Neurosurgeon Dr. Paul Saphier breaks down what brain aneurysms are, how they’re detected, and what Kim Kardashian’s recent diagnosis means for public awareness. He discusses the warning signs, rupture risks, and treatment options—plus why early screening is critical for those with a family history. A must-listen for anyone looking to better understand brain health and prevention. Wellness Unmasked is part of the Clay Travis & Buck Sexton Podcast Network - new episodes debut every Tuesday & Friday.
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Episode Transcript
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Speaker 1 (00:00):
Welcome to Wellness Unmasked. This is doctor Nicole Sapphire and
we have to tackle something that hit the news media
headlines this week. It is medical, but I guess when
you're talking about the Kardashians.
Speaker 2 (00:12):
Though, it feels like a little less medical. That's right.
Speaker 1 (00:15):
Kim Kardashian has announced that when she was undergoing brain
emri imaging that they found, in her words, a little
brain aneurism, and she said that they told her it
was probably due to stress, and she blames the divorce
stress from her tumultuous divorce from Kanye West. Kim Kardashian
(00:37):
blaming her brain aneurysm on divorce stress is probably the
most Kardashian thing I've seen this year, maybe even the
last several years. To truth be told, I've never actually
seen an episode of the show. Obviously, it's wildly popular,
and all of these sisters and their mamager Chris Jenner,
are wildly successful, so they're clearly doing something right. But
(00:59):
it seems to be they're always surrounded by drama and
this brain aneurism diagnosis. While it is dramatic and can
be lethal, the way that it came about kind of
made me chuckle in the sense that divorce brain aneurysm. Well,
that's a first for me. So I decided why not
ask an expert. I happen to be married to one,
doctor Paul Sapphire. He's an endovascular Board certified neurosurgeon who
(01:23):
specializes in yep, brain aneurisms, strokes. Here we go, let's
dive right in and here he is everyone, my husband,
doctor Paul Sapphire, As I mentioned, endovascular neurosurgeon who he
specializes in brain tumors, vascular malformation, strokes, but also brain aneurysms. So, Paul,
thank you so much for joining wellness.
Speaker 2 (01:43):
I'm measked thank you for having me again.
Speaker 1 (01:46):
So here's the question. I told you about this headline
because I know you're not up with the Kardashian drama,
But so what do you make of the fact that
Kim Kardashian now has this incidental brain aneurism? Tell us
a little bit about it.
Speaker 3 (01:58):
Well, in a way, finding incidental brain aneurysms can sometimes
be almost like opening up Pandora's box, right, because clearly,
from what I understand, she's had no symptoms. This is
purely a screening type. Imaging scenario in which she under
a wellness check and they found this brain aneurysm. And
sometimes it's hard to know exactly what's the right thing.
(02:20):
You know, air quotes the right thing to do for aeurisms. Obviously,
whatever gets us to having patients of a long healthy
life is the right answer. But when we refer to
incidental aneurisms, you know, incidental means what incidental, I'm sorry,
means that it is incidentally discovered. It has not caused
a problem, it's not causing any symptoms.
Speaker 2 (02:40):
But you found it one way or another.
Speaker 3 (02:42):
Either you come from a long line of family members
that have a history of brain aneurysms or bleeding in
the brain or things like that, or you have certain
risk factors that maybe they screened you for, you know,
for brain aneurisms. But incidental in the sense that it's
not causing a problem, the question always becomes.
Speaker 2 (02:59):
Well can it potentially cause a problem.
Speaker 3 (03:01):
And anyone who's been a patient of mind that's set
in my office and has talked to me about their
incidental angeism has heard me use this analogy, which is
anything can happen to anyone. Any airplane, god forbid, could crash, right,
But there are things that may or may not make
an airplane crash more likely.
Speaker 2 (03:19):
Right.
Speaker 3 (03:20):
So you know, thankfully, if you're leaving from a you know,
lax or Newark airport in the middle of the day
and it's a beautiful weather and you're on a brand
new airplane, the risk you know, of the airplane crash
is incredibly low, not zero, but incredibly low.
Speaker 1 (03:34):
Right.
Speaker 3 (03:35):
So, there are certain characteristics of a brain aneurism that
may make it incredibly low risk of that andery bleeding
in someone's lifetime or higher. And if someone has an
aneurism that has certain characteristics, or they themselves have certain
health characteristics that may make it like more or less
likely in their lifetime or that aneurism to bleed, then
(03:56):
maybe we do correct that aneurism ahead of time before
or it becomes a problem for that person.
Speaker 1 (04:03):
So I just want to give some background and aneurism.
If you think of the blood vessels in the brain, right,
they're kind of like, I mean to basically put like
a canal system. You have blood flowing through them, and
they're kind of like in these tubes. And aneurism is
like a focal area where that wall of the tube
has weakened and it's kind of ballooning out right.
Speaker 2 (04:21):
That's right.
Speaker 3 (04:21):
So an aneurism is a weakening the wall of blood vessel.
It can occur anywhere in the body. It can happen
in any blood vessel in the body. So when people say, oh,
my my grandmother had an aneurysm, well, I may know
if that means, but we don't really know exactly where
that anural is located. When we talk about a brain aneurism,
we're talking about obviously the blood vessels that are within
(04:43):
the brain. Now, the interesting thing is that when we
talk about brain aneurysms, we have to, you know, segregate
which blood vessels within the brain, because ironically, certain blood
vessels may have a higher or lower likelihood of those
having an aneurism of those aneurisms bleed, meaning that you
can have a brain aneurysm, a blood vessel that is
(05:04):
within the segment of the brain that has an aneurysm,
but the likelihood of that aneurism rupturing may be solow
we choose never treat it, and if it were on
a slightly different blood vessel within the brain, that same aneurism,
we may say, oh gosh, maybe we should treat it
before it cause the problem. But yes, it is a
weakening the wall of a blood vessel. Clearly the size
(05:26):
of that aneurism. The bigger, the larger that aneurism, the
more likely it is for that aneurism to rupture. Probably
what's the most important risk factor of that aneurism rupturing
is actually the rate of growth. So typically people aren't
born with brain androisms. They form over time. It can
happen in just about anybody. There are certain risk factors
which we can talk about in a moment that may
(05:46):
increase or decrease the likelihood of you having a brain
aneurysm or an angerism rupture. But probably the most important
thing is the rate of growth. So when we find
someone like ms Kardashian who gets a scan, you know
whenever you just recently had it done and snapshot in time,
we don't know what that aneism looked like six months ago,
six years ago, so we don't really know the rate
of growth of that aneurism. Now, she probably has been recommended.
