THE SILENT WITNESS
Richard followed the advice and on reaching Nairobi , went to see a clinical officer who performed a series of blood tests which were all normal . The blood pressure was however found to be slightly elevated and the clinician advised him not to use medication but to monitor it for one week . He was also advised on lifestyle modification .
Even though Richard was not feeling unwell , he decided to seek a second opinion from his friend who is a medical doctor . He was especially worried due to the fact that he had convulsed suddenly , something that is unusual in adulthood , especially when one is of good health . His doctor friend performed an Electrocardiography ( ECG ) on him , a test that looks at the heart functions . The heart functions were found to be normal . The doctor also checked his blood pressure and found that it was slightly elevated . He advised Richard to see him after one week while continuing to monitor his blood pressure . He also promised Richard that he would perform a scan of his brain when he comes back in one week ’ s time to find out why he had convulsed .
Meanwhile he did not put him on any medication . Three days later , as Richard was walking to his car after work , he collapsed . The passersby ’ s rushed him to hospital where he was pronounced dead on arrival . Post mortem also revealed extensive bleeding in the brain and a rupture of an aneurysm in one of the arteries within the brain .
The above three cases lead us to the question of what an aneurysm is and its associations with persistent headaches and high blood pressure . Incidentally , the three cases took place within a span of one month .
An aneurysm is a bulge on the wall of a blood vessel . This is caused by weakness on that part of the wall leading it to bulge like a balloon . In the brain , the section of blood vessel affected by an aneurysm appear like a berry hanging on a stem .
Aneurysms can be found in blood vessels in many parts of the body including veins and arteries , with the arteries being the most affected . For the purpose of this article , we will discuss aneurysms of the cerebral arteries ( arteries within the brain , which supply blood to various regions of the brain ).
Brain aneurysms are mainly caused by a weakness in the wall of the blood vessel , sometimes one is born with it ( inherited conditions ). Other causes of aneurysms include high blood pressure , smoking , heavy consumption of alcohol , drug abuse ( especially cocaine ), head injury and infections .
Symptoms vary with majority of people having no symptoms at all . However , as the bulge becomes bigger , it causes pressure to the surrounding brain tissues and as a result , the patient may present with headaches , convulsion , weakness on one side , vomiting and so forth .
One can live with an aneurysm for a long time . However , the problem sets in when it ruptures . This is because it causes bleeding into the brain ( stroke ) and this is dangerous because it may lead to death . It is hence important to ensure that this stage is avoided by seeking medical help if you are experiencing persistent headaches , convulsions or sudden weakness on one side of the body .
Rupture of the aneurysm is mainly associated with high blood pressure as has been seen in the above three cases where all of the three victims had high blood pressure . The swelling is similar to the way a balloon stretches and becomes weaker and weaker as it fills with water and when its capacity to stretch is exceeded it ruptures .
It is hence important to ensure that your blood pressure is controlled . High blood pressure can be caused by many things with majority of the cases being idiopathic ( unknown causes ). Some of the cases of high blood pressure are of genetic origin . Once you have been diagnosed with high blood pressure , it is important that you stay compliant to medication , monitor your blood pressure regularly and attend clinic for follow-up . There are people who are never compliant to medication , choosing to use the medicine prescribed only when they feel that their blood pressure is high . There is never anything like feeling that your blood pressure is high . Sustained high blood pressure has negative impact on your organs including the heart which gets enlarged due to increased burden , ( an enlarged heart is an incompetent heart ), blood vessels which can get destroyed , ( as we have seen in the above three cases ), the kidneys which can lead to kidney failure , among others .
In milder cases of complications of aneurysms , blood can leak from the aneurysms . In these instances , the bleeding is slight and the person so affected will have symptoms including headaches and sometimes convulsions . These are warning signs that there is something grave coming and hence should be treated seriously and with urgency . This is because of the danger of further bleeding of the leaking aneurysm if there is no urgent intervention . I suspect that this was the case in our case number three where Richard had a convulsion when he was attending a funeral . The delayed diagnosis led to re-bleeding of the leaking aneurysm leading to his death .
It is important that you don ’ t ignore that persistent headache that you may be having . Headaches are caused by many things and is one of the most common pains experienced by human beings . I don ’ t know of any adult who has never experienced a headache . This is due to the stresses that we experience in our day-to-day activities . However , anytime you experience a more that occasional headache , it is important to seek medical intervention because you may be dealing with a serious disease , one of which is an aneurysm .
It is also unusual for an adult to convulse suddenly , so it is important to seek medical help in case you experience a convulsion . Always seek a second opinion if you think that the doctor is not adequately addressing your concerns . In case number 3 , we can see that the doctors did not address the convulsions that Richard experienced and this led to a delay in diagnosis , with the aneurysm being sadly diagnosed post humorously . The same was seen in case number 2 in which a clinician told Daniel to stop taking medication even though it was clear that he was having hypertension . ■
Dr . Johansen Oduor , MBChB ( UoN ), MMed Path ( UoN ), Dip for Med ( College of Medicine South Africa ), is a Forensic Pathologist and President Emeritus , African Society Forensic Medicine . You can commune with him via mail at :
Johansenoduor @ gmail . com .
MAL 47 / 22 ISSUE 17