Massive! "Drunken Rage" or Genuine Illness? It Turns Out to Be a "Time Bomb" in the Body

At 37 years old, Zhang Wen (pseudonym) suddenly suffered a severe headache after drinking alcohol, accompanied by constant shouting and pounding. His family initially thought the headache was caused by alcohol and that the shouting was just “drunken rage.” However, his sharp-eyed cousin sensed something unusual and believed his headache was not simple, so she rushed him to the hospital.

At 2:00 AM, the medical team began the challenge of racing against time.

Two months ago, Zhang Wen was brought to HeYou Hospital due to a severe headache, during which he kept shouting and pounding his head. The doctor immediately performed a head CT scan, which revealed significant subarachnoid hemorrhage. Emergency intracranial decompression was performed, successfully controlling the bleeding and significantly alleviating the headache symptoms.

Subsequently, a CT angiography scan of the head confirmed that the cause of the bleeding was a ruptured aneurysm at the ophthalmic segment of the internal carotid artery. The aneurysm measured 25×12 mm, classifying it as a giant aneurysm.

Examination Revealed a Giant Cerebral Aneurysm

A cerebral aneurysm is an extremely dangerous condition that can cause sudden death, with a mortality rate as high as 40% after a single rupture. It is like a “time bomb” already “hidden” in the skull. Without prompt and standardized treatment, the aneurysm is highly likely to rupture and bleed again, leading to cerebral herniation, cardiac and respiratory arrest, or cerebral vasospasm resulting in paralysis, coma, or even death.

Given this, Professor Li Baomin, Director of the Neurointerventional Department, who participated in the consultation, immediately led the team to manage the case. “Treatment options for cerebral aneurysms generally include surgical clipping and endovascular embolization. Given the size and unique location of his aneurysm, we decided to proceed with endovascular embolization,” said Director Li. Endovascular embolization is the optimal method to prevent a second rupture and bleeding of a cerebral aneurysm.

Although Zhang Wen's condition was stable at the time, a re-rupture could occur at any moment. Therefore, the team urgently conducted a preoperative discussion and formulated a detailed two-stage surgical strategy. Why two surgeries? According to Director Li, Zhang Wen's aneurysm was giant, and simple stent-assisted coiling would have a high recurrence rate. The primary goal of the first surgery was to stop the bleeding. After the bleeding was controlled, a second surgery would be performed to completely occlude the aneurysm.

Director Li Baomin in Surgery | Archive Image

During the procedure, Director Li skillfully guided the blood flow to change direction using his exquisite technique and experience, effectively preventing further expansion and rupture of the aneurysm. The surgery was completed successfully, and angiography showed dense embolization of the aneurysm with no opacification of the sac. On the third day post-surgery, Zhang Wen was able to get out of bed, and his limb movement, language function, etc., were all normal. “He felt completely relieved and could even chat happily with the doctors and nurses,” his family said with a smile.

Recently, Zhang Wen successfully underwent the second-stage surgery at HeYou Hospital. Director Li completely occluded the aneurysm and reconstructed the arterial channel, eliminating the risk of recurrence.

Although the term “aneurysm” contains the word “tumor,” it is not a tumor. It is a localized, abnormal dilation of the inner wall of a cerebral artery, forming a bulge at a weak point.

Congenital vascular wall defects or vascular developmental abnormalities are significant causes of aneurysm formation. Additionally, long-term conditions such as hypertension and hyperlipidemia leading to atherosclerosis can also trigger aneurysms. Infections, trauma, and certain rare factors may also contribute to aneurysm development.

The clinical manifestations of a cerebral aneurysm differ depending on whether it has ruptured:

When Unruptured: There may be no obvious symptoms, or only mild headache, dizziness, etc. When the aneurysm is large, it may compress adjacent nerves or brain tissue, causing corresponding compression symptoms such as oculomotor nerve palsy (manifested as unilateral ptosis, dilated pupil, etc.), trigeminal neuralgia, facial numbness, etc.

When Ruptured: It presents as a sudden, severe headache (often described by patients as “my head is going to explode”), frequent vomiting, profuse sweating, fever, neck stiffness, altered consciousness, or even coma. Some patients have triggers such as fatigue or emotional agitation before the hemorrhage, while others have no obvious triggers or experience onset during sleep.

Cerebral aneurysms are also metaphorically described as “still as water, fierce as a beast.” How to prevent this “beast”? Focus on the following six aspects:

1. Control Hypertension: Hypertension is one of the main risk factors for cerebral aneurysms. Regular monitoring and keeping blood pressure within the normal range is crucial.

2. Healthy Diet: Maintain a diet low in salt, low in fat, and high in fiber. Eat plenty of vegetables, fruits, whole grains, and fish rich in high-quality protein.

3. Weight Management: Obesity increases the risk of developing a cerebral aneurysm, so maintaining a healthy weight is important.

4. Quit Smoking and Limit Alcohol: Smoking and excessive alcohol consumption increase the risk of cerebral aneurysms. Quit smoking and limit alcohol intake as early as possible.

5. Maintain Mental Health: Actively coping with stress, maintaining a positive attitude and emotional state can also help reduce the risk of cerebral aneurysms.

6. Regular Brain Check-ups: For individuals with a family history or high-risk factors, regular brain examinations should be performed to detect and treat cerebral aneurysms early.

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Author of this article>>>Niu Si

Professional Guidance>>>Li Baomin Chief Physician, Professor, Director of Neurointerventional Department (Former Lead of Neurointerventional Specialty at PLA General Hospital)