(06:08):
If they're not recommending treatment for the aneurism, my supposition
is that they're recommending that she follow it with regular
imaging and so you're going to try from the fact.
Speaker 1 (06:16):
That she said that it was very small, right.
Speaker 3 (06:19):
Based upon that fact, I have no idea. I mean,
I'm assuming she's seeking treatment out in Los Angeles. I'm
assuming that's where she lives. And you know, I know
a lot of colleagues out there who are excellent and
I'm sure they're giving her very solid medical advice in
terms of how to manage or monitor that aneurism. But yeah,
if the angurism is small, incidental, and the risk calculated,
(06:40):
and we have different kinds of algorithms that we can
look at that give us a potential in terms of
someone's lifetime what that risk of rupturing is. If that
risk is low over their lifetime, well, then treating that
aneurism with some type of surgical maneuver ahead of time
may not be warranted.
Speaker 1 (06:56):
Okay. So ultimately, when it comes to Brandy anisism, obviously
the thing that we're most concerned about is it rupturing,
because that is when there's bleeding in the brain. And
historically this had a very high fatality rate, right like
over fifty percent of people who had a ruptured brain
andewism would die.
Speaker 3 (07:14):
So well, back in the day, you know, before people
were getting certainly screening MRIs so regularly or routinely. You know,
back vida, the only way that we really found patients
that had brain and were after they had ruptured. And
you know, the mortality rate for brain animal ruptures and
casts of bleeding in the brain, the risk of mortality
(07:34):
is actually really high. I think overall it's probably as
high as seventy percent in some instances seventy to eighty percent.
And really importantly too, is all those people that survive.
Of the twenty to thirty percent overall that survive, the
majority of those patients do not return to functional independence.
And functional independence doesn't necessarily mean going back to driving
(07:55):
and working. It we're talking about the daily activities that
we all take for granted until taken away. Bathing yourself,
clothing yourself, grooming, feeding yourself.
Speaker 2 (08:06):
That sort of thing.
Speaker 3 (08:07):
So you're talking about a really serious condition, and that's
why we have a low threshold as neurosurgeons. We have
a very low threshold for treating what might seem as
relatively small aneurism, especially in someone who's younger and has
many lives ahead of them, many years ahead of them
in their lifetime. Well aggregating that risk over time, that
risk of ayers and rupturing may be quite high, so
you may choose to treat that person. But yes, overall,
(08:27):
the risk of death and major disability from a rupture
brain and very very high. In fact, upwards of a
third of people that have a ruptured brain and yours
don't even survive to make it to the hospital.
Speaker 1 (08:37):
You're listening to Wellness and Mass. We'll be right back
with more. So I know that I know this from
personal experience, because you get called in the middle of
the night or during dinner or wherever we may be,
or treating someone who's already had a ruptured brain anerism,
and you go in. You know, sometimes you do end
of vascularly where you're going in through the groin or
(08:59):
the and blood vessels to access the brain, but you're
also going in sometimes removing the skull, cleaning out if
it's already ruptured, all the blood. But you're saying, I
know this, but just for everyone listening. One of the
key things when you've identified an aneurysm, if you've determined
that it's at risk of rupture, and this is based
on many things, like you said, the size, the rate,
(09:20):
of growth, if you decide to treat it to try
and prevent it from rupturing, what does that look like.
Speaker 3 (09:27):
So treatment has evolved in everything in medicine, but certainly
in neurosurgery has evolved tremendously, and so in twenty twenty five,
soon to be twenty twenty six, we have a lot
of treatment options for brain and reskins. But they fall
into two main category. Either conventional brain surgery, which although
that's the most most invasive and the most time consuming
(09:49):
and complex, is the most relatively straightforward to understand.
Speaker 1 (09:52):
You know, conventional that's the clipping. You're talking about clipping.
Speaker 3 (09:55):
So essentially what we do is we make an incision
wherever this in the head. We open up that part
of the skull which gently dissect the different layers of
the brain, identify the blood vessels and the aneurism itself,
and place a clip and a clip the analogy that
I use think of the.
Speaker 2 (10:10):
Small clothes pin, so a little.
Speaker 3 (10:13):
Matt but it's made out of metal, made out of titanium,
a little spring loaded pin that actually cinches down and
it seals off. You place that that cinch at the
base of the aneurism that called the neck of the aneurism,
and that blocks blood flow into the anurism, so blood
cannot flow into the aneurysm. If blood can't flow into
the aneurysm but still is flowing within the normal blood vessels,
(10:34):
the aneurysm cannot rupture. Again, that's a very basic conceptual
understanding of that and of vascular treatment on the other
end of the spectrum, And there's many different.
Speaker 1 (10:44):
Like this is something specialized that you did advance straining for.
Actually at UCLA, not all neurosurgeons one can clip aneurysms,
but even fewer can do endovascular treatment.
Speaker 2 (10:55):
Right, that's true.
Speaker 3 (10:56):
So there are very few neurosurgeons, relatively speaking, across the
country who are dual trained, you know, doing both open
vascular and the aravascular surgery as well as doing endovascular surgery.
And the analogy that I use is very similar to say,
heart surgery. You have open heart surgeons that will crack
open the chest and do open heart surgery and fix
(11:16):
the heart that way, and then you also have interventional
cardiologists will go through the blood vessels usually in the
arm or the leg with their tubes and cafeters and
fix the heart from the inside out, and we do
something similar albeit very different for the brain and blood
vessels within the brain. And I'm capable of performing both
those types of procedures, and so for endovascular therapy or
endovascular surgery for brain aneurysms, there's a couple different ways
(11:41):
that we can treat them, a very couple different technologies
that we can employ right now.
