Biomedical Engineering Reference
In-Depth Information
the mind have a certain signifi cance at a time of a 'mentalist celebration of
intellect, the triumph of even an almost disembodied mind over material
impediment' (1998: 547).
Living with cold aneurysms
More recently, the available technology has been improved, and the diagnosis
can be made much more easily due to development in imaging methods such
as CT and magnetic resonance imaging (MRI), which can produce three-
dimensional computed information about the brain. The most important
feature of these techniques is the enormously increased sensitivity.
7
Today,
the sensitivity and specifi city of these new imaging methods are in fact so high
that small aneurysms can be reliably discovered even before they rupture,
so-called 'cold' aneurysms. The ease by which these 'cold' aneurysms are
discovered creates new challenges as the natural history, and hence the
risk of a fatal bleed, of the condition is largely unknown (Wiebers 1998).
Of particular interest is the situation people fi nd themselves in when the
improved medical imaging technique not as in the standard situation confi rms
or disconfi rms a suspected aneurysm, but delivers unwarranted information
about an aneurysm that nobody suspected or asked for.
For example, if a quite healthy person, without any symptom of a disease,
has a bad fall or a bang on the head, X-ray examination is often done to
ensure that the knock did not cause bleeding in the brain. In such a situation,
the new effi cient medical imaging methods can rapidly show that this is
not the case, at the same time as they may disclose that the patient has a
few millimetres big balloon-shaped deformation on one of the vessels of
the brain. And from that very moment, when the 'cold' aneurysm appears
on the screen and presents itself to the neuroradiologist, there is somebody
who knows. This situation, the visualization of the aneurysm as a result of
technological advancement within radiology, unwarrantedly 'forces' itself on
the doctors involved, creating problems for both doctors and patients. In
Webster's words, medical technology creates patients without symptoms, the
'worried well', who occupy what we might call a therapeutic limbo, adding
new forms of ambiguity and risk for both physicians and those subject to
their gaze (Webster 2002: 445).
In one of the few published studies on this specifi c topic, van der Schaaf
et al
. (2002) measured health-related quality of life and psychological state
in 21 patients who were aware of having a 'cold' aneurysm or arteriovenous
malformation. Compared with the reference population, these patients
had a reduced health and quality of life in several dimensions. While
standard questionnaires are widely used to obtain subjective assessment of
health, and are useful as indicators, they shed no light on the meaning of
respondents' answers (Mallinson 2001). In most of the narratives linked to
the Aneurysm Support Homepage the authors deal with their experiences
of bleeding, rupturing or intervened aneurysms, but there are also some
