If you or a first-degree family member has been diagnosed with a brain aneurysm, you may be a good candidate for the study that Dr. Hanel is talking about. You can contact 904-388-6518, extension 58762 for more information. To learn more about aneurysm risk factors, symptoms and treatment, please visit baptistjax.com/aneurysm.
Thanks again for listening. My name's Prakash Chandran, and we'll talk next time.
Prakash Chandran: Welcome to Baptist Health Radio. As the most preferred healthcare provider in Northeast Florida, we're here to help you stay informed with the latest news, views and resources for your health and wellbeing.
Today, we'll be discussing brain aneurysms, a condition that is often referred to as the silent killer because of the lack of warning signs. But the important thing to know is that they are treatable, and even more so when you are aware of the symptoms and risk factors. We're going to talk about it today with Dr. Ricardo Hanel, a neurosurgeon and Co-medical Director of the Baptist Stroke and Cerebrovascular Center for Baptist Health of Northeast Florida.
This is Baptist Health Radio. My name is Prakash Chandran. So Dr. Hanel, thank you so much for joining us today. I wanted to get started by asking, in simple terms, what exactly is an aneurysm? And what is the difference between a ruptured and unruptured one?
Dr Richardo Hanel: It's great to be here with you guys. So, if you think about an aneurysm, we think about a little balloon that forms on the side of a blood vessel and, in this case, the blood vessels on the brain, thus, brain aneurysm. When the balloon bursts, we call these a ruptured aneurysm. Before the balloon bursts, we call this a non-ruptured or unruptured aneurysm. They happen up to 4% of people that carries a brain aneurysm. So, it's not truly a rare problem.
Prakash Chandran: I did not realize that so many people had them. So, in the case of an unruptured aneurysm, where the balloon hasn’t popped yet, what exactly does it do? And what are some of the risk factors of living with an unruptured aneurysm and what can it cause?
Dr Richardo Hanel: So, a brain aneurysm that never bled pose a risk of a bleeding. So, it depends on the size of the aneurysm, location of the aneurysm; if the balloon is regular or irregular, if it’s a smooth surface or if it's a bumpy surface. So, a person that has a brain aneurysm and the aneurysm bleeds, it pops, that carries a chance of 40% chance of killing this person. So, it's important to find out if you have a brain aneurysm before it pops, because after it pops, it's a life-threatening condition and many of the options are not great when the damage is already established by the bleeding.
Prakash Chandran: Taking more of a step back, can you talk about some of the risk factors that actually cause aneurysms? And if we have any of them, should we talk to our doctors?
Dr Richardo Hanel: Absolutely. So, cigarettes is number one. Cigarettes create brain aneurysms. Cigarette makes you more prone for bleeding of an aneurysm. If you got treated from an aneurysm, if you smoke, it makes you more prone to have the aneurysm coming back. That's a factor that you can control. High blood pressure is another one that you can control. If you have high blood pressure, you should be treated and that prevents formation of brain aneurysms.
Some other factors you cannot control, for example, if you have a family history of brain aneurysm and that one is very important to know about. If you have a family history of brain aneurysm, you need to tell your primary care physician, "My mom died from an aneurysm. My father died from an aneurysm." Because if you have more than one family member, there's good recommendation to get the screen for brain aneurysms.
Prakash Chandran: Okay. Yeah, my sense is from what I've heard about brain aneurysms is they happen pretty quickly. So, for example, there are standards and guides around when you should get screened for lung cancer if you're a smoker, a certain amount of pack years. Do you have certain criteria for when someone should be screened for brain aneurysms?
Dr Richardo Hanel: Definitely if you have more than two family members or two or more to be more precise, you should be screened. If you have just one family member, then it's a personal decision to discuss with your primary care physician if you want to be screened or not.
Another condition that is very common in the ladies is called fibromuscular dysplasia. If you have fibromuscular dysplasia and you’re a lady, you have four times higher chance of having a brain aneurysm. So, you should be screened for a brain aneurysm.
Prakash Chandran: Now, are there any symptoms that people should be on the lookout for?
Dr Richardo Hanel: So when an aneurysm ruptures, in general, a person is going to have one of the worst headaches of their life. So if you have type of headache that you always have, that's not typical of a concern. But if you're a headache person and you have a different type of headache, or I like to tell my patients, different flavor of headache, "This is not my typical headache," that's a red flag and you should see a doctor.
Prakash Chandran: And is this something where if they have that type of symptom, they should call 911, because that kind of sounds also like a stroke, if you're having the worst headache of your life. What do you recommend someone does if they have that severe headache that comes on?
Dr Richardo Hanel: If it's a severe headache they never had before, you should see a doctor immediately, because sometimes we have what we call sentinel bleed, a small little bleed that comes before a big one. So, if you find the aneurysm before you have a big burst, that can be a lifesaver. And a bleeding is a type of stroke that one can prevent.
Prakash Chandran: Okay, understood. I want to talk a little bit about treatment. Is there a treatment for an aneurysm? And if so, what does it look like?
If an aneurysm ruptures, it is a medical emergency. This person needs to be treated as soon as possible to prevent a second possible devastating type of bleeding. So ruptured aneurysm equals medical emergency, got to be treated right away.