Speaker 2 (11:45):
But the basic principle.
Speaker 3 (11:46):
Is, again, we go through the ardor usually oftentimes I'll
go through the ardor here in the wrist, the very
thin but long tube guide that all the way up
to the blood vessels of the neck. Using X ray,
inject a little bit of dye contrast see the blood vessels,
and then go further up into the blood vessels of
the brain. And then similar to the clipping in the
sense we're trying to exclude the brain aneurysm from the
(12:07):
normal circulation. So we're trying to block off the blood
flow into the aneurism, but preserve blood flow within the
main blood vessels. And again there's different devices that we use.
Some people have heard of coiling, some people have heard
of stints. We have other types of devices that we
can place within the aneurism, It doesn't really matter so
much as to how you accomplish it, as.
Speaker 2 (12:26):
Long as you do accomplish it, accomplish it safely.
Speaker 1 (12:29):
So well, you know, Kim Kardashian, she said that it
was the divorce stress that may have led to her aneurism.
I kind of rolled my eyes and chuckled at that
a little bit. Yes, I understand that chronic high blood pressure,
which in theory may come from you know, high cortisol
levels from chronic stress in your life, may result in
(12:50):
a brain aneurysm. But the truth of the matter is
her divorce probably did not cause her aneurysm. The fact
of the matter is she's a woman and she has
an autoimmune disease. Aren't those two in dependent risk factors
for brain aneurysms.
Speaker 3 (13:02):
Well, I mean, I can tell you if the divorce
rate in the United States is approximately fifty percent, you know,
of married couples, we don't see nearly that many aneurysms.
So I don't know that divorce in and of itself
caused aneurism. I would eventually say divorce and of itself
did not cause aneurism. I think that, you know, one
of my colleagues back in back in la He taught
(13:24):
me this nice way of kind of breaking it down
for patients. There's modifiable and non modifiable risk fectives, things
that we can control modify, and things that we can't
control non modifiable. And you're right, actually being a woman
has a higher risk of having brain aneurism in men.
Being a woman has a higher risk of many medical
complications specifically related to unfortunately short end of the stick.
(13:46):
I apologize, but it is what it is. But being
a woman family history, right, so I know nothing about
her family history, but there either are some patients I
treat six of their family members because you know that
for certain family histories, certain genetic traits, there's a higher
risk of having a brain aneurism. Things like diabetes, high
blood pressure, cholesterol, you know, the sort of obvious things
(14:06):
in the sense things that are bad for the heart
are also bad for the brain. Certain substance abuse, cigarette smoking,
huge risk factor, huge modifiable risk factor for for aneurism, growth,
and aneurysm rupture. You know, certain illicit drug use like methamphetamine, cocaine,
stimulus like that.
Speaker 2 (14:24):
Those are the those are some of the modifiable risk factor.
Speaker 3 (14:27):
The unmodifiable age, gender, genetic predisposition that sort.
Speaker 1 (14:32):
Of Obviously, from what I understand, I believe Kim Kardashian
was undergoing one of those kind of executive welleness scans
where they just scanned their entire body, which for the
general population has very expensive and we don't all necessarily
have Kardashian gender money. So for people out there who
are listening to this and essentially saying to themselves like, well,
how do I know maybe I have a brain aneurism,
(14:55):
what do you recommend for people who should be getting screened?
And where should we you know, the general population, what
should we do in terms of brain analysms.
Speaker 2 (15:03):
That's I mean, that's a great fundamental question.
Speaker 3 (15:06):
Yeah, I mean I do, oftentimes ingest somewhat say, yeah,
if anyone can get an MRI to look for brain aneurism,
why not, because sure, I mean, if you can find it,
and let's say, God forbid, let's say, you know, Kim
Kardashian's aneurism was a larger aneurism and she found it
and they treated it and she didn't have any complications
from the treatment, Well, yeah, she dodged a huge bullet there, right,
(15:29):
as do a lot of my other patients in such
a scenario. But in general, we identify certain people that
are higher risk for brain androalm. So family history is
a huge one. So and unfortunately a lot of families,
we don't know everyone's family history. I don't know every
member of my family's intimate family history.
Speaker 1 (15:49):
But also but also with people with ruptured brain aneurism,
some people they just say they died of old age,
or they die a sudden death. They didn't have to
They don't know that it was actually a brain aneurism
in the coast front.
Speaker 2 (16:00):
Or a stroke. People are, oh, Grandma died from a stroke?
What kind of stroke?
Speaker 3 (16:03):
I have no IDEA stroke is a very big general term,
generalized term. It can mean a lot of different things
to a lot of different people myself.
Speaker 1 (16:10):
And if a brain anaism ruptures, that could be called
that could cause what's called a hemorrhagic stroke. Right, people may.
Speaker 2 (16:16):
Just as a hemorrhagic stroke.
Speaker 3 (16:19):
And certainly, as you can imagine, based upon which generation,
in which decade that person suffered that event, who knows, right,
who knows what that was? So what I tell people
is you know family members that are families that have
two family members considering for either known brain aneurysms, a
condition called pecistic kidney disease, which is, you know, a
kidney disorder that carries a high rate of correlation with
(16:40):
brain aneurysms, or importantly, people that have had two family
members that have a history of bleeding in the brain,
brain aneurysms, or sudden death or died in their sleep.
Because there's only a couple of things that are caused
sudden death, and those couple of things are a massive
heart attack, it's not called a pulmonary embolism or a
rupture braining.
Speaker 2 (17:00):
So let's say when I see.
Speaker 3 (17:01):
A patient who's got a known aneurism, whether it's treatable
or not, doesn't require treatment, but they also have a
family history of oh, my aunt died in her sleep,
or my father went to work collapse suddenly died at
the age of fifty seven, and that was.
Speaker 2 (17:18):
It, and we never did an autopsy. We just assumed
you had a heart attack.
Speaker 3 (17:21):
What I encourage those patients' families to say is, well,
we know that patient X here in my office has
an aneurism, there is a family member that has sudden death.
