Premium

Biggest brain stroke risk in the young: Like Kim Kardashian, 32-year-old discovers aneurysm after pain behind eye, blurry vision

Aneurysms are vastly underreported due to misconceptions about MRI scans and a lack of awareness about their subtle early signs, says neurologist. A World Stroke Day special

cerebral aneurysms and although celebrities like Kim Kardashian and Emilia Clarke have gone public on experiencing this condition, these abnormalities are surprisingly common, affecting nearly one in every 100 people.

Celebrities like Kim Kardashian have gone public on experiencing cerebral aneurysms. (Credit: Facebook/KimKardashian)

Thirty-two-year-old Neha (name changed), a marketing executive from Delhi, had been dismissing recurring headaches for years as a side effect of work stress. The pain, often concentrated behind one eye, was occasionally accompanied by blurred vision. “It was not a throbbing pain at the temples but often felt like a tight band that was squeezing my head. I never thought much of it because I always rationalised why it could have happened. There was performance anxiety as I was making pitches and chasing targets. There were work emergencies that triggered my stress levels. Sedentary hours meant poor posture and muscle tension. Except that each of these symptoms was indicating something abnormal in my brain,” she says.

What she was experiencing were headaches from an unruptured aneurysm. In simple terms, this is an abnormal bulge in the wall of a blood vessel in the brain. It forms when the vessel’s wall weakens, thins out, stretches and balloons out. “Large, unruptured aneurysms can put pressure on nearby brain tissues and nerves, which can cause headaches along with other symptoms. The headaches can be persistent, and in some cases, the pain can be localized, such as behind or above one eye as in my patient. Untreated aneurysms can rupture, triggering strokes and internal bleeding, or causing blood clots that block blood flow to the brain, which can be life-threatening depending on their location,” says Dr Gaurav Goel, Senior Director, Neurosciences, Medanta, Gurugram.

Neha called on the doctor when her headaches became severe, keeping her awake for much of the night. Dr Goel suggested an MRI angiogram, a non-invasive imaging test that she almost skipped due to fear and anxiety. The MRI revealed a small 4 mm aneurysm in the middle cerebral artery. “She was diagnosed in the nick of time before it could haemorrhage and lead to a stroke. But most young stroke patients these days come in with a bleed following an aneurysm burst. Over the last two days, I attended to three such patients,” he says.

Story continues below this ad

How common are brain aneurysms?

These are also called cerebral aneurysms and although celebrities like Kim Kardashian and Emilia Clarke have gone public on experiencing this condition, these abnormalities are surprisingly common, affecting nearly one in every 100 people. “Yet these are vastly underreported due to misconceptions about MRI scans and a lack of awareness about their subtle early signs,” says Dr Goel.

How to take care of both unruptured and ruptured aneurysm

Neha was treated with a minimally invasive endovascular coiling procedure. A tiny catheter was inserted through the groin and guided up to the brain, where coils were placed to seal off the aneurysm from circulation, effectively eliminating the risk of rupture.

A ruptured aneurysm has very pronounced symptoms. The patient experiences a “thunderclap” headache, a kind that is excruciatingly painful and comes on suddenly, reaching a maximum intensity within 60 seconds. “Some call it the worst headache they have ever had and may also complain of nausea, vomitting, stiff neck and sensitivity to light. Yet others may experience a Sentinel headache, where an aneurysm leaks, leading to blood pooling days or weeks before a full rupture. This can cause a warning headache. We usually use medication to stabilise blood pressure and manage the condition before we do a procedure to prevent re-bleeding,” says Dr Goel.

What are risk factors of aneurysm?

Most aneurysms and strokes induced by them are almost always a result of stress

Story continues below this ad

and resulting high blood pressure. “These are diagnosed mostly in women aged between 40 and 60. Now although no study and scientific evidence have actually been able to pinpoint the trigger, theoretically, a significant drop in estrogen after menopause is linked to aneurysm formation. Estrogen is believed to have a protective effect on blood vessel walls, and its reduction can decrease collagen content and weaken arteries,” says Dr Goel.

Equally important is controlling modifiable risks such as smoking, drug use, excessive alcohol intake and high blood pressure, all of which damage the lining of blood vessel walls. Then there are co-morbidities like diabetes, cholesterol and obesity to watch out for.

A first-degree relative with an aneurysm increases risk significantly. Medical conditions like polycystic kidney disease, connective tissue disorders and prior head injuries create conditions for aneurysm to develop.
Certain daily activities — intense physical exertion, emotional stress, or straining — can momentarily raise blood pressure and trigger rupture in a weakened vessel.

“Early detection is the strongest safeguard against life-threatening complications. Had she delayed another few weeks, Neha’s aneurysm could have burst with catastrophic results. Today, specialists can identify aneurysms before rupture using state-of-the-art neuroimaging techniques such as CT angiography (CTA) and MR angiography (MRA). Non-invasive treatment options include coiling (placing coils to seal the aneurysm), flow diverters (stents to redirect blood flow for healing), and surgical clipping (placing a clip at the aneurysm’s neck to stop blood flow),” says Dr Goel.

Story continues below this ad

How brain aneurysms manifest

Aneurysms typically occur in the arteries that are located at the base of the brain. Most brain aneurysms are silent — small and unruptured, producing no symptoms, until they become large or ruptured and are discovered incidentally during imaging for unrelated issues. However, larger or growing aneurysms may compress nearby brain tissue or nerves, causing subtle warning signs that must never be ignored — persistent or unusual headache (especially behind or above one eye), blurred or double vision, pain above or behind the eye, drooping eyelids or facial weakness, numbness on one side of the face, trouble talking or understanding.

Why are younger people being affected now?

Recent years have seen a troubling rise in aneurysm cases among young adults, driven by lifestyle stressors. “Chronic stress, poor sleep, erratic diets, and stimulant use (including energy drinks or recreational drugs) are elevating blood pressure earlier in life. While stress may not directly cause an aneurysm, it can accelerate risk factors. Chronic stress is the worst as it may elevate blood pressure, cause inflammation and vascular alterations that produce a weakening of the arterial walls. In Kim Kardashian’s situation, she described that the emotional stress she experienced during her relationship and personal stress may have pushed her over the edge — a reminder that mental health and physical health are interconnected,” says Dr Goel.

Combined with increased access to MRI and CT imaging, more incidental aneurysms are being detected in the young, some before they can cause harm.

Being vigilant: Protecting your brain

Know your family history and discuss screening if relevant. Monitor your blood pressure regularly — even in your 20s and 30s. Quit smoking and limit alcohol consumption. Don’t ignore persistent headaches or vision changes. Seek immediate help for sudden, severe headaches. “We need to educate everybody. A full body check-up comprises a battery of tests geared to heart health but not brain health. So consult a neurologist whenever you experience persistent headaches, seizures, stroke symptoms, dizziness, or memory loss. A brain aneurysm may be silent but lack of awareness is its greatest enemy. And contrary to fears, a brain MRI is a non-invasive procedure, does not use radioactive materials and therefore has no associated radioactivity costs. You don’t even need a contrast dye always. It is an outpatient procedure, costing around Rs 2,500 in public facilities and anything between Rs 5,000 and Rs 10,000 in a private facility,” explains Dr Goel.

Story continues below this ad

Although older policies may only cover diagnostic tests associated with a hospital stay, many newer policies and comprehensive plans include outpatient coverage, sometimes up to a certain limit. Some companies insist upon a pre-authorisation before the procedure. “Brain imaging tests are cheaper than the heart ones and help in controlling aneurysms,” says Dr Goel.