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mmc Some aneurysms are more prone to rupture

But the reason why is still a mystery

Tribune Media Services

DEAR MAYO CLINIC: I am 34 years old and have endured two brain aneurysms bursting within the last two years. I want to find out why this is happening and what can be done. What can you tell me?

A: An aneurysm is a thinning of blood-vessel walls that produces a sac-shaped bulge vulnerable to rupture. As you have already experienced, a ruptured brain aneurysm is a medical emergency; unless treated swiftly, its bleeding can cause brain damage and death.

Millions of people have brain aneurysms -- some 10 to 15 million in the United States, as suggested by autopsies -- yet physicians have long been puzzled by the fact that aneurysms rupture only in a relatively small fraction of those people (about 30,000 per year). Clearly, some aneurysms are more prone to rupture than others. While we do not know why, and we also are unable to predict rupture, we are conducting studies to help answer these questions.

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Approximately 10 percent of patients have a family history of aneurysms; these cases are known as "familial." The remaining 90 percent fall into the category of "sporadic" -- they appear to be randomly distributed in the population, except that aneurysms are slightly more frequent in women and smokers. When an aneurysm ruxtures, half of the patients die within the first month. Among the survivors, half are disabled. The fact that you have survived two ruptured brain aneurysms in two years is a testament to good fortune and to the quality of care you have received. But this history suggests that you are at risk to form new aneurysms.

As best we can tell from natural-history studies, many aneurysms either stabilize or rupture soon after forming, prompting some physicians to argue against surveillance imaging of the brain. However, given your degree of risk, I recommend that you adopt the following practices: 1) Have lifelong follow-up with a good cerebrovascular neurologist; 2) undergo periodic surveillance imaging of your brain; 3) never smoke; 4) and discuss any new problems that arise with your neurologist. -- Dr. John Atkinson, Neurosurgery, Mayo Clinic.

READERS: Vitamins are taking on a new role in health care -- to help manage or treat disease. You may only think of your over-the-counter multivitamin as backup for not getting enough vitamins in your diet. But researchers are finding ways for vitamins to do more:

B vitamins to manage cardiovascular health. When your body breaks down protein, a byproduct is homocysteine (ho-mo-SIS-teen). High homocysteine in the blood is linked to heart disease and stroke. A number of factors are thought to influence increased homocysteine, including a lack of certain B vitamins, especially folic acid, vitamin B9.

Niacin (vitamin B-3) to improve "good" cholesterol. Taken in large doses, niacin can potentially boost high-density lipoprotein (HDL), the "good" cholesterol by 15 percent to 30 percent, or occasionally up to 50 percent.

Riboflavin (vitamin B-2) to help prevent migraine headaches. Very preliminary evidence has found that high doses of riboflavin might help prevent migraine headaches for some people.

Taking vitamins as medicine should be done under a doctor's supervision. The recommended doses can be significantly higher than those in a multivitamin and may cause side effects.

To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

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