Speaker 2 (17:32):
Assume that was an aneurism.
Speaker 3 (17:34):
Because now other people meet medical criteria for screening covered
by insurance the American Heart American Stroke Association's recommendations, or
that those patients should then be screened. And if they're
screened and it's like a mammogram, if they're screened and
it's normal, it doesn't mean they're not going to have
an aneurism today or in the future. Just me today
they don't have it. So they need to have a
(17:54):
routine screening on a regular interval. But if they end
up finding that they have an a at least they
have the option potentially doing something before it causes a major.
Speaker 1 (18:03):
Problem, and doing something meaning you just watch it with
imaging see if it's growing it does. Just because you
have an aneurism doesn't mean you need surgery, you need
an intervention.
Speaker 3 (18:13):
And I can't tell you the number of times I've
heard of some of my patient's family members say, yeah,
I spoke to my brother and he knows we come
from a high risk family, but he doesn't want.
Speaker 2 (18:20):
To get screened. Why not? Knowledge is power?
Speaker 3 (18:23):
Get screened, at least for your sake, for your kid's sake,
for your other family member's sake, get screened. Find out
that doesn't mean you have to commit to doing brain surgery.
Doesn't mean that you may need brain surgery, but at
least have that knowledge, have that power. Put yourself in,
you know, in the driver's seat for your own well being.
Some way you can make a conscientious decision that's appropriate
for you. Not knowing may not be the best answer,
(18:46):
you know, I think knowledge is key. Find out and
make the decision that's appropriate for you and your family.
Speaker 1 (18:51):
I mean, I agree, obviously knowledge is power. More coming
up on Wellness Unmasked with doctor Nicole Sapphire, We're going
to put my radiologists cap on real quick as we
wrap this up. But people who were out there who
may have gotten a brain MRI for something else like
a headache, or a CT scan of their brain for
a car accident, just so you know, these will not
(19:12):
necessarily pick up brain aneurysms, especially if they're small. So
just because you've had a recent MRI or a CT
scan of your head and they didn't mention an aneurism,
that doesn't mean you don't have it. There's actually very
specialized sequences and images that neurosurgeons will order to look
at the vessels of the brain. That's why it's really
important if you consider yourself at higher risk for these
(19:33):
brain aneurysms, you talk to someone who specializes in them
so they can get you to the right thing. And
you know, again, I don't necessarily love these executive full
body wellness MRI scans because you know, we call them
incidental loomas. You do find a lot of incidental things. Now,
some things like a brain aneurysm, that's worth noting because
(19:55):
the risk with that is could be so detrimental that
you absolutely want to know if it's there. But oftentimes
these whole body MRIs just lead to more tests, sometimes
more invasive procedures, and it doesn't necessarily help the outcome.
I mean, that's just my that's just my opinion on
these whole breath or these whole that's the challenge.
Speaker 2 (20:15):
You do kind of open up Pandora's box sometimes.
Speaker 3 (20:18):
But in this particular case, in Kim Kardashian's case, Hey,
she now knows that she has a small aneurism.
Speaker 2 (20:24):
She may not need to do anything.
Speaker 3 (20:25):
But what I would tell her if I just met her,
you know, out and about which I find very unlikely
to happen. But if I happen to bump into her
at the supermarket, I would say, oh, yeah, you know,
you should really delve into your family history. Ask your mom, ask,
you know, find out if did somebody die suddenly and
they're sleep. Did they have a massive heart attack but no,
but no autopsy was performed.
Speaker 2 (20:46):
Did someone have bleeding?
Speaker 3 (20:47):
Because now, all of a sudden, her sisters should probably
be screened, you know, depending upon which parents side of
the family was on.
Speaker 2 (20:53):
You know, other family members should be screened as well.
Speaker 1 (20:55):
Based on the fact that just she has one. I mean,
do you think her siblings and her children at a
certain age should all be screened for brain aneurysms.
Speaker 3 (21:05):
That's hard to say, you so, the official recommendation from
the American Heart and American Stroke Association is too family members.
But I always tell people someone's going to be number two, right,
So you know, it's hard to know. That's why I'm saying,
if there's a concern, if she's like, oh, yeah, I
spoke to my mom and maybe we'll see it on
the Kardashians one night. If she's like, oh, mom, did
you know what happened to grandma? Oh, Grandma just died
(21:25):
peaceful in heer, asleep at the age of seventy. But
you know, we don't know why. Maybe assume that was
a ruptured aneurysm, and now other people on that lineage
should be screened.
Speaker 1 (21:34):
All right, Well, that's good advice, doctor Paul Sapphire. Also,
my husband, thanks so much for joining Wellness on MASS.
I'm so happy you came. This is an important conversation.
I'm sure a lot of people appreciated the advice. Thanks
so much for joining.
Speaker 2 (21:47):
Thanks for having me.
Speaker 1 (21:49):
I know talking about brain aneurysms can be scary, but
the good news is most people walking around do not
have brain aneurysms. In fact, only three to five percent
of the population has a brain annuals And of all
of those brain aneurisms out there, only about one to
two percent of those rupture every single year. So please
don't walk away from this podcast being scared. But it's
(22:11):
always good to have knowledge about risk. Like if you're
at high risk for breast cancer, you probably need more
than mammograms looking for breast cancer. If you have a
family history of brain aneurisms or questionable histories of sudden death,
as you heard my husband say, you should consider being
screened for brain aneurisms. Chances are you don't have them.
Statistically speaking, you don't have one. But if you do
(22:34):
have one, albeit if it's tiny, you'll just monitor it.
If it's bigger, you want to make sure someone like
an endovascular neurosurgeon like my husband intervenes before it ruptures,
because rupturing is worst case scenario. And for the Kardashian
Jenner clan, I mean you heard it here on Wellness
and MASS, it's possible that all the siblings and maybe
(22:54):
even Kim Kardashian's kids should be screened for brain aneurisms
in the future. You have to kind of to dig
deep into that family history and see. At the end
of the day, knowledge is power, and you are the
quarterback of your healthcare team. You know your body, you
know your family better than anyone else, and you're going
to do what's right for you. Thanks so much for
(23:15):
listening to Wellness on MASS. I'm doctor Nicole Saffire. Make
sure you get your podcasts on Apple Podcasts, iHeartRadio, or
wherever you listen to your podcasts, and we will see
you next time.
