Stroke Concerns: Exploring Non-Surgical Options for an 80-Year-Old

Q: Stroke Concerns: Exploring Non-Surgical Options for an 80-Year-Old

Hello Ms. <br>Mikle： Your mother is 80 years old and has a 0.5 cm aneurysm in a major blood vessel as seen on the CT scan. <br>She is experiencing dizziness and aphasia. <br>Since it is unclear whether the tumor is intravascular or extravascular and what her current condition is,

Stroke-related complications (Please help my mother)

Hello Dr.
Lee! My mother is 80 years old and a CT scan revealed a 0.5 cm aneurysm (located at the largest cerebral blood vessel).
Initially, for three days, she had no stroke symptoms and her limbs were functioning well.
However, she is now experiencing dizziness (which she has had occasionally in the past but could manage with medication; currently, the doctor is hesitant to prescribe anything, believing it may be related to a stroke).
Due to her agitation, she was given a sedative, and for the first three days, she could say a few words (her speech was normal before), mainly mentioning dizziness and throat pain.
Now, she is unable to speak.
Aside from surgery, are there any other options available, such as injecting a substance into the blood vessel at the site of the aneurysm to prevent rupture, thus avoiding brain surgery? I would appreciate any relevant information you could provide.
Thank you in advance for your prompt response.
(Date: 94/12/20)

MILLE, 80~89 year old female. Ask Date: 2005/12/19

Dr. Li Junde reply Surgery

Hello Ms.
Mikle: Your mother is 80 years old and has a 0.5 cm aneurysm in a major blood vessel as seen on the CT scan.
She is experiencing dizziness and aphasia.
Since it is unclear whether the tumor is intravascular or extravascular and what her current condition is, it would be more appropriate to have the attending physician explain the situation and possible management options.

Reply Date: 2005/12/19

More Info

When considering the treatment options for an 80-year-old patient with a 0.5 cm aneurysm in a major cerebral artery, it is crucial to weigh the risks and benefits of surgical intervention versus non-surgical management. The decision-making process can be particularly challenging in elderly patients, especially when they present with additional complications such as dizziness, agitation, and impaired speech.

Firstly, it is essential to understand the nature of the aneurysm. A cerebral aneurysm is a bulge in a blood vessel in the brain that can potentially rupture, leading to a hemorrhagic stroke. The size of the aneurysm, its location, and the patient's overall health are critical factors in determining the appropriate course of action. In this case, the aneurysm is relatively small (0.5 cm), which may influence the decision regarding surgical intervention.

Surgical options typically include clipping or endovascular coiling. Clipping involves opening the skull to place a clip on the neck of the aneurysm, while coiling is a less invasive procedure that involves inserting coils into the aneurysm through a catheter to promote clotting and seal it off. Both procedures carry risks, especially in older patients who may have comorbidities such as hypertension or cardiovascular disease.

Given your mother's age and current health status, the risks associated with surgery must be carefully considered. Older patients often have a higher risk of complications from anesthesia and surgery, including infection, bleeding, and prolonged recovery times. Additionally, if your mother is already experiencing cognitive decline and communication difficulties, the potential for a poor outcome post-surgery may be higher.

On the other hand, non-surgical management may be a viable option, particularly if the aneurysm is stable and not causing significant symptoms. This approach typically involves regular monitoring through imaging studies (such as CT or MRI) to assess any changes in the size or characteristics of the aneurysm. Medications may also be prescribed to manage symptoms such as dizziness or agitation, although caution is warranted given the potential for interactions and side effects in elderly patients.

In some cases, endovascular techniques may be considered as a less invasive alternative to traditional surgery. For example, if the aneurysm is accessible, a neurointerventionalist may be able to place coils or stents to manage the aneurysm without the need for open surgery. This approach can reduce recovery time and minimize the risks associated with general anesthesia.

Ultimately, the decision should involve a thorough discussion with your mother's healthcare team, including her neurologist and possibly a neurosurgeon. They can provide insights into the specific risks and benefits of each option based on her individual health status and the characteristics of the aneurysm. It may also be beneficial to seek a second opinion to ensure that all potential treatment options are considered.

In conclusion, while surgical intervention may be necessary in some cases, it is essential to evaluate the risks and benefits carefully, especially in elderly patients. Non-surgical options, including careful monitoring and possibly endovascular treatments, may provide a safer alternative. Open communication with healthcare providers and family discussions about your mother's wishes and quality of life are vital in making the best decision for her care.

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