Question Title: Cerebral Aneurysms, Hypertension, Clinical Depression & OCD

44 yo White Male with 3 yr Hx of Clinical Depression, OCD and Generalized Anxiety
Disorder. Was treated with Luvox, up to 300 mg day, changed Psychiatrists 3mos ago
and meds changed to Ativan and Prozac. Was experiencing numbness in both legs from knees
to hips and left arm as well as left part of face on one occasion. An MRI an MRA was
conducted to R/O MS and a suspected aneurysm was found. A cerebral angiogrom was
conducted and the reports reads "Selective injection of the right internal
carotid artery and examination of the intercranial circulation supplied by the
right internal carotid artery shows a posterior communicating artery aneurysm
appro. 4mm, in size. Remainder of the intercranial vascular structures are unremarkable
although ther is non filling of the anterior cerebral system noted. My Neurologist
had a consult prepared for surgery, the next day. Frankly I was totally unprepared.
What are risks, surgery vs. non surgery, this size is relatively small in
comparison to other information I have read. I have taken hypertension meds for
20+ years, smoke 2 ppd, weigh 250 lbs, am a bank executive with a ton of stress.
Take Avapro 150 mg QD,HS for BP. Is aneurysm related to hypertension. Can I expect to
continue to work without surgery. While we have several Neurosurgeons in this
area, I am sure this in not done here everyday. Have the Surgery or not?
Is this a chronic, acute or terminal illness. Will the stress kill me.
Thank you,
Steve

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Dear Steve, I am afraid I camnnot answer specific questions like
" will stress kill me " however I can give you statistical chances regarding
some of your questions. The combination of smoking 2 packs per day, obesity,
hypertension and stress is obviously not the best autuarial profile and
enourmously increases your risk for a heart attack or stroke in the future.
It is very likely that your chronic hypertension caussed the aneurysm.
The presence of an anuerysm is obviously not an acute illness since this
implies that it appeared suddedenly, it would only be terminal if it
ruptured and caused your death, so by exclusion it is a chronic condition which
you can chose to ignore, continuing to work without surgery if you wish. The
problem is that small aneurysms usually cause no problems until the point
when the burst, at that stage they can cause major problems.
A recent canadian study found that the YEARLY risk for rupture was 2%,
the risk of death or significant disability 735 and the risk of surgical complications
6.5%.
As you can see the longer you continue the more the risks of leaving the
aueurysm intact (20% chance of rupture over the next 10 years), outweigh the risks associated with surgery.

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