Welcome to Wellness Unmasked. This is doctor Nicole Sapphire and
we have to tackle something that hit the news media
headlines this week. It is medical, but I guess when
you're talking about the Kardashians.
Speaker 2 (00:12):
Though, it feels like a little less medical. That's right.
Speaker 1 (00:15):
Kim Kardashian has announced that when she was undergoing brain
emri imaging that they found, in her words, a little
brain aneurism, and she said that they told her it
was probably due to stress, and she blames the divorce
stress from her tumultuous divorce from Kanye West. Kim Kardashian
(00:37):
blaming her brain aneurysm on divorce stress is probably the
most Kardashian thing I've seen this year, maybe even the
last several years. To truth be told, I've never actually
seen an episode of the show. Obviously, it's wildly popular,
and all of these sisters and their mamager Chris Jenner,
are wildly successful, so they're clearly doing something right. But
(00:59):
it seems to be they're always surrounded by drama and
this brain aneurism diagnosis. While it is dramatic and can
be lethal, the way that it came about kind of
made me chuckle in the sense that divorce brain aneurysm. Well,
that's a first for me. So I decided why not
ask an expert. I happen to be married to one,
doctor Paul Sapphire. He's an endovascular Board certified neurosurgeon who
(01:23):
specializes in yep, brain aneurisms, strokes. Here we go, let's
dive right in and here he is everyone, my husband,
doctor Paul Sapphire, As I mentioned, endovascular neurosurgeon who he
specializes in brain tumors, vascular malformation, strokes, but also brain aneurysms. So, Paul,
thank you so much for joining wellness.
Speaker 2 (01:43):
I'm measked thank you for having me again.
Speaker 1 (01:46):
So here's the question. I told you about this headline
because I know you're not up with the Kardashian drama,
But so what do you make of the fact that
Kim Kardashian now has this incidental brain aneurism? Tell us
a little bit about it.
Speaker 3 (01:58):
Well, in a way, finding incidental brain aneurysms can sometimes
be almost like opening up Pandora's box, right, because clearly,
from what I understand, she's had no symptoms. This is
purely a screening type. Imaging scenario in which she under
a wellness check and they found this brain aneurysm. And
sometimes it's hard to know exactly what's the right thing.
(02:20):
You know, air quotes the right thing to do for aeurisms. Obviously,
whatever gets us to having patients of a long healthy
life is the right answer. But when we refer to
incidental aneurisms, you know, incidental means what incidental, I'm sorry,
means that it is incidentally discovered. It has not caused
a problem, it's not causing any symptoms.
Speaker 2 (02:40):
But you found it one way or another.
Speaker 3 (02:42):
Either you come from a long line of family members
that have a history of brain aneurysms or bleeding in
the brain or things like that, or you have certain
risk factors that maybe they screened you for, you know,
for brain aneurisms. But incidental in the sense that it's
not causing a problem, the question always becomes.
Speaker 2 (02:59):
Well can it potentially cause a problem.
Speaker 3 (03:01):
And anyone who's been a patient of mind that's set
in my office and has talked to me about their
incidental angeism has heard me use this analogy, which is
anything can happen to anyone. Any airplane, god forbid, could crash, right,
But there are things that may or may not make
an airplane crash more likely.
Speaker 2 (03:19):
Right.
Speaker 3 (03:20):
So you know, thankfully, if you're leaving from a you know,
lax or Newark airport in the middle of the day
and it's a beautiful weather and you're on a brand
new airplane, the risk you know, of the airplane crash
is incredibly low, not zero, but incredibly low.
Speaker 1 (03:34):
Right.
Speaker 3 (03:35):
So, there are certain characteristics of a brain aneurism that
may make it incredibly low risk of that andery bleeding
in someone's lifetime or higher. And if someone has an
aneurism that has certain characteristics, or they themselves have certain
health characteristics that may make it like more or less
likely in their lifetime or that aneurism to bleed, then
(03:56):
maybe we do correct that aneurism ahead of time before
or it becomes a problem for that person.
Speaker 1 (04:03):
So I just want to give some background and aneurism.
If you think of the blood vessels in the brain, right,
they're kind of like, I mean to basically put like
a canal system. You have blood flowing through them, and
they're kind of like in these tubes. And aneurism is
like a focal area where that wall of the tube
has weakened and it's kind of ballooning out right.
Speaker 2 (04:21):
That's right.
Speaker 3 (04:21):
So an aneurism is a weakening the wall of blood vessel.
It can occur anywhere in the body. It can happen
in any blood vessel in the body. So when people say, oh,
my my grandmother had an aneurysm, well, I may know
if that means, but we don't really know exactly where
that anural is located. When we talk about a brain aneurism,
we're talking about obviously the blood vessels that are within
(04:43):
the brain. Now, the interesting thing is that when we
talk about brain aneurysms, we have to, you know, segregate
which blood vessels within the brain, because ironically, certain blood
vessels may have a higher or lower likelihood of those
having an aneurism of those aneurisms bleed, meaning that you
can have a brain aneurysm, a blood vessel that is
(05:04):
within the segment of the brain that has an aneurysm,
but the likelihood of that aneurism rupturing may be solow
we choose never treat it, and if it were on
a slightly different blood vessel within the brain, that same aneurism,
we may say, oh gosh, maybe we should treat it
before it cause the problem. But yes, it is a
weakening the wall of a blood vessel. Clearly the size
(05:26):
of that aneurism. The bigger, the larger that aneurism, the
more likely it is for that aneurism to rupture. Probably
what's the most important risk factor of that aneurism rupturing
is actually the rate of growth. So typically people aren't
born with brain androisms. They form over time. It can
happen in just about anybody. There are certain risk factors
which we can talk about in a moment that may
(05:46):
increase or decrease the likelihood of you having a brain
aneurysm or an angerism rupture. But probably the most important
thing is the rate of growth. So when we find
someone like ms Kardashian who gets a scan, you know
whenever you just recently had it done and snapshot in time,
we don't know what that aneism looked like six months ago,
six years ago, so we don't really know the rate
of growth of that aneurism. Now, she probably has been recommended.
