Possible un-ruptured intracranial aneurysms

[Tripacer1]

Guys,

I have a friend who has a possible un-ruptured intracranial aneurysms. It was discovered in a CAT scan for an other problem, that turned out fine. He went to a doctor who advised him, since it was only 2mm, the likely hood of a problem would be less than one percent, and the complications from surgery were 5% to 25%. The doctor said, that the person had probably had it from birth and the condition was genetic. Therefore, the doctor advised him to not have an operation.



Tripacer 1

 

[bbchien]

And that is good advice. The rate of rupture at clipping of intracranial aneurysms is about 20%. It's pretty near fatal.

I have a colleague whose father stepped onto the curb at Mitchell Field to be taken to the hotel for an overnight before flying out the next AM on American (was a DC7 Captain). He fell to the curb, and never recovered. How does he know what happened? The guy's a Neurosurgeon.

The real question is, say you get one of those advertised "proactive health" scans and they find a "berry aneurysm" in your head. Now, WHAT DO YOU DO WITH THE INFORMATION?

 

[Tripacer1]

Bruce,


That is the problem.

And he is a pilot as well.

Does he report it on his next FAA medical?

Or does he just fly as a Sport Pilot?

Tripacer1

 

[bbchien]

The presence of an asymptomatic aneurysm of that small size should not be disqualifying....I would not describe it, I would describe on the 8500-8 why the scan was done and that whatever it was he was looking for was not found....

 

[n741dm]

The presence of an asymptomatic aneurysm of that small size should not be disqualifying....I would not describe it, I would describe on the 8500-8 why the scan was done and that whatever it was he was looking for was not found....

Bruce~
As always, I appreciate reading your responses to things Medical. It seems to me though, continued medical certification aside, that something like this brings up some serious "ethical" or real world problems for the affected pilot...

Let's assume you are the one with the recently diagnosed little time bomb buried in your cranial cavity - would you continue to fly your family? Would you warn your passengers? Would you only fly with another competent pilot?

That is a toughie, isn't it?

 

[Unregistered]

Don,

That is a tough process to go through.

But 1 in 15 Americans will develop an aneurysm some time in their life.

There are a lot of the people do not know, if they have an un-ruptured aneurysm or not. There appear to be no symptoms.

Only through an MRI, MRA or CAT scan , with contrast are they noticed.

Would you want to have an expensive test, for a FAA physical, with NO symptoms?

I think not.

Radiologist

 

[n741dm]

Don,
Would you want to have an expensive test, for a FAA physical, with NO symptoms?

I think not.

Radiologist

I agree completely. As a matter of fact, my father-in-law dropped dead from just such an undiagnosed aortal aneurysm when he stood up to open the door for his wife...

My point was not that they do not exist, nor that testing should be done willy-nilly to try to find them. I guess I was questioning the ethics of continuing to fly as the only capable pilot aboard after you know one exists. Difficult question, given the low incidence rate of failures for the small ones. One I suspect each will have to answer individually.

Oh, and thank you for chiming in! It is good to have you on the board looking around. Why not sign-up? The price is certainly right.

 

[Carol]

I agree completely. As a matter of fact, my father-in-law dropped dead from just such an undiagnosed aortal aneurysm when he stood up to open the door for his wife...

My dad's brother had an aortic aneurysm repair. Shortly after that my dad heard about a study being done at a nearby major medical center of siblings of patients with aortic aneurysms. He enrolled, they did the tests, and sure enough he had one. (The study apparently showed a statistically significant occurence of AA in siblings of patients with them.)

Now, did they go ahead and operate on my dad? Noooooo. The aneurysm was "too small." As a former operating room nurse who has witnessed death on an OR table from a ruptured aneurysm I was ****ED. Long story short, they watched it for a few years and finally it got "big enough" to operate.

So, if he were a pilot should he have grounded himself with that knowledge in hand?

 

[bbchien]

Don, We think about 0.02% (or some such low number) of Americans have Berry aneurysms in their brains. They are out there flying- it might be you or I for that matter! So now, just because the individual has a known Berry aneurysm- is his risk of incapacitation any greater now that we know?

Nope. It's the same. Posterior probability is unchanged.

Now the Abdominal Aortic aneurysm is a different matter. Elective repair has a very high success rate. Rupture has a terribly bad survival rate even with within the first hour intervention. Plus, we know how to follow these- annual echograms, and when the diameter exceeds 6 cms, it's time to operate. This is NOT a condition that will rupture suddenly when below 6 cms in size, so is not a disqualifier.

 

[n741dm]

Bruce~
Good to know that. Thanks for sharing your expertise once again. I know when Russ' aortal aneurysm burst, the Dr said he was probably dead before he hit the floor. Terrible shock of course to all the surviving family members, but in retrospect, not a bad way to go when it is time.