The patient, Huyen, was rushed to the emergency room in a semi-conscious state, unresponsive to calls, after experiencing a day of severe headaches. Tam Anh General Hospital in Ho Chi Minh City activated its "Code Stroke" protocol. Her blood pressure was high at 154/90 mmHg, and her Glasgow Coma Scale score was 12, indicating severe neurological damage. She had a history of hypertension but hadn't been consistently taking her medication.

Dr. Chu Tan Si, Head of the Department of Neurosurgery - Spine at the Neuroscience Center, suspected a hemorrhagic stroke. A 1975-slice CT scan with integrated AI technology helped pinpoint a nearly 0.6 cm aneurysm at the end of the left middle cerebral artery (M1) in the Circle of Willis, a critical area with numerous blood vessels supplying the brain. The scan also revealed what appeared to be a daughter aneurysm, suspected to be the rupture point.

The patient also had extensive cerebral hemorrhage with a large blood clot, over 5.5 cm long, in the left temporal-parietal lobe. This caused surrounding cerebral edema, compressing the left ventricle and shifting the midline 0.5 cm to the right. The scan also showed subarachnoid hemorrhage spreading across both hemispheres, into the ventricular system above and below the tentorium, along with slight dilation of the ophthalmic veins.

"A ruptured aneurysm like this is very serious and dangerous, with a generally poor prognosis," Dr. Si said. The medical team decided on surgery to remove the blood clot and clip the neck of the aneurysm to prevent further complications like deep coma, progressive paralysis, and seizures.

Doctors examine a 3D image of the skull before surgery. Photo: Tam Anh General Hospital

Doctors examine a 3D image of the skull before surgery. Photo: Tam Anh General Hospital

According to Dr. Si, clipping the aneurysm neck is the gold standard treatment for complex ruptured aneurysms, preventing recurrent bleeding while maximizing neurological function preservation. However, this is a difficult microsurgical procedure because the area around the Circle of Willis contains many vessels that supply blood to the brain, and even a small mistake can have serious consequences.

Before the surgery, a neuronavigation system processed and reconstructed precise anatomical images, allowing doctors to continuously monitor the position of instruments relative to blood vessels and healthy brain tissue in real-time. This enabled them to accurately target the aneurysm neck, clip it completely, remove the large blood clot, and relieve pressure on the brain.

On the third day after surgery, Huyen was alert, with no further seizures or recurrent bleeding. By the fifth day, she was walking with the assistance of a physical therapist.

Doctors perform surgery to remove the blood clot using a Zeiss Kinevo 900 surgical microscope. Photo: Tam Anh General Hospital

Doctors perform surgery to remove the blood clot using a Zeiss Kinevo 900 surgical microscope. Photo: Tam Anh General Hospital

Dr. Si explained that a ruptured brain aneurysm is one of the most dangerous causes of hemorrhagic stroke, with a mortality rate of up to 50%. It can leave lasting effects like paralysis, speech loss, and dementia if not treated promptly.

The condition can remain silent for years, only manifesting when the aneurysm ruptures, often with sudden severe headaches, vomiting, altered consciousness, or seizures. Risk factors include hypertension, smoking, heavy alcohol consumption, high cholesterol, genetic predisposition, and being a woman over 50.

For prevention, Dr. Si recommends controlling blood pressure, adhering to medication, maintaining a healthy lifestyle, limiting alcohol, and quitting smoking. Those with a family history of aneurysms or unusual headaches should seek early consultation at a specialized facility for screening with MRI or CT angiography. Early detection allows doctors to monitor or implement preventative measures, avoiding serious complications.

Phuong Thy