(06:08):
If they're not recommending treatment for the aneurism, my supposition
is that they're recommending that she follow it with regular
imaging and so you're going to try from the fact.
Speaker 1 (06:16):
That she said that it was very small, right.
Speaker 3 (06:19):
Based upon that fact, I have no idea. I mean,
I'm assuming she's seeking treatment out in Los Angeles. I'm
assuming that's where she lives. And you know, I know
a lot of colleagues out there who are excellent and
I'm sure they're giving her very solid medical advice in
terms of how to manage or monitor that aneurism. But yeah,
if the angurism is small, incidental, and the risk calculated,
(06:40):
and we have different kinds of algorithms that we can
look at that give us a potential in terms of
someone's lifetime what that risk of rupturing is. If that
risk is low over their lifetime, well, then treating that
aneurism with some type of surgical maneuver ahead of time
may not be warranted.
Speaker 1 (06:56):
Okay. So ultimately, when it comes to Brandy anisism, obviously
the thing that we're most concerned about is it rupturing,
because that is when there's bleeding in the brain. And
historically this had a very high fatality rate, right like
over fifty percent of people who had a ruptured brain
andewism would die.
Speaker 3 (07:14):
So well, back in the day, you know, before people
were getting certainly screening MRIs so regularly or routinely. You know,
back vida, the only way that we really found patients
that had brain and were after they had ruptured. And
you know, the mortality rate for brain animal ruptures and
casts of bleeding in the brain, the risk of mortality
(07:34):
is actually really high. I think overall it's probably as
high as seventy percent in some instances seventy to eighty percent.
And really importantly too, is all those people that survive.
Of the twenty to thirty percent overall that survive, the
majority of those patients do not return to functional independence.
And functional independence doesn't necessarily mean going back to driving
(07:55):
and working. It we're talking about the daily activities that
we all take for granted until taken away. Bathing yourself,
clothing yourself, grooming, feeding yourself.
Speaker 2 (08:06):
That sort of thing.
Speaker 3 (08:07):
So you're talking about a really serious condition, and that's
why we have a low threshold as neurosurgeons. We have
a very low threshold for treating what might seem as
relatively small aneurism, especially in someone who's younger and has
many lives ahead of them, many years ahead of them
in their lifetime. Well aggregating that risk over time, that
risk of ayers and rupturing may be quite high, so
you may choose to treat that person. But yes, overall,
(08:27):
the risk of death and major disability from a rupture
brain and very very high. In fact, upwards of a
third of people that have a ruptured brain and yours
don't even survive to make it to the hospital.
Speaker 1 (08:37):
You're listening to Wellness and Mass. We'll be right back
with more. So I know that I know this from
personal experience, because you get called in the middle of
the night or during dinner or wherever we may be,
or treating someone who's already had a ruptured brain anerism,
and you go in. You know, sometimes you do end
of vascularly where you're going in through the groin or
(08:59):
the and blood vessels to access the brain, but you're
also going in sometimes removing the skull, cleaning out if
it's already ruptured, all the blood. But you're saying, I
know this, but just for everyone listening. One of the
key things when you've identified an aneurysm, if you've determined
that it's at risk of rupture, and this is based
on many things, like you said, the size, the rate,
(09:20):
of growth, if you decide to treat it to try
and prevent it from rupturing, what does that look like.
Speaker 3 (09:27):
So treatment has evolved in everything in medicine, but certainly
in neurosurgery has evolved tremendously, and so in twenty twenty five,
soon to be twenty twenty six, we have a lot
of treatment options for brain and reskins. But they fall
into two main category. Either conventional brain surgery, which although
that's the most most invasive and the most time consuming
(09:49):
and complex, is the most relatively straightforward to understand.
Speaker 1 (09:52):
You know, conventional that's the clipping. You're talking about clipping.
Speaker 3 (09:55):
So essentially what we do is we make an incision
wherever this in the head. We open up that part
of the skull which gently dissect the different layers of
the brain, identify the blood vessels and the aneurism itself,
and place a clip and a clip the analogy that
I use think of the.
Speaker 2 (10:10):
Small clothes pin, so a little.
Speaker 3 (10:13):
Matt but it's made out of metal, made out of titanium,
a little spring loaded pin that actually cinches down and
it seals off. You place that that cinch at the
base of the aneurism that called the neck of the aneurism,
and that blocks blood flow into the anurism, so blood
cannot flow into the aneurysm. If blood can't flow into
the aneurysm but still is flowing within the normal blood vessels,
(10:34):
the aneurysm cannot rupture. Again, that's a very basic conceptual
understanding of that and of vascular treatment on the other
end of the spectrum, And there's many different.
Speaker 1 (10:44):
Like this is something specialized that you did advance straining for.
Actually at UCLA, not all neurosurgeons one can clip aneurysms,
but even fewer can do endovascular treatment.
Speaker 2 (10:55):
Right, that's true.
Speaker 3 (10:56):
So there are very few neurosurgeons, relatively speaking, across the
country who are dual trained, you know, doing both open
vascular and the aravascular surgery as well as doing endovascular surgery.
And the analogy that I use is very similar to say,
heart surgery. You have open heart surgeons that will crack
open the chest and do open heart surgery and fix
(11:16):
the heart that way, and then you also have interventional
cardiologists will go through the blood vessels usually in the
arm or the leg with their tubes and cafeters and
fix the heart from the inside out, and we do
something similar albeit very different for the brain and blood
vessels within the brain. And I'm capable of performing both
those types of procedures, and so for endovascular therapy or
endovascular surgery for brain aneurysms, there's a couple different ways
(11:41):
that we can treat them, a very couple different technologies
that we can employ right now.
Speaker 2 (11:45):
But the basic principle.