For an aneurysm that never ruptured, then you have many options you can discuss with your doctor.. Traditionally, opening up the skull or clamping up the aneurysm that we call clip, that applies for both ruptured and unruptured. We can go through the groin or through the wrist of the patient all the way to the inside of the aneurysm and stop this aneurysm with little platinum wires that we call coils. We can put a little mesh on the inside of the aneurysm that are called the Web device. We can put a little mesh on the inside of the vessel, the mother vessel where the aneurysm is coming from, that we call flow diverter to change the flow on that. So all these options are available and patients do better when they go to places that have all these tools available.
Prakash Chandran: When they are treated in this way that feels minimally invasive, I imagine that the recovery time isn't that long. Is that correct?
Dr Richardo Hanel: Yeah. So if you're dealing with that aneurysm that never ruptured on an elective way with a minimal invasive treatment like coiling or the Web device or flow diverter, those in general is an overnight stay.
If the procedure requires a craniotomy for clipping, then we're talking about two, three days in hospital for an aneurysm that never bled. If the aneurysm bled, then it's a totally different ballgame. Because an aneurysm that bled, you have the aftermath of the bleeding that can give you short-term memory problem, trouble with concentration, chronic headache, all kinds of different problems if the bleeding occurs.
Prakash Chandran: So one of the things that I've heard about is a Familial Brain Aneurysm Study. Can you tell us what this is and what you hope to find with a study like this?
Dr Richardo Hanel: When you go to your primary care physician, there's a list of questions that you're going to answer. If you look at your primary care physician list, there's no such a thing as do you have a history of family with a brain aneurysm? Do you have anybody in your family, mom or dad's side with a brain aneurysm? And we know this happens and we know this exists, but there is a tremendous need to educate the population, including the physicians about the fact that aneurysms are preventable and aneurysms are screenable. You can find this before they rupture.
So, the Florida Familial Aneurysm Study, with the help of the Trinity Hoblit Foundation and Senator Aaron Bean, we are able to submit this to Governor DeSantis and we got funded last year and got funded again this year to offer to our patient's families. So, anybody that has a brain aneurysm and has a family member that wants to be screened, it has to be a first-degree relative. So, if your mom had an aneurysm, as a daughter or a sibling of that person that had an aneurysm, you're eligible to come and get a screen. We're collecting blood samples from both the patient and the family members looking for genetic markers in the future for brain aneurysm, and all these people are getting an MR angiogram. So we're hoping that in the near future, we have good information about the prevalence in our region for a person that has a family history of a brain aneurysm.
Prakash Chandran: And as a result of what you find, might it change the way you treat the aneurysms themselves?
Dr Richardo Hanel: I wouldn't say we're going to change the way we treat the aneurysm, but we screen now over 200 people and we found already many aneurysms. So, it gives the opportunity of that family member to have a discussion with his doctor or her doctor about, "Look, my mom had an aneurysm. Now I have an aneurysm. What should we do about that?" So, we're giving these people an opportunity to do a preventive measure because, again, some of these aneurysms will be small in safe locations that don't require treatment, but some of the aneurysms would require treatment and will prevent a catastrophic brain hemorrhage that could happen in the future.
Ideally, we would love to come up with a screening test that doesn't require an MRI. The dream is in the future to find a blood test that we can run in a family or in any given individual that wants to know, "Do I have a risk of a brain aneurysm?" And you run a genetic test and potentially you define if you're higher risk or lower risk for that. We're not there yet, but that's the dream.
Prakash Chandran: And it seems like broadly the initial goal is to really have that family history of aneurysms be just part of a general questionnaire in medical exams, just like heart and cancer history. Is that correct?
Dr Richardo Hanel: Absolutely. We are working very heavily on that in many fronts. We're hoping when we have this publication, we can work with American Heart Association and others to put this on the screening list for all primary care physicians in the country.
Prakash Chandran: And, you know, just in terms of the audience that's listening, can you share with us some of the challenges that you're facing to make this common practice? Is there anything we can do to help make this a reality?
Dr Richardo Hanel: I think the major issue was the problem of complication of the treatment of a brain aneurysm. If you think about just 10 - 15 years ago, an aneurysm would carry a risk of a 10 - 15% risk of complication for the person undergoing treatment. So maybe back then, it did not make sense to screen an aneurysm and find an aneurysm in a person that has no symptoms and expose this person to the risk of treatment. In 2022, this is not the reality anymore. We have multiple options of treatment with a risk profile under 2 to 5%. That makes sense on the right person to treat an aneurysm to prevent a bleeding. So screening makes more sense today than it did 10 years ago.
Prakash Chandran: Well, thank you, Dr. Hanel, for the work that you do, your research that you and your team are doing, and thank you for joining us today.
Dr Richardo Hanel: I was glad to be here. Thank you.
Prakash Chandran: If you or a first-degree family member has been diagnosed with a brain aneurysm, you may be a good candidate for the study that Dr. Hanel is talking about. You can contact 904-388-6518, extension 58762 for more information. To learn more about aneurysm risk factors, symptoms and treatment, please visit baptistjax.com/aneurysm.
Thanks again for listening. My name's Prakash Chandran, and we'll talk next time.