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Family History Influences Aneurysm Risk; About Dizziness

Dear Dr. Roach: I read your article regarding aortic aneurysms. During a MRI on my mom for a seizure, they found two brain aneurysms — one behind her eye, and another somewhere in her head/brain. She was well into her 80s, and they did nothing about them.

A year later, when she was in a nursing home, she had a few mini-strokes and died at age 87 of “cerebral vascular disease.” One brother died of a sudden stroke while shopping in his 70s, and her other brother and sister died in their 80s with vascular problems, and they also had mini-strokes.

My question is whether I should have an MRI or be tested for a brain aneurysm. I am 65, 5 feet, 4 and 1/2 inches tall and weigh 118 pounds; I never smoked or drank, have low blood pressure and good cholesterol readings.

Should I be concerned about the family predisposition to brain aneurysms? — J.S.

Answer: Just like aortic aneurysm, a brain aneurysm is a weakening of the wall of an artery, which eventually can rupture, with devastating effects, usually resulting in a large stroke. Up to 6 percent of people can have unruptured brain aneurysms, most of which will never cause problems.

A strong family history of two or more first-degree relatives (parent, sibling, child) does make a person more likely to have one, and makes the case for screening. However, with only one family member — in your case, your mother — your risk isn’t much higher than the general population’s, and you also have done as well as you can to reduce your risk by maintaining good blood pressure, keeping your cholesterol low and by not smoking.

I found helpful information from the Brain Aneurism Foundation at www.bafound.org.

Dear Dr. Roach: I’m sure I speak for many seniors and perhaps others who are experiencing balance problems. I have been diagnosed with a form of vertigo, but neither a change in an eye med known to aggravate this condition nor basic tai chi (which I am going to continue) has done anything to help.

I am nearly 77 and in good physical shape except for this.

I didn’t realize that this was the problem when I began falling off my bike three years ago; I never thought I needed to see a doctor and thought it was a problem of age and very reluctantly stopped cycling and gave away my bike.

Now, the condition threatens my tennis playing. Toward the end of last summer season, I experienced a couple of falls on the court. My doctors determined the rapid motion of my head to track and reach balls hit by my opponent caused me to fall.

I wasn’t injured, but I was and remain afraid to play any further. —W.S.

Answer: Congratulations on remaining so active. I’ll do what I can to help you remain so.

First off, I can’t be sure you have vertigo. You have fallen a few times but haven’t described the spinning sensation that is most common with vertigo. Rapid neck motion can bring on vertigo but it also can cause a totally unrelated type of fall — carotid sinus hypersensitivity. In this condition, stretching the neck triggers a reflex for the heart rate to slow, and you can fall or even lose consciousness. This is easy to test for in the office, if it’s thought of.

If you have had symptoms of vertigo, I would consider vestibular rehabilitation, done by occupational or physical therapists. It’s the most effective treatment for most causes of vertigo. Tai chi is a great way to improve balance.

for anyone.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.