Speaker 3 (11:46):
Is, again, we go through the ardor usually oftentimes I'll
go through the ardor here in the wrist, the very
thin but long tube guide that all the way up
to the blood vessels of the neck. Using X ray,
inject a little bit of dye contrast see the blood vessels,
and then go further up into the blood vessels of
the brain. And then similar to the clipping in the
sense we're trying to exclude the brain aneurysm from the
(12:07):
normal circulation. So we're trying to block off the blood
flow into the aneurism, but preserve blood flow within the
main blood vessels. And again there's different devices that we use.
Some people have heard of coiling, some people have heard
of stints. We have other types of devices that we
can place within the aneurism, It doesn't really matter so
much as to how you accomplish it, as.
Speaker 2 (12:26):
Long as you do accomplish it, accomplish it safely.
Speaker 1 (12:29):
So well, you know, Kim Kardashian, she said that it
was the divorce stress that may have led to her aneurism.
I kind of rolled my eyes and chuckled at that
a little bit. Yes, I understand that chronic high blood pressure,
which in theory may come from you know, high cortisol
levels from chronic stress in your life, may result in
(12:50):
a brain aneurysm. But the truth of the matter is
her divorce probably did not cause her aneurysm. The fact
of the matter is she's a woman and she has
an autoimmune disease. Aren't those two in dependent risk factors
for brain aneurysms.
Speaker 3 (13:02):
Well, I mean, I can tell you if the divorce
rate in the United States is approximately fifty percent, you know,
of married couples, we don't see nearly that many aneurysms.
So I don't know that divorce in and of itself
caused aneurism. I would eventually say divorce and of itself
did not cause aneurism. I think that, you know, one
of my colleagues back in back in la He taught
(13:24):
me this nice way of kind of breaking it down
for patients. There's modifiable and non modifiable risk fectives, things
that we can control modify, and things that we can't
control non modifiable. And you're right, actually being a woman
has a higher risk of having brain aneurism in men.
Being a woman has a higher risk of many medical
complications specifically related to unfortunately short end of the stick.
(13:46):
I apologize, but it is what it is. But being
a woman family history, right, so I know nothing about
her family history, but there either are some patients I
treat six of their family members because you know that
for certain family histories, certain genetic traits, there's a higher
risk of having a brain aneurism. Things like diabetes, high
blood pressure, cholesterol, you know, the sort of obvious things
(14:06):
in the sense things that are bad for the heart
are also bad for the brain. Certain substance abuse, cigarette smoking,
huge risk factor, huge modifiable risk factor for for aneurism, growth,
and aneurysm rupture. You know, certain illicit drug use like methamphetamine, cocaine,
stimulus like that.
Speaker 2 (14:24):
Those are the those are some of the modifiable risk factor.
Speaker 3 (14:27):
The unmodifiable age, gender, genetic predisposition that sort.
Speaker 1 (14:32):
Of Obviously, from what I understand, I believe Kim Kardashian
was undergoing one of those kind of executive welleness scans
where they just scanned their entire body, which for the
general population has very expensive and we don't all necessarily
have Kardashian gender money. So for people out there who
are listening to this and essentially saying to themselves like, well,
how do I know maybe I have a brain aneurism,
(14:55):
what do you recommend for people who should be getting screened?
And where should we you know, the general population, what
should we do in terms of brain analysms.
Speaker 2 (15:03):
That's I mean, that's a great fundamental question.
Speaker 3 (15:06):
Yeah, I mean I do, oftentimes ingest somewhat say, yeah,
if anyone can get an MRI to look for brain aneurism,
why not, because sure, I mean, if you can find it,
and let's say, God forbid, let's say, you know, Kim
Kardashian's aneurism was a larger aneurism and she found it
and they treated it and she didn't have any complications
from the treatment, Well, yeah, she dodged a huge bullet there, right,
(15:29):
as do a lot of my other patients in such
a scenario. But in general, we identify certain people that
are higher risk for brain androalm. So family history is
a huge one. So and unfortunately a lot of families,
we don't know everyone's family history. I don't know every
member of my family's intimate family history.
Speaker 1 (15:49):
But also but also with people with ruptured brain aneurism,
some people they just say they died of old age,
or they die a sudden death. They didn't have to
They don't know that it was actually a brain aneurism
in the coast front.
Speaker 2 (16:00):
Or a stroke. People are, oh, Grandma died from a stroke?
What kind of stroke?
Speaker 3 (16:03):
I have no IDEA stroke is a very big general term,
generalized term. It can mean a lot of different things
to a lot of different people myself.
Speaker 1 (16:10):
And if a brain anaism ruptures, that could be called
that could cause what's called a hemorrhagic stroke. Right, people may.
Speaker 2 (16:16):
Just as a hemorrhagic stroke.
Speaker 3 (16:19):
And certainly, as you can imagine, based upon which generation,
in which decade that person suffered that event, who knows, right,
who knows what that was? So what I tell people
is you know family members that are families that have
two family members considering for either known brain aneurysms, a
condition called pecistic kidney disease, which is, you know, a
kidney disorder that carries a high rate of correlation with
(16:40):
brain aneurysms, or importantly, people that have had two family
members that have a history of bleeding in the brain,
brain aneurysms, or sudden death or died in their sleep.
Because there's only a couple of things that are caused
sudden death, and those couple of things are a massive
heart attack, it's not called a pulmonary embolism or a
rupture braining.
Speaker 2 (17:00):
So let's say when I see.
Speaker 3 (17:01):
A patient who's got a known aneurism, whether it's treatable
or not, doesn't require treatment, but they also have a
family history of oh, my aunt died in her sleep,
or my father went to work collapse suddenly died at
the age of fifty seven, and that was.
Speaker 2 (17:18):
It, and we never did an autopsy. We just assumed
you had a heart attack.
Speaker 3 (17:21):
What I encourage those patients' families to say is, well,
we know that patient X here in my office has
an aneurism, there is a family member that has sudden death.
Speaker 2 (17:32):
Assume that was an aneurism.
Speaker 3 (17:34):
Because now other people meet medical criteria for screening covered
by insurance the American Heart American Stroke Association's recommendations, or
that those patients should then be screened. And if they're
screened and it's like a mammogram, if they're screened and
it's normal, it doesn't mean they're not going to have
an aneurism today or in the future. Just me today
they don't have it. So they need to have a
(17:54):
routine screening on a regular interval. But if they end
up finding that they have an a at least they
have the option potentially doing something before it causes a major.
Speaker 1 (18:03):
Problem, and doing something meaning you just watch it with
imaging see if it's growing it does. Just because you
have an aneurism doesn't mean you need surgery, you need
an intervention.
Speaker 3 (18:13):
And I can't tell you the number of times I've
heard of some of my patient's family members say, yeah,
I spoke to my brother and he knows we come
from a high risk family, but he doesn't want.
Speaker 2 (18:20):
To get screened. Why not? Knowledge is power?
Speaker 3 (18:23):
Get screened, at least for your sake, for your kid's sake,
for your other family member's sake, get screened. Find out
that doesn't mean you have to commit to doing brain surgery.
Doesn't mean that you may need brain surgery, but at
least have that knowledge, have that power. Put yourself in,
you know, in the driver's seat for your own well being.
Some way you can make a conscientious decision that's appropriate
for you. Not knowing may not be the best answer,
(18:46):
you know, I think knowledge is key. Find out and
make the decision that's appropriate for you and your family.
Speaker 1 (18:51):
I mean, I agree, obviously knowledge is power. More coming
up on Wellness Unmasked with doctor Nicole Sapphire, We're going
to put my radiologists cap on real quick as we
wrap this up. But people who were out there who
may have gotten a brain MRI for something else like
a headache, or a CT scan of their brain for
a car accident, just so you know, these will not
(19:12):
necessarily pick up brain aneurysms, especially if they're small. So
just because you've had a recent MRI or a CT
scan of your head and they didn't mention an aneurism,
that doesn't mean you don't have it. There's actually very
specialized sequences and images that neurosurgeons will order to look
at the vessels of the brain. That's why it's really
important if you consider yourself at higher risk for these
(19:33):
brain aneurysms, you talk to someone who specializes in them
so they can get you to the right thing. And
you know, again, I don't necessarily love these executive full
body wellness MRI scans because you know, we call them
incidental loomas. You do find a lot of incidental things. Now,
some things like a brain aneurysm, that's worth noting because
(19:55):
the risk with that is could be so detrimental that
you absolutely want to know if it's there. But oftentimes
these whole body MRIs just lead to more tests, sometimes
more invasive procedures, and it doesn't necessarily help the outcome.
I mean, that's just my that's just my opinion on
these whole breath or these whole that's the challenge.
Speaker 2 (20:15):
You do kind of open up Pandora's box sometimes.
Speaker 3 (20:18):
But in this particular case, in Kim Kardashian's case, Hey,
she now knows that she has a small aneurism.
Speaker 2 (20:24):
She may not need to do anything.
Speaker 3 (20:25):
But what I would tell her if I just met her,
you know, out and about which I find very unlikely
to happen. But if I happen to bump into her
at the supermarket, I would say, oh, yeah, you know,
you should really delve into your family history. Ask your mom, ask,
you know, find out if did somebody die suddenly and
they're sleep. Did they have a massive heart attack but no,
but no autopsy was performed.
Speaker 2 (20:46):
Did someone have bleeding?
Speaker 3 (20:47):
Because now, all of a sudden, her sisters should probably
be screened, you know, depending upon which parents side of
the family was on.
Speaker 2 (20:53):
You know, other family members should be screened as well.
Speaker 1 (20:55):
Based on the fact that just she has one. I mean,
do you think her siblings and her children at a
certain age should all be screened for brain aneurysms.
Speaker 3 (21:05):
That's hard to say, you so, the official recommendation from
the American Heart and American Stroke Association is too family members.
But I always tell people someone's going to be number two, right,
So you know, it's hard to know. That's why I'm saying,
if there's a concern, if she's like, oh, yeah, I
spoke to my mom and maybe we'll see it on
the Kardashians one night. If she's like, oh, mom, did
you know what happened to grandma? Oh, Grandma just died
(21:25):
peaceful in heer, asleep at the age of seventy. But
you know, we don't know why. Maybe assume that was
a ruptured aneurysm, and now other people on that lineage
should be screened.
Speaker 1 (21:34):
All right, Well, that's good advice, doctor Paul Sapphire. Also,
my husband, thanks so much for joining Wellness on MASS.
I'm so happy you came. This is an important conversation.
I'm sure a lot of people appreciated the advice. Thanks
so much for joining.
Speaker 2 (21:47):
Thanks for having me.
Speaker 1 (21:49):
I know talking about brain aneurysms can be scary, but
the good news is most people walking around do not
have brain aneurysms. In fact, only three to five percent
of the population has a brain annuals And of all
of those brain aneurisms out there, only about one to
two percent of those rupture every single year. So please
don't walk away from this podcast being scared. But it's
(22:11):
always good to have knowledge about risk. Like if you're
at high risk for breast cancer, you probably need more
than mammograms looking for breast cancer. If you have a
family history of brain aneurisms or questionable histories of sudden death,
as you heard my husband say, you should consider being
screened for brain aneurisms. Chances are you don't have them.
Statistically speaking, you don't have one. But if you do
(22:34):
have one, albeit if it's tiny, you'll just monitor it.
If it's bigger, you want to make sure someone like
an endovascular neurosurgeon like my husband intervenes before it ruptures,
because rupturing is worst case scenario. And for the Kardashian
Jenner clan, I mean you heard it here on Wellness
and MASS, it's possible that all the siblings and maybe
(22:54):
even Kim Kardashian's kids should be screened for brain aneurisms
in the future. You have to kind of to dig
deep into that family history and see. At the end
of the day, knowledge is power, and you are the
quarterback of your healthcare team. You know your body, you
know your family better than anyone else, and you're going
to do what's right for you. Thanks so much for
(23:15):
listening to Wellness on MASS. I'm doctor Nicole Saffire. Make
sure you get your podcasts on Apple Podcasts, iHeartRadio, or
wherever you listen to your podcasts, and we will see
you next time.
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